The treatment algorithm and clinical guidance, which this panel wishes to support, aim to treat men at a similar 10-year fracture risk as in women, because the morbidity and mortality associated with major osteoporotic fractures in men are substantial. Available evidence suggests that treatment algorithms in women are also applicable to men. In practice, this is likely to involve the use of FRAX and clinical risk factors (Table 1). The use of fixed intervention thresholds is viewed as counter-intuitive to current practice, because the risk is to exclude too many younger patients and, conversely, to include too many older patients above a threshold

value. The available level of evidence that Selleck RG7204 treatment decreases the risk of fracture in men is lower than for women. As such, the US Endocrine Society is of the opinion that there is currently not enough information in men to make a recommendation, because too few fractures have been recorded in men to link BMD changes Enzalutamide supplier with anti-fracture efficacy. Additional fracture data are needed to endorse the clinical care of osteoporosis in men. However, this panel believes that this view can be countered, based on available epidemiological and clinical efficacy data in male subjects, which display similarities with data acquired in women, in terms of treatment effects on BMD, biochemical markers

of bone turnover, and fracture endpoint, despite the recorded differences in pathophysiology of bone loss and bone microarchitecture. Overall, empirical data from men and women are so similar that differences in morphology may not be clinically relevant. Despite the wealth of available data from numerous studies in women, the current strategy of drug development for the treatment of osteoporosis in men is such that there is a delay of several years before clinical trial data in men become available. Perhaps the lag between comparable treatments becoming available for female and for male osteoporosis can be reduced. The situation is not unlike coronary artery disease, which was initially thought to be principally a male disease, Orotidine 5′-phosphate decarboxylase but for which female treatment was made

more rapidly available. A logical conclusion would eventually be to design mixed studies, as recommended by the WHO [111]. From a pragmatic point of view, it is unlikely that drugs for the specific treatment of osteoporosis in men will be developed. One area of research that deserves more attention is the hormonal and non-hormonal factors influencing bone loss in men. There appears to be potential in measuring serum oestradiol levels, in addition to testosterone levels in men with low BMD. We wish to encourage the development of standardised mass spectroscopy assays for the assessment of sex steroid contribution in male osteoporosis. Awareness of osteoporosis in men is improving, although it remains under-diagnosed and under-treated.