Although osteoporosis is more common in women, it is not unusual in men. One-fifth of all hip fractures and approximately one-seventh of all vertebral fractures are seen in men. One in six men has a hip fracture by the age of 90.7,8 The lower incidence of osteoporosis in men may be attributed to the higher peak bone mass attained (˜10% higher) and to the absence of a menopause equivalent in men. Adult men with a history of constitutional delay in puberty have lower radial and spinal bone mineral densities.250 Overall, when osteoporosis is encountered in a non-elderly man, the two most frequent causes are alcohol abuse and hypogonadism.43,44,134,135,251 Heavy smoking also is common in young men with osteoporosis. Preliminary data suggest that alendronate therapy might improve bone mass in osteoporotic men.

Juvenile osteoporosis is a rare, self-limiting disease of prepubertal children.252 These patients commonly present between the ages of 8 and 14 with the acute onset of back pain secondary to vertebral compression fractures. Spontaneous remission usually occurs after 2 to 6 years. Juvenile osteoporosis must be differentiated from osteogenesis imperfecta, Cushing syndrome, leukemia, and other disorders of bone marrow. Laboratory values are generally normal, as in the adult with osteoporosis. Although the temporal relation of juvenile osteoporosis to puberty implies an endocrine cause, the primary defect is unknown. Biopsy data suggest a relatively uncontrolled activity of metaphyseal osteoclasts.

Analgesic therapy, early mobilization, supportive physical therapy, and preventive measures against further bone loss are used. Currently no treatment approved by the Food and Drug
Administration exists for osteoporosis in children. Sex hormone therapy is not effective (and not advisable), and the use of bisphosphonates253 should not be recommended because of their long skeletal half-lives.