Osteoporosis: What about men?

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Applied Evidence

Osteoporosis: What about men?

J Fam Pract. 2015 September;64(9):542-545,549-552

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References

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2. Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513-521.

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4. Ebeling PR. Clinical practice. Osteoporosis in men. N Engl J Med. 2008;358:1474-1482.

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6. Memon A, Pospula WM, Tantawy AY, et al. Incidence of hip fracture in Kuwait. Int J Epidemiol. 1998;27:860-865.

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10. National Institutes of Health. NIH osteoporosis and related bone diseases national resource center. Osteoporosis in men. January 2012. National Institutes of Health Web site. Available at: http://www.niams.nih.gov/health_info/bone/osteoporosis/men.asp. Accessed April 22, 2015.

11. Bruder JM, Ma JZ, Basler JW, et al. Prevalence of osteopenia and osteoporosis by central and peripheral bone mineral density in men with prostate cancer during androgen-deprivation therapy. Urology. 2006;67:152-155.

12. Tracz MJ, Sideras K, Boloña ER, et al. Testosterone use in men and its effects on bone health. A systematic review and meta-analysis of randomized placebo-controlled trials. J Clin Endocrinol Metab. 2006;91:2011-2016.

13. World Health Organization. WHO scientific group on the assessment of osteoporosis at primary health care level. Summary meeting report. Geneva, Switzerland: World Health Organization. 2007. Available at: http://who.int/chp/topics/Osteoporosis.pdf. Accessed April 22, 2015.

14. The International Society for Clinical Densitometry. 2007 official positions & pediatric official positions of The International Society for Clinical Densitometry. The International Society for Clinical Densitometry Web site. Available at: http://www.iscd.org/wp-content/uploads/2012/10/ISCD2007OfficialPositions-Combined-AdultandPediatric.pdf. Accessed August 11, 2015.

15. U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med. 2011;154:356-364.

16. Qaseem A, Snow V, Shekelle P, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;148:680-684.

17. National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation Web site. Washington, DC: 2014. Available at: http://nof.org/files/nof/public/content/file/2791/upload/919.pdf. Accessed April 22, 2015.

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25. Ringe JD, Dorst A, Faber H, et al. Alendronate treatment of established primary osteoporosis in men: 3-year results of a prospective, comparative, two-arm study. Rheumatol Int. 2004;24:110-113.

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27. Boonen S, Orwoll ES, Wenderoth D, et al. Once-weekly risedronate in men with osteoporosis: results of a 2-year, placebocontrolled, double-blind, multicenter study. J Bone Miner Res. 2009;24:719-725.

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31. Orwoll ES, Scheele WH, Paul S, et al. The effect of teriparatide [human parathyroid hormone (1-34)] therapy on bone density in men with osteoporosis. J Bone Miner Res. 2003;18:9-17.

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36. Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Institute of Medicine Web site. Available at: http://www.iom.edu/reports/2010/dietary-reference-intakes-for-calcium-and-vitamin-d.aspx. Accessed April 10, 2015.

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Supplementation of testosterone to restore correct physiologic levels in men with low testosterone will decrease bone turnover and increase bone density.

Men with vitamin D levels below 30 ng/mL should receive vitamin D supplementation to attain blood 25(OH) D levels of at least 30 ng/mL.⁵ The Institute of Medicine recommends a daily intake of 600 international units (IU) of vitamin D for men ages 51 to 70 and 800 IU for men 70 and older.³⁶ A recent Cochrane review on vitamin D and vitamin D analogues concluded that vitamin D alone was unlikely to prevent fractures in older people; when taken with calcium, however, it may have a preventive effect.³⁷

Counseling and follow-up

Lifestyle modification is an important means of primary prevention for osteoporosis. Advise men at risk for osteoporosis to limit alcohol consumption to 2 drinks daily.^4,5,8,10 Tell those who smoke that doing so increases their risk for osteoporotic fracture and refer them for smoking cessation counseling. Emphasize that weight-bearing exercise can improve BMD and should be done at least 3 days per week.^4,5,8,10 It is important, too, to do a medication review to look for drug-drug interactions and to discuss fall prevention strategies, such as gait training and an environmental assessment and removal of fall hazards.

A Cochrane review concluded that vitamin D alone was unlikely to prevent fractures in older people; when taken with calcium, however, it may have a preventive effect.

The evidence for monitoring treatment using BMD is not very strong.^5,14 However, the Endocrine Society recommends that response to treatment be monitored using DEXA scans every one to 2 years, with reduced frequency once the BMD has stabilized.⁵ Any patient found to have a decrease in BMD after treatment is initiated should undergo further evaluation to determine the cause of the decline.

CORRESPONDENCE
Bryan Farford, DO, Mayo Clinic Division of Regional Medicine, 742 Marsh Landing Parkway, Jacksonville Beach, FL 32250; farford.bryan@mayo.edu