Osteoporosis in men continues to be an intriguing issue. From a practical viewpoint men respond as well to the approved osteoporosis therapies as do women. Testosterone replacement is clearly indicated if the presentation is not with osteoporosis but with sexual dysfunction (of course not suitable in men treated with androgen deprivation therapy for prostate cancer). BMD does increase with testosterone but there is no data documenting that this decreases the risk of fracture. It almost certainly would but the studies have not been done. Combined use of testosterone and specific osteoporosis therapy is safe and effective. Excellent clinical research continues to demonstrate that circulating estrogen levels (free estradiol) are more closely linked to BMD than free testosterone levels but there is no apparent clinical value in measuring estrogen in most men with hypogonadism.

* Michael Kleerekoper is a member of the Board of Directors of the Michigan Consortium for Osteoporosis and of the Board of Trustees of the national Osteoporosis Foundation.