From the Guidelines
Osteoporosis management in men should prioritize vitamin D and calcium repletion, with oral bisphosphonates as first-line treatment for those at high risk of fracture. The most recent evidence from 2024 suggests that ensuring vitamin D and calcium levels is crucial for men above 65 years 1. Management options include:
- Oral bisphosphonates (alendronate or risedronate) as first-line treatments for men at a high risk of fracture 1
- Denosumab or zoledronate as second-line treatments for men at a high risk of fracture 1
- A sequential therapy starting with a bone-forming agent followed by an anti-resorptive agent for men at a very high risk of fracture 1
- Physical exercise and a balanced diet recommended to all men with osteoporosis 1
- Assessment of serum total testosterone as part of the pre-treatment assessment 1
- Consideration of appropriate hormone replacement therapy in men with low levels of total or free serum testosterone 1
It is essential to consider the entire clinical context, including fracture risk assessment using tools like FRAX, when making treatment decisions 1. The latest guidelines emphasize the importance of a comprehensive approach, combining lifestyle modifications and medication therapy to manage osteoporosis effectively 1.
From the FDA Drug Label
Prolia is a prescription medicine used to: Treat osteoporosis (thinning and weakening of bone) in women after menopause ("change of life") who: are at high risk for fracture (broken bone) cannot use another osteoporosis medicine or other osteoporosis medicines did not work well Increase bone mass in men with osteoporosis who are at high risk for fracture Treat osteoporosis in men and women who will be taking corticosteroid medicines (such as prednisone) for at least 6 months and are at high risk for fracture.
The management options for Osteoporosis include:
- Prolia (denosumab), a prescription medicine used to treat osteoporosis in women after menopause who are at high risk for fracture, increase bone mass in men with osteoporosis, and treat osteoporosis in men and women taking corticosteroid medicines.
- Calcium and vitamin D supplementation, as patients should take these as their doctor tells them to while receiving Prolia.
- Dental care, as patients should take good care of their teeth and gums while receiving Prolia and tell their dentist that they are receiving Prolia before having dental work.
- Monitoring for side effects, as Prolia may cause serious side effects, and patients should tell their doctor if they have any side effect that bothers them or that does not go away 2.
From the Research
Management Options for Osteoporosis
The management of osteoporosis involves a combination of lifestyle modifications, pharmacologic agents, and other interventions. Some of the key management options include:
- Lifestyle modifications:
- Pharmacologic agents:
- Other interventions:
Goal-Directed Treatment
A goal-directed approach to osteoporosis management involves assessing clinical fracture history, vertebral fracture identification, measurement of bone mineral density, and consideration of other major clinical risk factors 6. Treatment targets should be tailored to each patient's individual risk profile and based on the specific indication for beginning treatment.
Monitoring and Duration of Treatment
The monitoring and duration of treatment for osteoporosis vary depending on the patient's response to treatment and the presence of any adverse effects. The proposed intervals of repeat bone mineral density testing after initiation of drug therapy range from 1-5 years 3. Bone turnover markers may be used to monitor treatment in bone specialist centers 3.