Osteoporosis in Men – A Contemporary Perspective on Diagnosis, Treatment and Fracture Prevention Strategies

Introduction: Osteoporosis in men is an increasingly acknowledged but underdiagnosed public health issue. Despite accounting for 20% of osteoporosis cases, male patients are frequently overlooked due to lower awareness, stereotypical associations with female aging, and subtler clinical presentation. Mortality following hip fractures in men reaches up to 37%. This review summarizes current knowledge and highlights emerging concepts in male osteoporosis. Material and Methods: A narrative review based on a PubMed literature search and analysis of international osteoporosis guidelines (2017–2025). Included were high-quality reviews, randomized trials, and position statements focused on osteoporosis in men. Results: Male osteoporosis is mainly secondary, linked to hypogonadism, androgen deprivation therapy, glucocorticoids, chronic disease, and poor lifestyle factors such as alcohol, smoking, low activity, and vitamin D deficiency. Diagnosis remains challenging due to female-based T-score thresholds and limitations of FRAX in male populations. Bone turnover markers and HR-pQCT imaging improve risk stratification. Treatment combines antiresorptive agents (bisphosphonates, denosumab) and anabolic therapies (romosozumab), often sequenced under treat-to-target (T2T) models. New approaches include the role of gut microbiota, osteosarcopenia, and personalized digital tools. Conclusions: Male osteoporosis requires earlier recognition, individualized therapy, and public awareness. Advancing care involves closing diagnostic gaps, integrating male-focused strategies into clinical guidelines, and embracing novel therapeutic targets and technologies.