Patterns in the Diagnosis and Treatment of Osteoporosis in Men: A Questionnaire-based Survey in Central and Eastern European Countries

M. A. Boyanov 1 , E. Czerwinski 2 , A. Shinkov 3 , V. Palička 4 , P. Lakatos 5 , C. Poiana 6 , J. Payer 7 , Z. Killinger 7 , T. Kocjan 8 , O. Lesnyak 9 , 10 , G. Holzer 11  and H. Resch 12
  • 1 Department of Internal Medicine, Clinic of Endocrinology and Metabolism, University Hospital “Alexandrovska”, Medical University, Sofia, Bulgaria
  • 2 Jagiellonian University Medical College, Faculty of Health Sciences, Department of Bone and Joint Diseases, Cracow, Poland
  • 3 Clinic of Thyroid and Bone Metabolic Diseases, University Hospital of Endocrinology “Acad. Ivan Penchev”, Medical University, Sofia, Bulgaria
  • 4 Osteocentra, University Hospital and Charles University, School of Medicine, Hradec Kralove
  • 5 1st Department of Medicine, Semmelweis University, Budapеst, Hungary
  • 6 Department of Endocrinology, National Institute of Endocrinology, University of Medicine and Pharmacy, Bucharest, Romania
  • 7 5th Department of Internal Medicine, University Hospital, Medical Faculty of Comenius University, Bratislava, Slovakia
  • 8 Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
  • 9 Urals State Medical University, , Yekaterinburg, Russian Federation
  • 10 North-Western State Medical University, , Saint Petersburg, Russian Federation
  • 11 Department of Orthopedic Surgery, Medical University of Vienna, Vienna, Austria
  • 12 Metabolic Bone Diseases, Medical Faculty, “Sigmund Freud” University, Department of Internal Medicine II, St. Vincent Hospital Vienna, Academic Teaching Hospital of the Medical University, Vienna, Austria


To assess the current practice patterns in the diagnosis and treatment of male osteoporosis based on questionnaires. Questionnaires were presented and filled out by osteoporosis experts from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, Slovenia and Russia. The questions included focused on the proportion of male referrals to DXA, the main reasons for referral, the preferred measurement sites and reference database, the definition of male osteoporosis, needed laboratory investigations, data on calcium and vitamin D supplementation as well as on treatment modalities and their reimbursement rate. Men comprised 5 to 10% of all DXA referrals. The main reasons for referral were low back pain and fractures. Most of the respondents used the International male reference database. The diagnosis of osteoporosis was based mainly on a T-score below −2.5 after the age of 50, but a few respondents added fractures as a necessary condition. Only 1/3 of men visiting DXA sites are expected to have normal BMD. A consensus for the use of laboratory investigations in male osteoporosis is practically lacking. Treatment modalities include alendronate, risedronate, zoledronate, denosumab, rhPTH and strontium (with some restrictions for the latter three). Data on treatment adherence and persistence are generally lacking except for Austria, Romania and Slovakia. The levels of reimbursement vary a lot across countries. Osteoporosis in men is an under-recognized problem in CEE countries, leading to a tremendous gap in the diagnosis and treatment.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Donaldson LJ, Cook A, Thomson RG. Incidence of fractures in a geographically defined population. J Epidemiol Community Health 1990, 44:241-245.

  • 2. Khosla S. Update in male osteoporosis. J Clin Endocrinol Metab 2010, 95:3-10.

  • 3. Willson T, Nelson SD, Newbold J et al. The clinical epidemiology of male osteoporosis: a review of the recent literature. Clin Epidemiol 2015. 7:65-76.

  • 4. Dimai HP, Redlich K, Peretz M et al. Economic burden of osteoporotic fractures in Austria. Health Econ Rev 2012, 2:12.

  • 5. Ismail AA, Pye SR, Cockerill WC et al. Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 2002, 13:565-571.

  • 6. Ha YC, Park YG, Nam KW, Kim SR. Trend in hip fracture incidence and mortality in Korea: a prospective cohort study from 2002 to 2011. J Korean Med Sci 2015, 30:483-488.

  • 7. Cawthon PM, Shahnazari M, Orwoll ES, Lane NE. Osteoporosis in men: findings from the Osteoporotic Fractures in Men Study (MrOS). Ther Adv Musculoskelet Dis 2016, 8:15-27.

  • 8. Alamri SH, Kennedy CC, Marr S et al. Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada. BMC Geriatr 2015. 15:94.

  • 9. Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on bone densitometry. J Clin Densitom 16:455-466.

  • 10. Leslie WD, Langsetmo L, Zhou W et al. CaMos Research Group (2014) Choice of lumbar spine bone density reference database for fracture prediction in men and women: a population-based analysis. J Clin Densitom 17:295-300.

  • 11. Schousboe JT, Tanner SB, Leslie WD. Definition of osteoporosis by bone density criteria in men: effect of using female instead of male young reference data depends on skeletal site and densitometer manufacturer. J Clin Densitom 2014, 17:301-306.

  • 12. Schousboe JT, Gourlay M, Fink HA et al. Osteoporotic Fractures in Men (MrOS) and Study of Osteoporotic Fractures (SOF) Research Groups (2013) Cost-effectiveness of bone densitometry among Caucasian women and men without a prior fracture according to age and body weight. Osteoporos Int 24:163-177.

  • 13. Nshimyumukiza L, Durand A, Gagnon M et al. An economic evaluation: Simulation of the cost-effectiveness and costutility of universal prevention strategies against osteoporosis-related fractures. J Bone Miner Res 2013, 28:383-94.

  • 14. Ettinger B, Ensrud KE, Blackwell T et al. Osteoporotic Fracture in Men (MrOS) Study Research Group (2013) Performance of FRAX in a cohort of community-dwelling, ambulatory older men: the Osteoporotic Fractures in Men (MrOS) study. Osteoporos Int 24:1185-1193.

  • 15. Ensrud KE, Taylor BC, Peters KW et al. Osteoporotic Fractures in Men Study Group (2014) Implications of expanding indications for drug treatment to prevent fracture in older men in United States: cross sectional and longitudinal analysis of prospective cohort study. BMJ 349: 4120.

  • 16. Giusti A, Bianchi G (2014) Treatment of primary osteoporosis in men. Clin Interv Aging 10:105-115.

  • 17. Chen L, Wang G, Zheng F, Zhao H, Li H. Efficacy of bisphosphonates against osteoporosis in adult men: a meta-analysis of randomized controlled trials. Osteoporos Int 2015, 26:2355-2363.

  • 18. Chen LX, Zhou ZR, Li YL et al.) Comparison of Bone Mineral Density in Lumbar Spine and Fracture Rate among Eight Drugs in Treatments of Osteoporosis in Men: A Network Meta-Analysis. PLoS One 10(5):e0128032; doi: 10.1371/journal.pone.0128032. eCollection 2015.

  • 19. Liu M, Guo L, Pei Y et al. Efficacy of zoledronic acid in treatment of osteoporosis in men and women-a meta-analysis. Int J Clin Exp Med 2015, 8:3855-3861.

  • 20. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2015 Oct. Denosumab (Prolia): Treatment to increase bone mass in men with osteoporosis at high risk for fracture; or who have failed or are intolerant to other available osteoporosis therapy [Internet].

  • 21. Cusano NE, Costa AG, Silva BC, Bilezikian JP. Therapy of osteoporosis in men with teriparatide. J Osteoporos 2011:463675.

  • 22. Hiligsmann M, Ben Sedrine W, Bruyère O, Reginster JY. Cost-effectiveness of strontium ranelate in the treatment of male osteoporosis. Osteoporos Int 2013, 24:2291-2300.

  • 23. Borst SE, Yarrow JF. Injection of testosterone may be safer and more effective than transdermal administration for combating loss of muscle and bone in older men. Am J Physiol Endocrinol Metab 2015, 308:E1035-1042.

  • 24. Svedbom A, Hernlund E, Ivergård M et al. EU Review Panel of IOF Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 2013, 8:137.

  • 25. Svedbom A, Hernlund E, Ivergård M et al. Epidemiology and economic burden of osteoporosis in Austria. Arch Osteoporos 2013, 8:137; 4-11.

  • 26. Svedbom A, Hernlund E, Ivergård M et al. Epidemiology and economic burden of osteoporosis in Austria. Arch Osteoporos 2013, 8:137; 20-27.

  • 27. Svedbom A, Hernlund E, Ivergård M et al. Epidemiology and economic burden of osteoporosis in the Czech republic. Arch Osteoporos 2013, 8:137; 35-42.

  • 28. Svedbom A, Hernlund E, Ivergård M et al. Epidemiology and economic burden of osteoporosis in Hungary. Arch Osteoporos 2013, 8:137; 91-98.

  • 29. Ivergård M, Svedbom A, Hernlund E et al. Epidemiology and economic burden of osteoporosis in Poland. Arch Osteoporos 2013, 8:137; 154-161.

  • 30. Ivergård M, Svedbom A, Hernlund E et al. Epidemiology and economic burden of osteoporosis in Romania. Arch Osteoporos 2013, 8:137; 170-177.

  • 31. Ivergård M, Svedbom A, Hernlund E et al. Epidemiology and economic burden of osteoporosis in Slovakia. Arch Osteoporos 2013, 8:137; 178-186.

  • 32. Ivergård M, Svedbom A, Hernlund E et al. Epidemiology and economic burden of osteoporosis in Slovenia. Arch Osteoporos 2013, 8:137; 187-194.

  • 33. Boyanov M, Christov V. Prevalence of low central bone mineral density in Bulgarian males. J Men’s Health 2005, 2:318-324.

  • 34. Kudma K, Krska Z Expense analysis of the proximal femoral fractures treatment. Rozhl Chr 2005, 84:631-634.

  • 35. Péntek M, Horváth C, Boncz I et al. Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999-2003. Osteoporos Int 2008, 19:243-249.

  • 36. Lakatos P, Tóth E, Szekeres L et al. A csontritkulás kezelésének hatékonysága Magyarországon. Az Országos Egészségbiztosítási Pénztár adatainak elemzése [Efficiency of osteoporosis treatment in Hungary – An analysis of the Hungarian Insurance Company’s data] Lam Kid 2012, 2:5-12.

  • 37. Grigorie D, Sucaliuc A, Johansson H et al. Incidence of hip fracture in Romania and the development of a Romanian FRAX model. Calcif Tiss Int 2013, 92:429-436.

  • 38. Dzajkovska B, Wertheimer AI, Mrhar A. The burden-of illness study on osteoporosis in the Slovenian female population. Pharm World Sci 2007, 29:404-411.

  • 39. Masaryk P. Hodnotenie rizika osteoporotických zlomenín v primárnej praxi (Fracture risk assessment in primary care). Rheumatologia 2012, 26:127-133.

  • 40. Lindsay BR, Olufade T, Bauer J, Babrowicz J, Hahn R. Patient-reported barriers to osteoporosis therapy. Arch Osteoporos 2016, 11:19.

  • 41. Kanis JA, Svedbom A, Harvey N, McCloskey EV. The osteoporosis treatment gap. J Bone Miner Res 2014, 29:1926-1928.

  • 42. Kanis JA, McCloskey EV, Johansson H et al. Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) (2013). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23-57.


Journal + Issues