Secondary osteoporosis in men over 50 years of age manifests with greater clinical and densitometric severity than primary osteoporosis

Abstract

Osteoporosis in men is an underdiagnosed condition, frequently associated with secondary causes, which are linked to greater clinical severity and fracture risk. We aimed to describe the clinical, densitometric, and biochemical characteristics of men aged ≥50 years with osteoporosis; to determine the frequency of secondary osteoporosis; and to compare bone mineral density and fracture prevalence between primary and secondary forms. Materials and methods: This retrospective cross-sectional study analyzed 183 medical records of men evaluated at IDIM between 2012 and 2021. Inclusion criteria were a T-score ≤−2.5 at the lumbar spine or femoral neck, or a fragility fracture. Clinical, densitometric, biochemical, and fracture variables were collected. Results: Mean age was 75.3±11.8 years and BMI 25.7±3.3 kg/m². A family history of osteoporosis was reported by 13% and parental hip fracture by 10%. DXA established the diagnosis in 75% of cases, with the hip most frequently affected (40%), followed by the lumbar spine (31%). Mean BMD was 0.830±0.20 g/cm² at the lumbar spine and 0.710±0.10 g/cm² at the femoral neck. Among 163 patients, 61% had vitamin D levels <30 ng/mL. Secondary osteoporosis was identified in 25% of cases, mainly associated with medications, hypogonadism, and hipercalciuria. These patients had lower femoral neck BMD (p=0.045) and higher fracture prevalence (74% vs. 41%; p=0.0002), particularly multiple vertebral fractures. Conclusions: Secondary osteoporosis in men presents greater clinical severity and higher fracture burden than primary osteoporosis, reinforcing the need for thorough etiological evaluation.