Osteoporosis, a man's issue

Prepared Foods, Jan, 2003 by Carol Lewis

Mone Zaidi, M.D., Ph.D., director of the bone program at the Mount Sinai School of Medicine in New York, says that men should get a BMD test if they have a bone fracture, experience lower back pain, or notice height loss.

"If one falls on an outstretched hand, that shouldn't break the wrist," says Zaidi. "If it does, there's a problem."

In 2001, the FDA approved Fosamax (alendronate) to increase bone mass in men with osteoporosis. Fosamax works by reducing the activity of the cells that cause bone loss. The drug was already approved to prevent and treat postmenopausal osteoporosis in women based on studies that indicated it not only increased BMD, but also reduced fractures related to a loss of bone mass. The study in men was designed only to examine the effect on BMD, not on fracture risk. However, it is believed that ultimate fracture benefits are likely to occur in men who experience increases in BMD with treatment, although the relationship between BMD increases and fracture benefits may differ between the genders.

More recently, a novel approach to treating osteoporosis in postmenopausal women and in men with primary or hypogonadal osteoporosis is being investigated. The active portion of human parathyroid hormone (PTH), which regulates normal calcium and phosphate metabolism in bones, has been administered by daily injections and shown to stimulate new bone formation, leading to increased bone mineral density. Post-menopausal women treated with this agent showed a reduction in the incidence of osteoporotic fractures relative to those treated with calcium and vitamin D alone. Like Fosamax, the trial of parathyroid hormone in men was not designed to test the effect of treatment on the risk of fractures. However, based on the study in women, some beneficial effect on fracture risk reduction is likely.

Until Fosamax was approved for men with osteoporosis, the FDA had approved medications only for the prevention and treatment of osteoporosis in postmenopausal women and steroid-induced osteoporosis in both men and women. Steroids, a class of compounds that includes prednisone and cortisone, are powerful anti-inflammatory substances that are used to treat many diseases, including rheumatoid arthritis and asthma. Steroids can cause bone to be removed faster than it is formed, and loss of bone density can occur, increasing the risk for osteoporosis and related fractures. Fosamax and Actonel (risedronate) are approved for use by men and women with steroid-induced osteoporosis.

Tailored to the particular reason for bone loss, the treatment plan for men with osteoporosis will include proper nutrition, exercise, and lifestyle modifications for preventing bone loss and, if needed, one of the FDA-approved osteoporosis medications. Doctors may want to monitor bone density and testosterone levels, recommending testosterone replacement as necessary, and may suggest changes to the current steroid dosage if they feel bone loss is due to steroid use. Finally, maintenance of adequate calcium and vitamin D intake is very important in the treatment and prevention of osteoporosis.