Male osteoporosis has a prevalence of around 5% (vertebral fractures). Secondary causes such as gastrointestinal diseases with malabsorption, alcoholism and malignant diseases are common. Hypogonadism is often not diagnosed since clinical signs are subtle. Diagnosis of osteoporosis is made using clinical history (riskfactors), clinical examination (e.g. reduction of stature, backpain), X-ray, densitometry and laboratory work-up. Cut-off values for the WHO classification of male osteoporosis and all densitometry techniques, such as dual-energy X-ray absorptiometry (DXA), quantitative ultrasound (QUS) and quantitative computed tomography (QCT), need to be developed. QUS can be measured at the calcaneus and phalanges. Phalangeal ultrasound is especially useful because it is easily accessible, fast, radiation-free, portable and cheap. Preliminary results show that phalangeal ultrasound may detect structural deterioration, especially inpatients on glucocorticoid treatment, earlier than spinal DXA.

The prevention of osteoporosis is based on the intake of calcium and vitamin D or its analogs. In hypogonadal men, or in men with osteoporosis with low-to-normal or decreased testosterone levels, the use of hormone replacement therapy with testosterone for at least 10 years, with yearly andrological examination and prostate ultrasonography, will lead to a significant increase of bone density. Bisphosphonates inhibit osteoclastic bone resorption and are the most effective treatment with regards to fracture reduction. Bone-forming drugs, such as fluoride or anabolic steroids, can activate osteoblasts; however, reduction in fracture incidence has not been shown. Parathyroid hormone, growth hormone and selective estrogen receptor modulators (SERMs) are prospective treatments for the future.