Osteoporosis has long been recognized as a disease affecting postmenopausal women but it has become increasingly clear that men are affected by low bone density and suffer the consequences of osteoporotic fractures. Men attending clinical urological practices might be at raised risk of bone loss due to hypogonadism, either identified during work-up of erectile dysfunction or induced by androgen deprivation therapy for treatment of prostate cancer. The availability of bisphosphonate drugs with proven efficacy in fracture reduction has revolutionized osteoporosis therapy in the past decade. The use of these agents has been traditionally based on data obtained predominantly from postmenopausal women and cases of glucocorticoid-induced osteoporosis, but data are becoming increasingly available to justify their use in men. Despite the availability and favorable safety profile of bisphosphonates, many patients are not receiving therapy. This article serves to review the data regarding bisphosphonate use in men, discussing particularly the pharmacology and mechanisms of action of these agents, and findings from clinical studies supporting their use for fracture prevention.
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