This patient has osteoporosis presenting with a low-trauma fracture.  Osteoporosis is often diagnosed based on DXA bone density findings (ie, T-score <−2.5), but a fragility fracture, which this patient has, is also adequate to make the diagnosis.

Osteoporosis is less common in men than in women, largely due to higher peak bone density in men and more rapid bone loss after menopause in women.  However, up to 40% of osteoporotic fractures occur in older men and are associated with a higher mortality rate compared to women.  In particular, advanced age is the most important risk factor for development of osteoporosis in men, with the risk rising rapidly after age 65.

In addition to age, other risk factors associated with osteoporosis for both men and women include:

• Heavy alcohol intake (eg, ≥3 drinks/day), likely due to decreased osteoblast activity.  This patient's light alcohol consumption is not likely a significant contributor to osteoporosis risk (Choice B).

• Low body weight, which is associated with accelerated bone loss.  This patient's high BMI is protective against osteoporosis and fracture (Choice D).

• Current cigarette smoking, due to direct osteoblast suppression, oxidative stress, and metabolic factors.  This patient's past light smoking is likely only a minor contributor to osteoporosis (Choice E).

(Choice C)  Thiazide diuretics (eg, chlorthalidone) reduce urinary calcium wasting and have been shown in some studies to reduce (not increase) the risk for fracture.

Educational objective:
Although osteoporosis is less common in men compared to women, the risk increases significantly with advanced age.  Other major risk factors in men include current smoking, low BMI, and heavy alcohol intake.