Osteoporosis Research in Men: Rethinking Standards and Reference Models

The Challenge

Men account for nearly a third of osteoporosis-related hip fractures in Europe and the U.S. (Dhanwal et al., 2010). Nonetheless, osteoporosis is considered primarily a disease of postmenopausal women, and men are rarely evaluated or treated for it (Szulc et al., 2012).

Method: Rethinking Standards and Reference Models

Research in many fields—for example, heart disease—has relied on reference models that treat men as the norm. Women are often studied as deviations from that norm. In the case of osteoporosis, however, diagnostic models have been developed for women using bone mineral density (BMD) norms of healthy young white women, and criteria to identify risk in men are not well established. Researchers are improving these reference models and opening new areas of research by considering disease progression in both women and men, and by evaluating risk using sex-specific reference models.

Gendered Innovations:

  1. Establishing Male Reference Populations By 1997, evaluation of men's bone quality was based on BMD norms of healthy young men rather than healthy young women (Looker, 1997). More work needs to be done to redefine diagnostic cutoffs for both women and men (Binkley et al., 2010).
  2. Creating New Diagnostics Based on Secondary Contributors to Osteoporosis and Metabolic Bone Disorders (SECOBs) Researchers have identified medical conditions (such as hypogonadism and hypercalciuria) and treatments (such as chemotherapeutics and anticonvulsants) that correlate with osteoporotic fracture, especially in men. New diagnostics take SECOBs into account—along with variables such as BMD, sex, and lifestyle. Accounting for these factors improves diagnosis in both women and men.