From the Guidelines
Elderly men with osteoporosis should be treated with oral bisphosphonates, such as alendronate or risedronate, as first-line therapy to reduce the risk of fractures, as recommended by the most recent evidence-based guideline for the management of osteoporosis in men 1.
Treatment Options
The treatment of osteoporosis in elderly men involves a combination of medication, lifestyle changes, and supplementation. The primary goal is to reduce the risk of fractures, which can significantly impact morbidity, mortality, and quality of life.
- Medications:
- Oral bisphosphonates, such as alendronate or risedronate, are recommended as first-line treatments for men at high risk of fracture 1.
- Denosumab or zoledronate are considered second-line treatments for men at high risk of fracture 1.
- Abaloparatide may be considered as a first-line treatment for men with osteoporosis at very high risk of osteoporotic fracture, although this recommendation is based on weaker evidence 1.
- Lifestyle modifications:
- Regular physical exercise, such as weight-bearing exercises, is recommended to all men with osteoporosis 1.
- A balanced diet and healthy lifestyle habits, including quitting smoking and limiting alcohol intake, are also essential.
- Supplementation:
- Vitamin D and calcium repletion should be ensured in all men above the age of 65 years, with a strong recommendation for calcium and vitamin D supplementation 1.
- Elderly men should aim for 1,200 mg of calcium daily and 800-1,000 IU of vitamin D3 daily.
Individualized Treatment
Treatment should be individualized based on the severity of osteoporosis, overall health status, and potential drug interactions. Regular follow-up with bone density scans every 1-2 years is recommended to monitor treatment effectiveness. Biochemical markers of bone turnover may be used to assess adherence to anti-resorptive therapy in men, although this is a weak recommendation 1.
Hormone Replacement Therapy
Serum total testosterone should be assessed as part of the pre-treatment assessment of men with osteoporosis, and appropriate hormone replacement therapy should be considered in men with low levels of total or free serum testosterone, although these recommendations are based on weaker evidence 1.
The most recent and highest quality study, published in 2024, provides a comprehensive guideline for the management of osteoporosis in men, emphasizing the importance of individualized treatment and regular follow-up to monitor treatment effectiveness 1.
From the FDA Drug Label
Osteoporosis in Men Treatment of men with osteoporosis with alendronate sodium 10 mg/day for two years reduced urinary excretion of cross-linked N-telopeptides of type I collagen by approximately 60% and bone-specific alkaline phosphatase by approximately 40%. Similar reductions were observed in a one-year study in men with osteoporosis receiving once weekly alendronate sodium 70 mg
The treatment options for osteoporosis in elderly males (older adults) include alendronate sodium 10 mg/day or once weekly alendronate sodium 70 mg.
- Key benefits: Reduced urinary excretion of cross-linked N-telopeptides of type I collagen by approximately 60% and bone-specific alkaline phosphatase by approximately 40% 2.
- Treatment duration: Up to two years for alendronate sodium 10 mg/day and one year for once weekly alendronate sodium 70 mg.
From the Research
Treatment Options for Osteoporosis in Elderly Males
- The treatment program for osteoporosis in elderly males should include awareness of diet and vitamin D status, fall risk reduction, and pharmaceutical therapy 3.
- Medications that are fracture-reducing in older women should also achieve fewer fractures in older men, although there is a paucity of studies in men with the primary outcome of fracture risk reduction 3.
- Most older men with osteoporosis should be treated with oral or intravenous bisphosphonates, denosumab especially when on androgen deprivation therapy, and initial anabolic treatment should be considered for men at very high risk of fracture 3.
- Bisphosphonates, especially alendronate and risedronate, are effective in improving BMD and seem to be the treatments of choice in aged men with osteoporosis 4.
- In cases where bisphosphonates are contra-indicated or ineffective, teriparatide or alternatives such as strontium should be considered 4.
- Some osteoporosis treatments have received approval to treat or prevent osteoporosis specifically in men, including alendronate 5, 6.
- The pharmacologic options for osteoporosis treatment in the elderly include bisphosphonates, calcitonin, and parathyroid hormone (PTH) 6, 7.
- Bisphosphonates and strontium ranelate are good choices for first- or second-line treatment, while parathyroid hormone should only be used for the second-line treatment of osteoporosis in the elderly 7.
Non-Pharmacological Interventions
- Improved household safety can reduce the risk of falls 6.
- Hip protectors have been found to be effective in nursing home populations 6.
- Exercise and calcium and vitamin D supplementation form an important adjunct to pharmacologic management of osteoporosis 6.
- Awareness of diet and vitamin D status, and fall risk reduction are also important components of osteoporosis treatment in elderly males 3.