Osteoporosis in the aging male: Treatment options

Abstract

In elderly women, loss in bone mass and micro-architectural changes are generally attributed to the onset of menopause. Men do not experience menopause, they do, however, experience age-related acceleration in bone loss and micro-architecture deterioration. The incidence of osteoporotic fractures in elderly men, just as in aged women, increases exponentially with age; the rise in men, however, is some 5–10 years later than in women. Up to 50% of male osteoporotics have no identifiable etiology; however elderly males have much higher likelihood of having an identifiable secondary cause than younger men. Therefore, clinical and laboratory evaluation of aged male osteoporotics must be thorough and should be aimed at identifying lifestyle or conditions contributing to bone loss and fragility. It is essential to identify and treat secondary causes and ensure adequate vitamin D and calcium intake before embarking upon treatment with pharmacological agents. The evidence from a limited number of trials suggests that bisphosphonates, especially alendronate and risedronate, are effective in improving BMD, and seem to be the treatments of choice in aged men with osteoporosis. In cases where bisphosphonates are contra-indicated or ineffective, teriparatide or alternatives such as strontium should be considered.

Bone fragility in male glucocorticoid-induced osteoporosis is not defined by bone mineral density

“…Approximately half the male patients with osteoporosis presenting with symptomatic VFs have identifiable secondary causes [4]; GC therapy is a common cause of osteoporosis in older men [5]. The prevention of fractures in men seems to be much more important than in women because male mortality rates within 1 or 2 years after a fracture are higher than in females [6,7].…”

Low Testosterone—An Important Predictor of Low Mineral Bone Density in Young Men—Our Own Experience and a Review of Literature

“…Alendronate (Fosamax) is approved in USA for use in men and has been shown to increase BMD with a trend toward reduction of non-vertebral and vertebral fracture risk [96]. Risedronate (Actonel] is often used in men with chronic steroid use and it has been shown to increase BMD in men as well [97,98].…”

Patterns of treatment in Australian men following fracture

“…There have been significant advances in the prevention of fracture in women, but the same cannot, as yet, be said for men. Over the past decade, osteoporosis in men has come to be increasingly recognised as a clinical and public health concern, and a much neglected area of study [5][6][7][8] The aetiology of bone fragility in men compared to women has received less attention in the literature [6,[9][10][11][12]. The diagnostic threshold for osteoporosis in men-and its treatment-is based on studies in women [5,10].…”

“…In the absence of evidence from large-scale, randomised, controlled clinical trials, fracture-prevention treatment recommendations for men remain open to consideration [11]. Several small studies have shown improvements in surrogate endpoints using pharmacological therapies such as bisphosphonates, human parathyroid hormone and calcium and vitamin D supplementation [6,11,[14][15][16][17]. For example, bisphosphonates increase BMD in men at the spine and proximal femur [16], and among older men with hip fracture, intravenous bisphosphonates therapy reduces overall risk of fracture [18].…”