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 repletion is crucial for all men above the age of 65 years 1. Management options for osteoporosis 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 of men with osteoporosis, with consideration of hormone replacement therapy for those with low levels 1
It is essential to consider the patient's overall risk of fracture, using tools such as FRAX, to guide treatment decisions 1. The latest evidence emphasizes the importance of a comprehensive approach to osteoporosis management, incorporating lifestyle modifications, supplementation, and medication therapy as needed 1. Regular monitoring of bone mineral density and reassessment of fracture risk are crucial to guide treatment decisions and adjust management strategies accordingly 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 does not go away 2.
From the Research
Management Options for Osteoporosis
The goal of osteoporosis management is to prevent fractures, and several pharmacological agents are available to lower fracture risk [(3,4,5,6)].
- Pharmacological Agents:
- Bisphosphonates are the most widely used anti-resorptives, reducing bone turnover markers and fracture rates [(3,4)]
- Denosumab is a monoclonal antibody against RANKL that potently inhibits osteoclast development and activity [(3,4)]
- Anabolic agents such as teriparatide, abaloparatide, and romosozumab stimulate bone formation and are considered for patients at very high risk or with previous vertebral fractures [(3,5,6)]
- Treatment Approach:
- A goal-directed approach to long-term management of fracture risk helps ensure that the most appropriate initial treatment and treatment sequence is selected for individual patients 6
- Treatment targets should be tailored to each patient's individual risk profile and based on the specific indication for beginning treatment 6
- Initial treatment selection should focus on reducing fracture risk rapidly for patients at very high and imminent risk 6
- Safety Considerations: