Highlights
- •Simultaneous bone loss and muscle atrophy are seen in ageing and several diseases.
- •Osteoporosis and sarcopenia often coincide in older men, leading to additive risks.
- •Androgens and oestrogens have important effects on male muscle and bone health.
- •However, they have limited clinical utility in older osteoporotic or sarcopenic men.
- •Emerging anabolic drugs offer hope for the treatment of osteosarcopenia in both genders.
Abstract
Bone and muscle are required for mobility but they also have endocrine and metabolic
functions. In ageing as well as in many chronic diseases, bone loss and muscle atrophy
occur simultaneously, leading to concomitant osteoporosis and sarcopenia. This occurs
in both genders but compared with postmenopausal women, men appear to be better protected
against age-related bone and muscle decay. Sex steroids (both androgens like testosterone
and oestrogens like estradiol) are mainly responsible for musculoskeletal sexual dimorphism.
They stimulate peak bone and muscle mass accretion during puberty and midlife, and
prevent subsequent loss in ageing men but not post-menopausal women. Still, recent
studies have highlighted the importance of intrinsic ageing mechanisms such as cellular
senescence and oxidative stress in both genders. Sarcopenia may predispose to dysmobility,
frailty, falls and fractures, but whether so-called osteosarcopenia qualifies as a
distinct entity remains debated. Although randomized clinical trials in male osteoporosis
are smaller and therefore underpowered for some outcomes like hip fractures, the available
evidence suggests that the clinical diagnostic and therapeutic approach to male osteoporosis
is largely similar to that in postmenopausal women. There is a clear unmet medical
need for effective and safe anabolic drugs to rebuild the ageing skeleton, muscle,
and preferably both tissues simultaneously. The Wnt/sclerostin and myostatin/activin
receptor signalling pathways appear particularly promising in this regard. In this
narrative review, we aim to provide an overview of our current understanding of the
pathophysiology and treatment of male osteoporosis and sarcopenia, and interactions
between these two diseases.
Keywords
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Article info
Publication history
Published online: January 23, 2019
Accepted:
January 22,
2019
Received in revised form:
January 20,
2019
Received:
January 12,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
