Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for osteoporosis and fractures because of lifestyle factors, systemic effects of the disease, side effects of treatment, and comorbidities. The initial evaluation of COPD men for osteoporosis must include a detailed medical history and physical examination, assessment of COPD severity, and additional tests, as suggested by results of clinical evaluation. Osteoporosis is diagnosed on the basis of bone mineral density (BMD) measurement with DEXA of the lumbar spine and hip, but fracture risk assessments tools, as FRAX, could be used as useful supplements to BMD assessments for therapeutics interventions. The prevention and treatment of osteoporosis in COPD involves nonpharmacologic and pharmacologic measures, as lifestyle measures and nutritional recommendations, management of COPD treatment (based on the use of limited corticosteroids doses), and drug therapy (bisphosphonates, teriparatide). In this paper, the current recommendations for diagnosis and management of osteoporosis in COPD men, based on recent medical bibliography, are presented and discussed. 1. Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and a secondary cause of bone loss [1–3]. It is characterised by a progressive airflow limitation that is not fully reversible and develops as a consequence of genetic susceptibility, increasing life span, environmental, and lifestyle factors [1, 3, 4]. The degree of airflow limitation can be assessed by spirometry and stratified in accordance with the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) [4]. Osteoporosis is a common systemic skeletal disease characterised by low bone mass with microarchitectural disruption and skeletal fragility, resulting in an increased risk of fracture, most commonly at the spine, hip, or wrist and causing significant morbidity and mortality [3, 5]. Osteoporosis in men continues to be underdiagnosed and untreated due to the rather exclusive focus on postmenopausal osteoporosis in the past; corticosteroid use, excessive alcohol use, and hypogonadism which are the most frequent secondary causes of male osteoporosis [2, 6]. Although osteoporosis is less prevalent in men, it has been estimated that 30% of all hip fractures occur in males and that one in eight men older than 50 years will experience an osteoporotic fracture [5]. Moreover, many studies have shown that osteoporotic fractures are associated with greater morbidity and mortality in men compared with
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