Male Osteoporosis Causes — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseMale Osteoporosis CausesSCE Rheumatology

A 65-year-old man is diagnosed with osteoporosis after sustaining low-trauma vertebral fractures. Assessment identifies hypogonadism, harmful alcohol consumption and long-term oral prednisolone therapy. Which figure is the best estimate of the proportion of men with osteoporosis in whom a secondary cause can be identified?

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Correct answer: E — Approximately 60%

Approximately 60% is the best estimate: contemporary reviews report that an identifiable secondary cause may be found in up to 60% of men with osteoporosis. This patient has several recognised contributors—hypogonadism, harmful alcohol consumption and prolonged systemic glucocorticoid exposure—making secondary osteoporosis particularly likely. Other causes include hyperparathyroidism, hyperthyroidism, malabsorption, chronic liver or renal disease and androgen-deprivation therapy. Approximately 90% overstates the prevalence, whereas 40%, 20% and 5% underestimate how commonly secondary factors are identified in affected men. Men presenting with osteoporosis or fragility fractures therefore require systematic assessment for underlying diseases, medication exposures and modifiable risk factors.

Reference: Björnsdottir S, Clarke BL, Mannstadt M, Langdahl BL. Male osteoporosis—what are the causes, diagnostic challenges, and management. Best Practice & Research Clinical Rheumatology. 2022;36(3):101766. https://pubmed.ncbi.nlm.nih.gov/35961836/