Treatment of osteoporosis in men
- Joel S Finkelstein, MD
Joel S Finkelstein, MD
- Associate Professor of Medicine
- Harvard Medical School
Osteoporosis is a leading cause of morbidity and mortality in older people. While less common in men than women, over 8 million men in the United States have low bone mass or osteoporosis [1,2]. The mortality rate associated with hip fractures [3,4], as well as vertebral and other major fractures , is higher in men than in women. In addition, men are even less likely than women to be evaluated or receive antiresorptive therapy after a hip fracture (4.5 versus 49.5 percent, respectively) [6-8].
The treatment of osteoporosis in men consists of lifestyle measures and drug or hormonal therapy. An overview of the approach to therapy of osteoporosis in men will be presented here. The diagnosis, evaluation, and epidemiology of osteoporosis in men are discussed separately. (See "Clinical manifestations, diagnosis, and evaluation of osteoporosis in men" and "Epidemiology and etiology of osteoporosis in men".)
In general, lifestyle modifications should be encouraged for all men with osteoporosis. A weight-bearing exercise regimen may be modestly beneficial given the association of reduced physical activity with bone loss and fracture in older men and the positive effect of exercise in women with osteoporosis (see "Epidemiology and etiology of osteoporosis in men", section on 'Physical activity and strength' and "Overview of the management of osteoporosis in postmenopausal women", section on 'Exercise'). In addition, smoking and excessive alcohol intake should be avoided.
As a general rule, men with osteoporosis should receive adequate calcium (1000 mg/day in younger men, 1000 to 1200 mg daily in older men, total diet plus supplement) and vitamin D (600 to 800 international units/day) supplementation. Older persons confined indoors and other high risk groups may have low serum 25-hydroxyvitamin D (25[OH]D) concentrations at this intake level and may require higher intakes of vitamin D. (See "Vitamin D deficiency in adults: Definition, clinical manifestations, and treatment", section on 'Groups at high risk'.)
In some trials, calcium and vitamin D have been shown to reduce fracture risk in men and women when administered at a dose of at least 700 international units/day (see "Calcium and vitamin D supplementation in osteoporosis"). However, in most cases, the addition of pharmacologic or hormonal therapy is necessary for the treatment of osteoporosis in men .
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- LIFESTYLE MEASURES
- TREATMENT OF SECONDARY CAUSES
- Testosterone therapy
- Glucocorticoid-induced osteoporosis
- Androgen deprivation therapy
- PHARMACOLOGIC THERAPY
- Candidates for therapy
- - Fracture risk assessment
- - Limitations
- Choice of therapy
- - Bisphosphonates
- Oral bisphosphonates
- IV bisphosphonates
- Adverse effects and precautions
- Duration of therapy
- - Parathyroid hormone
- - Combination therapy
- - Denosumab
- - Strontium ranelate
- - Other
- MONITORING THE RESPONSE TO THERAPY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS