Clinical manifestations, diagnosis, and evaluation of osteoporosis in men
- Joel S Finkelstein, MD
Joel S Finkelstein, MD
- Associate Professor of Medicine
- Harvard Medical School
Osteoporosis is a common disease that is characterized by low bone mass with microarchitectural disruption and skeletal fragility, resulting in an increased risk of fracture. The World Health Organization has defined diagnostic thresholds for low bone mass and osteoporosis based upon bone mineral density (BMD) measurements compared with a young adult reference population (T-score) (table 1).
The initial osteoporosis evaluation includes a history to assess for clinical risk factors for fracture and to evaluate for other conditions that contribute to bone loss, a physical examination, and basic laboratory tests. There are many coexisting medical conditions that contribute to bone loss (table 2). Thus, evaluation for alternative causes of bone loss to detect potentially reversible causes should be considered in those with abnormal initial findings.
Early diagnosis and quantification of bone loss and fracture risk have become more important because of the availability of therapies that can slow or even reverse the progression of osteoporosis.
The clinical manifestations, diagnosis and evaluation of osteoporosis in men will be reviewed here. The treatment and the epidemiology and etiology of osteoporosis in men are discussed separately. (See "Treatment of osteoporosis in men" and "Epidemiology and etiology of osteoporosis in men".)
Osteoporosis has no clinical manifestations until there is a fracture. Many vertebral fractures are asymptomatic. They may be diagnosed as an incidental finding on chest or abdominal radiographs. The clinical manifestations of symptomatic vertebral fractures include pain and height loss. (See "Osteoporotic thoracolumbar vertebral compression fractures: Clinical manifestations and treatment", section on 'Clinical manifestations'.)
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