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Screening, treating osteoporosis different for men vs. women
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ASBMR Annual Meeting
TORONTO — Osteoporosis is a significant public health problem for men, a researcher said here at the American Society of Bone and Mineral Research Annual Meeting.
However, when to screen men for osteoporosis is dependent on age and risk factors, according to Nelson Watts, MD, director of the University of Cincinnati Bone Health and Osteoporosis Center.
“Testing men at increased risk for osteoporosis seems to be sensible,” said Watts, also an endocrinologist and professor of medicine at University of Cincinnati College of Medicine. “Age is an important, independent risk factor and, without conclusive evidence, age 70 seems to be a reasonable time to start testing men who do not have other risk factors.”
Risk factors that would necessitate earlier testing before age 70 years include fracture, medications known to increase fracture risk such as glucocorticoids, low testosterone and low estradiol.
Watts said the gold standard for osteoporosis testing is central DXA, spine and hip imaging.
“Many men have degenerative changes, such that the spine is useless. The forearm is useful in cases where you cannot measure the spine or hip,” he said.
Additionally, it is important to conduct a serum testosterone level when screening men for osteoporosis to check for other endocrine disorders.
Rather than using bone mineral density, Watts said he proposes using T-score and a male reference database to calculate T-score, noting that men who fracture typically have a higher BMD compared with women who fracture.
The WHO fracture risk assessment tool, or FRAX, is a helpful tool to determine treatment for men who have a clinical diagnosis of osteoporosis or a high risk for fracture, Watts said.
When deciding on a treatment regimen, he said men with primary osteoporosis can be safely treated with bisphosphonates such as alendronate (Fosamax, Merck), risedronate (Actonel, Warner Chilcott), teriparatide (Forteo, Eli Lilly) and zolendronate (Aclasta, Reclast, Zomera and Zometa; Novartis).
Testosterone may also play a role in treatment, according to Watts. Injectable — but not transdermal — testosterone has been shown to increase BMD at the spine; however, testosterone trials have not shown a significant effect on BMD at the femoral neck, he said. Several analyses have demonstrated that testosterone produces a significant reduction in bone turnover markers.
“Testosterone appears to be primarily an antiresorptive agent,” Watts said, adding that there appears to be a role for testosterone in treating men with osteoporosis, particularly those who have organic hypogonadism or symptoms of hypogonadism.
Calcium and vitamin D requirements are similar for men and women. In both, smoking and excessive alcohol intake should be avoided, as they are bad for bones, he concluded. - by Louise Gagnon
For more information:
- Watts N. Symposium: Osteoporosis – Why do men get it? Presented at: American Society of Bone and Mineral Research 2010 Annual Meeting; Oct. 15-19, 2010; Toronto.