Back to Journals » Clinical Interventions in Aging » Volume 10

Treatment of primary osteoporosis in men

Authors Giusti A, Bianchi G

Received 12 June 2014

Accepted for publication 18 September 2014

Published 30 December 2014 Volume 2015:10 Pages 105—115

DOI https://doi.org/10.2147/CIA.S44057

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Richard Walker

Andrea Giusti,1 Gerolamo Bianchi2

1Bone Clinic, Department of Gerontology and Musculoskeletal Sciences, Galliera Hospital, 2Department of Rheumatology, La Colletta Hospital, ASL3, Arenzano, Genoa, Italy

Abstract: With the aging of the population worldwide, osteoporosis and osteoporotic fractures are becoming a serious health care issue in the Western world. Although less frequent than in women, osteoporosis in men is a relatively common problem. Hip and vertebral fractures are particularly relevant, being associated with significant mortality and disability. Since bone loss and fragility fractures in men have been recognized as serious medical conditions, several randomized controlled trials (RCTs) have been undertaken in males with osteoporosis to investigate the anti-fracture efficacy of the pharmacological agents commonly used to treat postmenopausal osteoporosis. Overall, treatments for osteoporosis in men are less defined than in women, mainly due to the fact that there are fewer RCTs performed in male populations, to the relatively smaller sample sizes, and to the lack of long-term extension studies. However, the key question is whether men are expected to respond differently to osteoporosis therapies than women. The pharmacological properties of bisphosphonates, teriparatide, denosumab, and strontium ranelate make such differentiation unlikely, and available clinical data support their efficacy in men with primary osteoporosis as well as in women. In a series of well-designed RCTs, alendronate, risedronate, zoledronic acid, and teriparatide were demonstrated to reduce the risk of new vertebral fractures in men presenting with primary osteoporosis (including osteoporosis associated with low testosterone levels) and to improve the bone mineral density (BMD). In preliminary studies, ibandronate, denosumab, and strontium ranelate also showed their beneficial effects on surrogate outcomes (BMD and markers of bone turnover) in men with osteoporosis. Although direct evidence about their non-vertebral anti-fracture efficacy are lacking, the effects of bisphosphonates, denosumab, teriparatide, and strontium ranelate on surrogate outcomes (BMD and markers of bone turnover) were similar to those reported in pivotal RCTs undertaken in postmenopausal women, in which vertebral and non-vertebral anti-fracture efficacy have been clearly demonstrated. In conclusion, sufficient data exist to support the use of these pharmacological agents in men with primary osteoporosis. Further RCTs are warranted to establish their long-term efficacy and safety.

Keywords: bisphosphonates, teriparatide, denosumab, strontium ranelate

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