Interpretation of Guidelines for the Diagnosis and Treatment of Male Osteoporosis / 中华内分泌代谢杂志

In October 2020, Chinese Society of Osteoporosis and Bone Mineral Research issued the Guidelines for Diagnosis and Treatment of Male Osteoporosis. Taken together with the Guideline for Diagnosis and Treatment of Primary Osteoporosis (2017), this article interprets guideline for male osteoporosis from the aspects of osteoporosis epidemiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, and treatment.

Efectos del ranelato de estroncio sobre la densidad mineral ósea en hombres / Effect of strontium ranelate on bone mineral density in men

La osteoporosis afecta al 6-7% de la poblaciónmasculina. Es alta la proporción de pacientes confractura osteoporótica sin diagnóstico previo de estaenfermedad. La mortalidad luego de una fracturaes mayor en hombres que en población femenina;a pesar de esto, la mayoría de los pacientes no reciben tratamiento. Los fármacos aprobados, en nuestro medio, para tratar la osteoporosis masculina son:bifosfonatos, teriparatida y ranelato de estroncio. Elobjetivo de este estudio fue evaluar el efecto del ranelato de estroncio sobre la densidad mineral ósea enhombres después de 1 año de tratamiento. Se incluyeron los registros de 20 hombres de 67.8±3.0 años,tratados con ranelato de estroncio (2 g/día) durante 1año. Todos los pacientes presentaban un T-score inferior a -2.5 en cadera o columna vertebral o un T-scoreinferior a -2.0 y factores de riesgo de fractura. Nohubo modificación de parámetros de laboratorio luego del tratamiento (calcemia, calciuria, fósforo sérico,parathormona, 25(OH)vitamina D, fosfatasa alcalinay desoxipiridinolina). Luego de 1 año de tratamiento con ranelato de estroncio se observó incrementode la densidad mineral ósea en columna lumbar:0.953±0.029 versus 0.997±0.030 g/cm2 (p=0.0068),cuello femoral: 0.734±0.013 versus 0.764±0.016 g/cm2 (p=0.0084) y cadera total: 0.821±0.02 versus0.834±0.02 g/cm2 (p=0.0419). Conclusión: luego de1 año de tratamiento el ranelato de estroncio produjoun incremento significativo de la densidad mineralósea en columna lumbar y fémur proximal en hombres con osteoporosis (AU)

Osteoporosis affects 6-7% of the male population. The proportion of patients with fragility fractures but without diagnosis of the disease is high. Mortality after hip fracture is higherin men than in women; in spite of this, mostpatients are left without treatment for osteoporosis. Drugs approved, for the treatment ofosteoporosis in our country are bisphosphonates, teriparatide, and strontium ranelate (SrR).The objective of this study was to evaluate theeffect of SrR on axial BMD in men after one yearof treatment. We obtained pertinent data frommedical registries of 20 men aged 67,8±3,0 years,treated with oral SrR (2 g/day) for 12 months. All patients had a T-score below -2,5 at the hipor the lumbar spine, or a T-score below -2,0and one or more risk factors for fracture. Thelevels of serum calcium, phosphate, alkalinephosphatase, 25-hydroxyvitamin D, or PTH,or urinary calcium and desoxipyridinoline remained unchanged following SrR administration. After treatment with SrR there weresignificant increases in BMD at the lumbarspine: 0,953±0,029 versus 0,997±0,030 g/cm2(p=0,0068), femoral neck: 0,734±0,013 versus 0,764±0,016 g/cm2 (p=0.0084), and total hip: 0,821±0,02 versus 0,834±0,02 g/cm2(p=0,0419). Conclusion: in osteoporotic men,treatment with SrR significantly increases BMDin the lumbar spine and the proximal femur (AU)

Efecto del ranelato de estroncio sobre la densidad mineral ósea en hombres con osteoporosis / Effect of strontium ranelate on bone mineral density in men with osteoporosis

La osteoporosis afecta al 6-7% de la población masculina. Es alta la proporción de pacientes con fracturas sin diagnóstico previo de esta enfermedad. La mortalidad luego de una fractura es mayor en hombres que en población femenina; a pesar de esto, la mayoría de los pacientes no reciben tratamiento. Los fármacos aprobados, en nuestro medio, para tratar la osteoporosis masculina son: bifosfonatos, teriparatida y ranelato de estroncio. El objetivo de este estudio fue evaluar el efecto del ranelato de estroncio sobre la densidad mineral ósea en hombres después de 1 año de tratamiento. Se incluyeron los registros de 20 hombres de 67,8±3,0 años, tratados con ranelato de estroncio (2 g/día) durante 1 año. Todos los pacientes presentaban un T-score inferior a -2,5 en cadera o columna vertebral o un T-score inferior a -2,0 y factores de riesgo de fractura. No hubo modificación de parámetros de laboratorio luego del tratamiento (calcemia, calciuria, fósforo sérico, parathormona, 25(OH)vitamina D, fosfatasa alcalina y desoxipiridinolina) en relación a los basales. Luego del tratamiento con ranelato de estroncio se observó incremento de la densidad mineral ósea en columna lumbar: 0,953±0,029 versus 0,997±0,030 g/cm2 (p=0,0068), cuello femoral: 0,734±0,013 versus 0,764±0,016 g/cm2 (p=0,0084) y cadera total: 0,821±0,02 versus 0,834±0,02 g/cm2 (p=0,0419). Conclusión: el tratamiento con ranelato de estroncio produjo un incremento significativo de la densidad mineral ósea en columna lumbar y fémur proximal en hombres con osteoporosis. (AU)

Osteoporosis affects 6-7% of the male population. The proportion of patients with fragility fractures but without diagnosis of the disease is high. Mortality after hip fracture is higher in men than in women; in spite of this, most patients are left without treatment for osteoporosis. Drugs approved, for the treatment of osteoporosis in our country are bisphosphonates, teriparatide, and strontium ranelate (SrR). The objective of this study was to evaluate the effect of SrR on axial BMD in men after one year of treatment. We obtained pertinent data from medical registries of 20 men aged 67,8±3,0 years, treated with oral SrR (2 g/day) for 12 months. All patients had a T-score below -2,5 at the hip or the lumbar spine, or a T-score below -2,0 and one or more risk factors for fracture. The levels of serum calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, or PTH, or urinary calcium and desoxipyridinoline remained unchanged following SrR administration. After treatment with SrR there were significant increases in BMD at the lumbar spine: 0,953±0,029 versus 0,997±0,030 g/cm2 (p=0,0068), femoral neck: 0,734±0,013 versus 0,764±0,016 g/cm2 (p=0.0084), and total hip: 0,821±0,02 versus 0,834±0,02 g/cm2 (p=0,0419). Conclusion: in osteoporotic men, treatment with SrR significantly increases BMD in the lumbar spine and the proximal femur. (AU)

Estudio de causas secundarias de osteoporosis masculina / Study of secondary causes of male osteoporosis

La osteoporosis (OP) es una enfermedad subdiagnosticada y subtratada en la mayoría de los hombres. Un tercio de las fracturas de cadera ocurren en la población masculina, con más complicaciones secundarias que en la población femenina y una tasa de mortalidad de 37,5 % dentro del año posterior a la fractura. Un gran número de fracturas ocurren en hombres cuya densidad mineral ósea (DMO) no está en rango osteoporótico, esto resalta la importancia de evaluar factores distintos a la DMO en la determinación del riesgo de fractura. Objetivos: establecer la prevalencia de causas secundarias de OP en hombres mayores de 50 años y analizar las posibles asociaciones entre los valores de DMO y distintos parámetros bioquímicos. Se evaluaron retrospectivamente 918 historias clínicas de varones mayores de 50 años, cuyo motivo de admisión fuese OP, osteopenia o fracturas óseas en cualquier localización. Criterios de inclusión: medición de parámetros plasmáticos y urinarios de metabolismo fosfocálcico, testosterona total y DMO de raquis lumbar, cuello femoral y trocánter. Resultados: 113 pacientes, de 70,6 ± 9,8 años, cumplieron los criterios de inclusión, el 75,2 % tenían diagnóstico de OP en al menos una localización y el 24,8 % osteopenia. En el 85,8 % de los pacientes se encontraron causas secundarias de OP, siendo las más frecuentes: hipovitaminosis D, hipogonadismo, corticoterapia crónica e hipercalciuria. El 22 % de los pacientes padeció alguna fractura sin sospecha previa de baja masa ósea. Conclusiones: en un alto porcentaje de hombres con OP se observaron causas secundarias. El diagnóstico de OP en el varón es tardío ya que el 22 % había padecido alguna fractura sin sospecha previa de baja masa ósea. Esto resalta la importancia de este problema y la necesidad de realizar un diagnóstico y tratamiento temprano en la población masculina.

Male osteoporosis (OP) is an underdiagnosed and undertreated disease in the majority of men. One third of hip fractures occur in men, who present more secondary complications than women, with a mortality rate of 37.5 % within one year of facture. The observation that most fractures occur in men, whose bone mineral density is not in the osteoporotic range, highlights the importance of different factors others than bone densitometry to evaluate the risk of fracture. Aims: to establish the prevalence of secondary factors OP in men older than 50 years and to analyze the possible associations between bone mineral density and biochemical parameters. Retrospective analysis of 918 medical records of men over 50 years old, admitted because of OP, osteopenia or bone fractures in any location. Inclusion criteria: measurements of plasma and urinary bone metabolism parameters, total testosterone, lumbar spine, femoral neck and trochanter bone mineral density. Results: 113 patients met the inclusion criteria, the mean age was 70.6 ± 9.8 years, of which 85 (75.2 %) had OP diagnosis in one location and 28 (24.8 %) osteopenia. Of 113 patients assessed, 97 (85.8 %) had secondary OP causes, such as hypovitaminosis D, hypogonadism, chronic corticotherapy and hypercalciuria. Twenty two per cent of the patients had suffered a fracture without previous suspicion of low bone mass. Conclusions: A high proportion of men with OP present secondary factors. Most of these factors are diagnosed by history taking and biochemical study. The diagnosis of male OP is delayed as 22 % had suffered a fracture without previous suspicion of low bone mass. This indicates the importance of this issue and its early diagnosis and treatment in the male population.

Are We Missing Osteoporosis-Related Vertebral Fractures in Men?

STUDY DESIGN: Retrospective study. PURPOSE: To assess the prevalence of osteoporosis related spinal fractures among Saudi Arabian males. OVERVIEW OF LITERATURE: Vertebral fractures are the most common complication of osteoporosis and is the first sign in both sexes and only 25 to 30% of radiographically observed vertebral deformities are recognized. METHODS: We analyzed the chest radiographs of consecutive Saudi Arabian men > or = 50 years and who visited the emergency room of King Fahd University Hospital, Al Khobar, Saudi Arabia for a period of 12 months between November 1, 2007 and October 31, 2008. The site and type of fractures were classified as per the semi-quantitative technique. The other data retrieved from the medical records of patients included medications and clinical investigations for osteoporosis. RESULTS: Nine hundred seventy chest radiographs were performed during the study period and 876 radiographs could be analyzed. One hundred fifteen patients (13.1%) had 157 fractures. The mean age was 67.85 +/- 10.1 years. There was more than one fracture in 21 patients (18.2%). The majority of fractures (n = 102, 64.9%) were observed in thoracic spine. Seventy-one (45.2%) fractures were classified as mild, 54 (34.4%) were moderate and 32 (20.4%) were severe. For 26 (22.6%) patients, the report of the radiologist highlighted the fracture. CONCLUSIONS: Saudi Arabian males with osteoporosis continue to be missed despite the high prevalence osteoporosis leading to vertebral fractures. We believe it is important for physicians to identify vertebral fractures early and treat then appropriately before an extremity fracture occurs with high mortality.

Total estradiol, rather than testosterone levels, predicts osteoporosis in aging men / Estradiol prediz melhor osteoporose que testosterona total em homens idosos

OBJECTIVE: To study and establish sex hormone cutoff levels for osteoporosis risk in men over 50 years old. METHODS: Case-control study of 216 men > 50 years, 110 with osteoporosis (O) and 106 with normal bone density (C). We measured estradiol (E2), sex hormone binding globulin (SHBG), total testosterone (TT) and albumin. Free testosterone (FT) and bioavailable testosterone (BT) were calculated through Vermeulen's formula. RESULTS: There was no difference in TT between groups. Relative risks of osteoporosis were 1.89 for E2 < 37 pg/mL (p = 0.02); 1.91 for SHBG > 55 nmol/L (p = 0.019); 2.5 for FT < 7 ng/dL (p = 0.015); 2.7 for BT < 180 ng/dL (p = 0.0003). CONCLUSIONS: In men over 50 years old, TT was not indicative of osteoporosis risk while E2 < 37 ng/mL was. SHBG > 55 nmol/L, FT < 7 ng/dL and BT < 180 ng/dL can represent additional indications for osteoporosis screening in men over 50 years old.

OBJETIVO: Estudar e estabelecer pontos de corte dos hormônios sexuais para risco de osteoporose em homens após os 50 anos de idade. MÉTODOS: Estudo caso-controle de 216 homens > 50 anos, 110 com osteoporose e 106 com densidade óssea normal. Foram dosados: estradiol (E2), globulina ligadora de hormônios sexuais (SHBG), testosterona total (TT) e albumina. Foram calculadas: testosterona livre (TLC) e testosterona biodisponível (TB) pela fórmula de Vermeulen. RESULTADOS: Não houve diferença na TT entre os grupos. Os riscos relativos de osteoporose foram de 1,89 para E2 < 37 pg/mL (p = 0,02); 1,91 para SHBG > 55 nmol/L (p = 0,019); 2,5 para TLC < 7 ng/dL (p = 0,015) e 2,7 para TB < 180 ng/dL (p = 0,0003). CONCLUSÕES: Em homens acima de 50 anos, TT não indicou risco de osteoporose, mas E2 < 37 pg/mL sim. SHBG > 55 nmol/L, TLC < 7 ng/dL e TB < 180 ng/dL podem representar indicações adicionais para pesquisa de osteoporose em homens acima de 50 anos.

Risk of late-onset hypogonadism (andropause) in Brazilian men over 50 years of age with osteoporosis: usefulness of screening questionnaires / Risco relativo de hipogonadismo tardio (andropausa) em brasileiros com mais de 50 anos com osteoporose e a utilidade de questionários de triagem

OBJECTIVE: To analyze the relative risk of late-onset hypogonadism in men with osteoporosis and the usefulness of screening questionnaires. METHODS: We correlated the Aging Male's Symptoms (AMS), Androgen Deficiency in Aging Male (ADAM) and International Index of Erectile Function (IIEF-5) questionnaires and the laboratory diagnosis of hypogonadism in 216 men aged 50-84 years (110 with osteoporosis and 106 with normal bone density, paired by age and ethnicity). RESULTS: Hypogonadism presented in 25 percent of the osteoporotic and in 12.2 percent of normal bone density men (OR 2.08; IC95 percent: 1.14-3.79) and was associated with ADAM first question (low libido, p=0.013). Levels of TT below 400 ng/dl correlated with an AMS score above 26 (p=0.0278). IIEF-5 showed no correlation with testosterone levels. CONCLUSION: Hypogonadism was 2.08 times more prevalent in osteoporotic men. The symptom that best correlated with late-onset hypogonadism was low libido (ADAM 1 positive).

OBJETIVOS: Avaliar o risco relativo de hipogonadismo tardio em homens com osteoporose e a utilidade de questionários de triagem. MÉTODOS: Correlacionamos a pontuação dos questionários Aging Male's Symptoms (AMS), Androgen Deficiency of the Aging Male (ADAM) e International Index of Erectile Function (IIEF-5) com dosagens de testosteronas em 216 homens entre 50 e 84 anos (110 com osteoporose e 106 com densidade óssea normal, pareados por idade e etnia). RESULTADOS: Hipogonadismo ocorreu em 25 por cento dos osteoporóticos e em 12,2 por cento dos com densidade óssea normal (RR 2,08; IC95 por cento: 1,143,79) e esteve associado à pergunta 1 do ADAM (diminuição de libido, p = 0,013). Testosterona total < 400 ng/dL associou-se a AMS > 26 (p = 0,0278). Disfunção erétil, avaliada pelo IIEF-5, não se correlacionou com dosagens de testosteronas. CONCLUSÃO: Hipogonadismo foi 2,08 vezes mais prevalente em homens com osteoporose e esteve associado à diminuição da libido (ADAM 1 positivo).

Osteoporosis y factores de riesgo en una población masculina latinoamericana / Osteoporosis and risk factors in a Latinoamerican male population

La osteoporosis es una de las principales causas de morbilidad y de mortalidad en la gente mayor. Aunque la presencia de osteoporosis es menos común en hombres que en mujeres, cerca de 1,5 millones de hombres por encima de 65 años en los Estados Unidos tienen osteoporosis, y otros 3,5 millones de hombres están en riesgo de padecer la enfermedad. En los últimos años el impacto de la osteoporosis en hombres se ha reconocido como problema importante de salud pública. Objetivos: para determinar la prevalencia y los factores de riesgo asociados a osteoporosis en hombres, se evaluó en un grupo de pacientes masculinos que asistían al Centro de Reumatología y Ortopedia, en Barranquilla, durante 2002-2005 para la realización del examen densitométrico. Métodos: realizamos un análisis descriptivo, transversal, incluyendo todos los varones mayores de 20 años en nuestra clínica ambulatoria (n=401), que no sabían que pudieran tener osteoporosis. Aplicamos una prueba centrada en los factores de riesgo relacionados con la osteoporosis, y se invitó a cada paciente a realizarse una medida central de la densitometría, en columna dorsal y fémur. Resultados: la edad media era de 57,65 años (SD+/-: 14,7); 71,4% eran mayores de 49 años. La prevalencia general de osteoporosis fue del 17,96%, y de osteopenia del 34,41%. La prevalen-cia más alta de osteoporosis fue encontrada en la categoría de edad de 70 a 79 años, y en el grupo de 40 a 49 años con 20,9%. La osteoporosis primaria estuvo presente en el 46,62% de todos los casos. En los pacientes con osteoporosis secundaria, 18,06% son fumadores, 13,9% han utilizado los corticoides por lo menos tres años, 11,1% tienen enfermedad prostática, 11,1% tienen artritis reumatoide, y cuando comparamos los factores de riesgo entre pacientes osteoporóticos con hombres sin osteoporosis, la diferencia era estadísticamente significativa (p<0,05) en todos. Conclusiones: la prevalencia de osteoporosis y de osteopenia encontrada en nuestro estudio, fue similar a las informadas por otros investigadores. Una proporción significativa de hombres tenía os-teoporosis primaria. Un número importante de hombres con osteoporosis tenían factores de riesgo para esta enfermedad. Adicionalmente, encontramos dos picos de prevalencia de osteoporosis por edad, en los grupos de 40 a 49 y 70 a 79, probablemente debido a la causa secundaria.

Osteoporosis is a leading cause of morbidity and mortality in elderly people. While less common in men than women, about 1.5 million men over age 65 years in the United States have osteoporosis, and another 3.5 million men are at risk. In the last few years the burden of osteoporosis in men has been recognized as an important public health issue. Objetive: to determine the prevalence and the risk factors associated with osteoporosis in a group of male outpatients assisting to the Centro de Reumatologia y Ortopedia, in Barranquilla, Colombia, during 2002-2005. Methods: we performed a descriptive, transversal survey, including all males older than 20 years in our ambulatory clinic (n= 401), who don’t knew they have osteoporosis. We apply a test focused on risk factors related to osteoporosis, and each patient was invited to do a central densitometry measure, in spine and femur . Results: the mean age was 57.65 years (SD+/-: 14.7); 71.4% was older than 49 years. The general prevalence of osteoporosis was 17.96%, and osteopenia 34.41%. The highest prevalence of os-teoporosis was found in the age group of 70 to 79 years, and in the group of 40 to 49 years with 20.9%. Primary osteoporosis was present in 46,62% from all cases. In patients with secondary osteoporosis, 18.06% are smokers, 13.9% have used corticoids for at least 3 years, 11.1% have prostatic disease, 11.1% have rheumatoid arthri-tis, and when we compare this risk factors between men patient with and without osteoporosis, the dif-ference was statistically significance (p<0.05) in all of them. Conclusions: the prevalence of osteoporosis and osteopenia was similar to those found by other groups. A high proportion of men had primary osteoporosis. An important number of men with osteoporosis had risk factors for this dis-ease. Additionally, we found two osteoporosis peaks by age, in the groups of 40 to 49 and 70 to 79, probably due to secondary cause.

A Study of Treatment Realities and Recognition of Male Osteoporosis

BACKGROUND: Osteoporosis has been thought of as a disease of women, but the incidence of male osteoporosis is increasing and is expected to keep rising due to alcohol abuse, smoking and increased life expectancy for men. This study was done to evaluate how many men recognized the significance of osteoporosis and its management. METHODS: There were 138 male subjects who underwent Bone Mineral Density (DEXA) from January 2000 to August 2003 at Sung Nam Central Hospital. We reviewed their BMD results and formed questionnaires which were constructed to evaluate men's recognition and treatment realities of osteoporosis. Telephone interviews and mailing services were utilized. The respondents were 96 (69.6%) and analysis was done. RESULTS: The average age of the 138 men was 55. Among them, there were 55 (39.9%) and 68 (49.3%) men who had been diagnosed with osteopenia and osteoporosis, respectively. Information on osteoporosis was obtained mainly from mass media like TV and newspaper (57.3% of total answers). The reason for undergoing test for osteoporosis was related to the annual screening tests (40.6% of total answers). Most of these people were likely to ignore the significance of osteoporosis, because only 26 percent answered they should receive proper treatment in case of osteoporosis although they did not have any symptoms at the time of the diagnosis. Among these osteoporotic patients, 76.7 percent did not seek any medical care and the most common reason for refusal to treatment was no existing symptoms for osteoporosis. Among the total, 67.4 percent of the patients said there had been no change of life behavior after the diagnosis. CONCLUSION: We found that men had relatively more knowledge of osteoporosis than we expected, but they knew little about the need for treatment and possible severe complications like major fractures that may occur. Also, we found the diagnosis of osteoporosis has little effect on behavioral changes. In conclusion, family physicians should take more interest in the education of patients to increase compliance for its treatment.

A Study of the Male Senile Osteoporosis, Its incidence, Diagnosis and Treatment / 中华骨科杂志

Objective To investigate the incidence and the factors related to male senile osteoporosiswith dual energy X - ray ahsorptiometry (DEXA). Methods 139 cases of healthy elderly men were examined by WHO T - Score with DEXA to estimate the incidence of male senile osteoporosis. The relationshipbetween osteoporosis and various parameters such as age, body weight, smoking etc. was assessed. The resultsof DEXA examination were compared with those of plain X - ray film of lateral view of lumbar spine, hip Singhindex etc. Bone turnover markers were examined to study their relationship with osteoporosis by DEXA. Results The incidence of male senile osteoporosis was 26. 6%. Body weight and smoking were closely relatedto osteoporosis. No signifieant relationship was found between bone turnover markers and osteoporosis. PlainX - ray film of lumbar spine and hip Singh index bore a relationship with osteoporosis by DEXA. ConclusionIncidence of male senile osteoporosis is rather high, and it is imper'tant to pay more attention to the preventionand treatment of male senile osteoporosis. DEXA equipment is not popular in general hospital, therefore theplain X - ray film of lumbar spine and hip Singh index were found to have some value for the diagnosis of senileosteoporosis.

Clinical characteristics and causes of primary male osteoporosis in Korea / 대한내과학회지

Osteoporosis in men has recently been recognized as an important public health problem. In women, pathophysiology, risk factors, etiology and treatment of osteoporosis have become well defined. However, less information has been availabe concerning men until now. Male osteoporosis has been known to be associated with drugs and diseases that threaten bone health. However, the causes of male osteoporosis are not apparent in some instances. This study was designed to evaluate the clinical characteristics and causes of primary osteoporosis in Korean men. METHODS: The BMD was measured with DEXA in 327 healthy adult Korean men who were employed by the same company in Seoul. Among them, we studied 20 patients who visited the department of internal medicine at Yonsei University Medical Center for evaluation of osteoporosis. Osteoporosis was defined by WHO criteria for women. We performed history taking, physical examination, nutritional assessment and laboratory examination. RESULTS: The mean age of patients was 52 years. None of them have taken corticosteroid or any other medicine. None of them had suffered from any other medical illness. The mean BMI was 22.1 kg/m2 and the values of 7 patients were less than the age-matched normal value of healthy Korean men. Six patients were current smokers and there were no heavy drinkers. Urinary calcium excretion was elevated in 5 patients and dietary calcium intake was less than 400mg/day in 4 patients. Vitamin D deficiency, as evidenced by serum 25(OH) D levels below 12 ng/mL, was detected in 2 patients, however, subclinical hypovitaminosis D (below 20 ng/mL) was observed in 8 patients. Serum free testosterone levels below normal value were observed in 5 patients. The mean serum IGF-I level was 183.7 ng/mL and that was lower than for normal Korean men. Lower IGF-I levels than age-matched normal values were observed in 5 patients. CONCLUSION: The clinical characteristics of Korean male osteroporosis were heterogenous in many aspects of its features. Several factors could be suggested as possible causes of idiopathic male osteoporosis. Men with osteoporosis in this study revealed low BMI(7 patients), family history of osteoporosis(1 patient), low calcium intake(4 patients), hypercalciuria(5 patients), Vitamin D deficiency(2 patients), subclinical hypovitaminosis D(8 patients), testosterone deficiency (5 patients) and low IGF-I level(5 patients). Multiple causes of osteoporosis were found in 6 patients.