What is the condition of osteoporosis that is seen primarily in men?

From the Guidelines

Osteoporosis that is seen primarily in men refers to idiopathic osteoporosis, which is a condition characterized by loss of bone mass and impaired bone microarchitecture, leading to a substantially increased risk of fracture, and should be managed according to the latest evidence-based guidelines, such as those outlined in the 2024 study published in Nature Reviews Rheumatology 1.

Key Points

• Idiopathic osteoporosis in men is a highly prevalent condition that is often neglected, leading to underdiagnosis and undertreatment 1.
• The condition is associated with substantial morbidity and excessive mortality compared to women with osteoporosis, with men being at a higher risk of death following a fracture than women 1.
• The management of osteoporosis in men should be guided by evidence-based guidelines, which recommend treatment for men at high risk of fracture, including those with a history of fragility fracture or low bone mineral density (BMD) 1.

Treatment Approach

• Bisphosphonates are widely advocated as a treatment option for men with osteoporosis, with teriparatide recommended for men with multiple vertebral fractures and denosumab for men with prostate cancer 1.
• Treatment should be individualized based on the patient's risk factors, medical history, and BMD, and should include calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily) 1.
• Weight-bearing exercise is also essential for maintaining bone health and preventing fractures in men with osteoporosis.

Monitoring and Follow-up

• Regular monitoring of BMD, testosterone levels, prostate-specific antigen, and hematocrit is necessary during treatment to assess the effectiveness of therapy and potential side effects 1.
• Patients should be aware that improvement in bone density may take 6-12 months to become evident, and treatment is typically long-term to maintain bone health.

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%.

The condition of osteoporosis seen primarily in men is Idiopathic Osteoporosis or Primary Osteoporosis, but the provided text does not explicitly state this. However, it does mention Osteoporosis in Men, which can be caused by various factors, including idiopathic or primary osteoporosis.

• The text does not provide a specific name for the condition of osteoporosis seen primarily in men.
• The provided information only discusses the treatment of osteoporosis in men with alendronate sodium. 2

From the Research

Osteoporosis in Men

The condition of osteoporosis seen primarily in men is characterized by a bone mineral density (BMD) that is 2·5 standard deviations or more below the mean for the young adult population, measured at the hip or lumbar spine 3.

Key Features

• Men with osteoporosis account for approximately one fifth of all patients with osteoporosis, and their morbidity and mortality rates from this disease are higher than in other patients 4.
• Secondary osteoporosis is more common in men than in women 3.
• Lifestyle changes, adequate calcium, vitamin D intake, and exercise programmes are recommended for the management of osteoporosis in men 3.
• Bisphosphonates, denosumab, and teriparatide have been shown to increase BMD and are used for pharmacological treatment 3.

Diagnosis and Treatment

• The diagnosis of osteoporosis in men is similar to that in women, based on a BMD T-score of -2·5 or lower 3, 5.
• Treatment of osteoporosis in men is influenced by the patient's fracture risk, the effectiveness of fracture risk reduction, and medication safety 5.
• Antiresorptive therapy, including bisphosphonates and denosumab, and anabolic agents such as teriparatide, abaloparatide, and romosozumab, are considered for patients at high risk of fracture 5, 6.

Prevention

• Lifestyle measures for fragility fracture prevention include good nutrition, adequate protein and calcium intakes, vitamin D sufficiency, and regular weight bearing physical exercise 7.
• A balanced diet including minerals, protein, fruits and vegetables is an important element in the prevention of osteoporosis and of fragility fracture 7.