Men have a higher trabecular bone volume/tissue volume, which declines at a similar rate to women. Peripheral quantitative computed tomography (CT) demonstrated that men seem to show a relative preservation of trabecular number, but more trabecular thinning [7] and [6], presumed to be secondary to reduced bone formation and correlated with indices of reduced bone formation. FRAX is a computer-based algorithm (http://www.shef.ac.uk/FRAX) launched in 2008. It calculates fracture probability from clinical risk factors (Table 1) and patient characteristics (age, weight, height, etc.) in both men and check details women. The output of FRAX

is the 10-year probability of a hip fracture and of a major osteoporotic fracture (hip, clinical spine, humerus or wrist fracture)

LY2835219 [48] and [49]. As is the case for women, there is presently no generally accepted algorithm for the management of osteoporosis in men [50], although FRAX is being increasingly incorporated into practice guidelines. An example for the UK is provided in Table 2. Before the advent of FRAX, management algorithms for men were very similar to those used in postmenopausal women. In the UK, in the event of a previous fracture, a DXA would be performed or treatment would be considered in the absence of a BMD measurement. In the absence of a previous fracture, but if other clinical risk factors are present (Table 1), a DXA should be performed, and the subject recommended for treatment if their T-score was below − 2.5 SD [51]. In other countries, other T-score thresholds have been used [2]. Although risks that justify treatment vary on a national basis, treatment is widely recommended in individuals with a prior history of fragility fracture [50]. Whereas the diagnosis of osteoporosis centres on the assessment

of BMD at the femoral neck using DXA, other sites and validated techniques can be used for fracture prediction. The FRAX clinical risk factors contribute to fracture risk independently of BMD. The use of these risk factors in conjunction with BMD improves sensitivity of fracture prediction without adverse effects on specificity [52]. Thus, the FRAX algorithm may significantly impact clinical practice because Suplatast tosilate it helps identify individuals at increased risk of fracture, while avoiding unnecessarily treating patients at low fracture risk. Treatment of osteoporosis in men at increased risk of fracture was first included in the latest revision of the European guidelines on the evaluation of medicinal products in the treatment of osteoporosis [53]. Previous guidelines were only for use in postmenopausal women. The guidelines state that, for women, an effect in reducing fracture risk must be demonstrated on both spinal and non-spinal fractures in a randomised, double-blind, placebo-controlled primary pivotal study with a minimum duration of two years to be conducted either in women with a BMD T-score below − 2.5 SD or in women with prevalent fracture.