Treatment of male osteoporosis

Pharmacological management of osteoporosis in men

Seek specialist advice.

Osteoporosis and fractures related to osteoporosis are less common in men than in women (1)

• has been estimated that up to 50% of osteoporosis in men is due to an underlying cause such as hypogonadism, glucocorticoid use, alcohol excess or other predisposing drugs and diseases
• many of the treatments that have been used in postmenopausal osteoporosis have also been investigated in men with osteoporosis
• for the purposes of this guideline, osteoporosis in men is defined by a T-score of -2.5 SD or less at the lumbar spine, total hip, or femoral neck in men aged 50 and older

Diet

• the advice for men with osteoporosis or at risk of fragility fracture is the same as for postmenopausal women. Men should aim to consume a healthy balanced diet which contains adequate intake of dietary calcium and vitamin D

Bisphosphonates:

• Alendronic acid - In summary, while alendronic acid increases BMD in men to a similar extent as women, evidence that it reduces fracture risk in men with low BMD is either not methodologically robust or conflicting and it is not possible to form a recommendation for its use
• risedronate may be considered for the treatment of osteoporosis in men
• zoledronic acid should be considered for the treatment of osteoporosis in men and the prevention of vertebral fractures

Reference:

• SIGN (June 2020). Management of osteoporosis and the prevention of fragility fractures