Treatment for Male Osteoporosis

Ego Seeman, MD, PhD

Disclosures

February 25, 2003

Question

What are suitable therapeutic options for a 72-year-old man who has osteoporosis but does not want to take calcium as he is subject to ongoing calcium kidney stones?

Mary Kaufmann, MA

Response

Ego Seeman, MD, PhD
Professor, The University of Melbourne, Melbourne, Victoria, United Kingdom

This is an excellent question. If one evaluates studies of men and osteoporosis according to principles of evidence-based medicine, no study yet published comes close to justifying treatment with a particular pharmaceutical agent. I assume this patient has no other underlying disease or hypogonadism -- that he just has osteoporosis and fractures. The only evidence at this time of any kind supporting treatment of male osteoporosis with a drug comes from a study of alendronate by Orwoll and colleagues[1] who reported that this antiresorptive agent reduced the risk of vertebral fractures in men with osteoporosis. The results did not reach statistical significance with semiquantitative methods, but did with quantitative methods. A reduction in the loss of height occurred in the group of men treated with alendronate as compared with controls. There was no evidence for a reduction in risk of nonvertebral fractures. The study involved only 241 men and was only 2 years in duration, so it was not the highest standard of randomized, controlled clinical trial.

So, does the drug work in men? My opinion -- ie, opinion-based evidence, the lowest form of evidence -- is yes. Another agent that shows promise is parathyroid hormone (PTH). Sudies of PTH have been done in men, but antifracture efficacy data are not published. There are data reporting increases in bone mass and bone mineral density. More data are forthcoming. Other than that we just don't have studies. There are none examining the effects of drugs on hip fractures and other nonvertebral fractures; we have no data regarding the effects of calcium or testosterone on antifracture efficacy. At this time, first-line treatment for men with primary osteoporosis is alendronate.

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