In men, osteoporosis treatment should be considered similar to women under which condition?

• A. Only after a major fracture occurs
• B. When risk factors or low BMD (T-score ≤ -2.5) or high fracture risk are present
• C. Only if secondary causes are ruled out
• D. Only in the presence of vertebral fractures

Answer: (B)

The important idea is that deciding to treat osteoporosis in men centers on fracture risk, not on fracture history alone. A T-score of -2.5 or worse clearly indicates osteoporosis and justifies treatment. But treatment is also appropriate if there are significant risk factors or if the calculated fracture risk is high, even if the T-score isn’t below -2.5. Tools like FRAX combine bone density with factors such as age, smoking, heavy alcohol use, low testosterone, and glucocorticoid use to estimate 10-year fracture risk and guide therapy. The aim is to prevent future fragility fractures, so treatment isn’t limited to men who’ve already had a major fracture or only to vertebral fractures. In short, treatment should be considered when risk factors are present, when BMD is low, or when overall fracture risk is high.