Osteoporosis Significantly Underdiagnosed, Undertreated in Men

Osteoporosis Treatment in Men

Endocrinologist Michael McClung, MD, who is the founding Director of the Oregon Osteoporosis Center in Portland, said diagnosing, managing and treating osteoporosis in men is not significantly different than in women.  

“The markers are the same, with the exception of the fact that markers rise in women right after menopause. In both men and women, after age 65, marker values rise and bone turnover increases with aging, and there are no differences between men and women,” said Dr. McClung in an interview with Endocrinology Advisor. 

Currently, men receive treatment based on their fracture probability, just as clinicians do with women. Evidence-based data on the efficacy of pharmacologic interventions in reducing fracture risk in men are convincing; however, they are far from conclusive, though one recent report suggests that bisphosphonates and teriparatide seem to be as effective in men as in women.⁴

“We don’t necessarily know when it is best to start treating men and if we should be dosing men differently. The studies really have not been done on men yet,” said Dr. Rozental.

There are well recognized gender differences in the pathophysiology of osteoporosis, including the pattern of bone loss. Drugs now approved for treatment of osteoporosis in men include alendronate, risedronate, zoledronic acid, denosumab and teriparatide.   

Denosumab has been well studied in men and is approved for treatment in men with prostate cancer receiving androgen deprivation therapy (ADT). Several novel compounds are in clinical development, including odanacatib (a selective inhibitor of the cysteine protease cathepsin-K) and romosozumab (a monoclonal antibody against sclerostin).⁵

While the data are far from conclusive on the optimal treatment regimens for older men with osteoporosis, clinicians can safely prescribe the same agents that they do for women, according to Dr. McClung

“As far as we can tell, they work the same. We have less information in men, but the assumption is that they will have the same effect in older men as they do in older women,” he said.

There are clear guidelines on which men should be tested and which men should be treated for male osteoporosis, yet it is markedly undertreated for a number of reasons, Dr. McClung noted. 

Overall, the message that osteoporosis is a disease of older men has not permeated the medical community and that is something that has to change, he said.

References:

1. Ebeling P. Osteoporosis in Men: Why Change Needs to Happen. http://www.iofbonehealth.org/data-publications/reports/osteoporosis-men-why-change-needs-happen. Accessed December 2014.
2. Harper CM et al. J Bone Joint Surg. 2014;doi:10.2106/JBJS.M.01497.
3. Korpi Steiner N et al. Clin Biochem. 2014;47(10-11):950-959.
4. Gielen E et al. Best Pract Res Clin Endocrinol Metab. 2011;25(2):321-335.
5. Kaufman JM et al. Best Pract Res Clin Endocrinol Metab. 2014;28(6):871-884.