Sex/Gender Differences in Osteoporosis

Osteoporosis is a systemic skeletal disorder characterized by a decrease in bone mass and microstructural abnormalities, ultimately resulting in weakened bones that are susceptible to fractures. The prevalence of osteoporosis is 7.5% in men and 37.3% in women over the age of 50, with women having more than four times the prevalence of men. However, the 1-year mortality rate after hip fracture due to osteoporosis is higher in men than in women (21% vs. 14%). The two major risk factors for osteoporosis are a low peak bone mass formed in early adulthood and rapid bone loss due to aging and menopause. Women experience a rapid decline in bone density after menopause, while the rate of bone loss is more gradual in men. The same diagnostic and therapeutic response evaluation criteria for osteoporosis apply to both men and women. Osteoporosis is diagnosed in postmenopausal women and men over the age of 50 based on a T-score of −2.5 or lower in the lumbar spine and femur on bone mineral density testing. Osteoporosis medications are broadly categorized into antiresorptive and anabolic agents. With the recent development of various effective treatments, it is expected that adequate treatment of osteoporosis in men, as well as in women, will substantially reduce the incidence of osteoporotic fractures. However, in men, the use of hormone-related medications is challenging, and caution is required when prescribing drugs approved for use in both sexes.