What bone health regimen is recommended for men over 70?

Bone Health Regimen for Men Over 70

Men over 70 should receive 1200 mg of calcium daily (preferably from diet), 800-1000 IU of vitamin D3 daily, and undergo fracture risk assessment with consideration for bisphosphonate therapy if at high risk. 1

Core Recommendations

Calcium and Vitamin D

• Calcium intake: 1200 mg daily for men over 70 1

  • Dietary sources preferred (dairy products, fish with bones, some vegetables)
  • Supplement only if dietary intake is inadequate
  • Upper intake limit: 2000 mg daily 1

• Vitamin D: 800-1000 IU daily 1

  • Target serum 25-hydroxyvitamin D level ≥20 ng/ml
  • Supplementation reduces non-vertebral fractures by 15-20% 1

Fracture Risk Assessment

• Perform FRAX assessment (https://www.shef.ac.uk/FRAX/tool.jsp) 1
• Consider baseline DEXA scan for men at increased risk 1
• Additional pharmacological treatment indicated when:
  • 10-year probability of hip fracture is ≥3% or
  • 10-year probability of major osteoporotic fracture is ≥20% 1

Pharmacological Treatment Options

When fracture risk warrants drug therapy, options include (in order of preference):

1. Oral bisphosphonates (first choice) 1

   • Alendronate 70 mg once weekly or 10 mg daily 2
   • Take with plain water 30 minutes before first food/beverage
   • Remain upright for 30 minutes after taking

2. IV bisphosphonates (if oral not tolerated) 1

   • Zoledronic acid 5 mg IV annually

3. Denosumab (alternative option) 1

   • 60 mg subcutaneously every 6 months

Lifestyle Modifications

• Regular weight-bearing and resistance training exercise
• Smoking cessation
• Limit alcohol intake to 1-2 alcoholic beverages/day
• Maintain weight in recommended range 1

Monitoring

• For those on pharmacological therapy, follow-up DEXA scan after 1 year 1
• Monitor serum vitamin D levels at the same time as DEXA scans 1
• Monitor for medication adherence and side effects

Special Considerations

• Men on androgen deprivation therapy (ADT) for prostate cancer have significantly increased fracture risk and should be considered at higher risk 1
• Men on glucocorticoid therapy should receive more aggressive bone health management 1
• Calcium supplementation alone has not demonstrated fracture reduction and may be associated with gastrointestinal side effects and potential cardiovascular risks 1, 3, 4

Common Pitfalls to Avoid

1. Inadequate calcium intake in elderly men (common in Europe, with intake often between 350-700 mg/day) 5
2. Unrecognized vitamin D insufficiency (prevalent in elderly populations) 5
3. Failing to assess fracture risk in men (often overlooked compared to women)
4. High-dose vitamin D administration (>4000 IU/day) which may increase falls and fracture risk 4
5. Overreliance on supplements when dietary sources of calcium are preferable 1

Following this evidence-based regimen can significantly reduce fracture risk and improve bone health outcomes in men over 70 years of age.