Consensus document on osteoporosis in males

Abstract

Objective

To provide practical recommendations to assess and treat osteoporosis in males.

Participants

Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology.

Methods

Recommendations were formulated using the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in Medline (PubMed) using the following associated terms: “osteoporosis”, “men”, “fractures”, “bone mineral density”, “treatment”, “hypogonadism”, and “prostate cancer”. Papers in English and Spanish with publication date before 30 August 2017 were included. Current evidence for each disease was reviewed by 2 group members. Finally, recommendations were discussed in a meeting of the working group.

Conclusions

The document provides evidence-based practical recommendations for diagnosis, assessment, and management of osteoporosis in men and special situations such as hypogonadism and prostate cancer.

Resumen

Objetivo

Proporcionar unas recomendaciones prácticas para la evaluación y tratamiento de la osteoporosis del varón.

Participantes

Miembros del Grupo de Metabolismo Mineral de la Sociedad Española de Endocrinología y Nutrición.

Métodos

Las recomendaciones se formularon de acuerdo con el sistema Grading of Recommendations, Assessment, Development and Evaluation (GRADE) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en Medline de la evidencia disponible sobre la osteoporosis del varón usando las siguientes palabras claves asociadas: osteoporosis, men, fractures, bone mineral density, treatment, hypogonadism y prostate cancer. Se revisaron artículos escritos en inglés y español con fecha de inclusión hasta el 30 de agosto del 2017; cada tema fue revisado por 2 personas del grupo. Tras la formulación de las recomendaciones, estas se discutieron en una reunión conjunta del grupo de trabajo.

Conclusiones

El documento establece unas recomendaciones prácticas basadas en la evidencia acerca del diagnóstico, evaluación y tratamiento de la osteoporosis del varón y situaciones especiales como el hipogonadismo y el tratamiento con terapia de déficit androgénico en el carcinoma de próstata.

Introduction

Osteoporosis is defined as a systemic skeletal disorder characterized by low bone mass and impaired bone microarchitecture, with a resultant increase in bone fragility and a greater susceptibility to fractures.1, 2 The densitometric definition of osteoporosis of the World Health Organization also applies to males.3, 4

Male osteoporosis is a condition with a high prevalence of secondary osteoporosis (40–60% in males aged less than 70 years) (Table 1).2, 4, 5 In Spain, the estimated prevalence rates of osteoporosis in males are 8.1% and 11.3% in those older than 50 and 70 years respectively.2, 6 Osteoporotic fractures in males are characterized by greater morbidity and mortality as compared to females.6, 7

The recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.⁸ In terms of the strength of the recommendation, a distinction is made between strong recommendations, expressed as “We recommend” and number 1, and weak recommendations, expressed as “We suggest” and number 2. The quality of evidence is expressed using symbols: ⊕, indicates very low evidence; ⊕⊕, low evidence; ⊕⊕⊕, moderate evidence; and ⊕⊕⊕⊕, high evidence.⁸ A systematic search was made in Medline for the evidence available regarding osteoporosis in males and the title of each chapter. Articles written in English and Spanish published up to August 30, 2017 were reviewed. Each topic was reviewed by two members of the group. Once the recommendations had been formulated, they were discussed at a joint meeting of the Working Group.