The International Osteoporosis Foundation announced that the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO) has introduced new evidence-based guidelines on the diagnosis, monitoring, and treatment of osteoporosis in male patients. About 20% of men older than age 50 years are expected to experience an osteoporotic fracture in their lifetime, and the incidence of hip fractures in this population is predicted to increase by 310% from 1990 to 2050. However, men may be underdiagnosed and undertreated for osteoporosis compared with women. An international, multidisciplinary working group of ESCEO examined the most recent advancements in the management of osteoporosis—including diagnostic and screening approaches, fracture risk assessment, and treatment thresholds—and developed new evidence-based guidelines. Among the recommendations were:
- Physicians should utilize the trabecular bone score, bone mineral density, and the FRAX diagnostic tool to assess fracture risk and set age-dependent intervention thresholds in male patients with osteoporosis
- An antiosteoporosis treatment regimen should be considered in all male patients with previous fragility fractures and should be adapted to their baseline fracture risk
- Male patients at high risk of fracture should receive oral bisphosphonates such as alendronate or risedronate as first-line treatment, and denosumab or zoledronate as second-line treatment. Those at very high risk of fracture should receive a sequential therapy involving a bone-forming agent and subsequent antiresorptive agent
- Physicians can use biochemical markers of bone turnover to evaluate adherence to antiresorptive agents
- Pretreatment serum total testosterone should be measured, and male patients with low levels of total or free testosterone should receive appropriate hormone replacement therapy
- All male patients with osteoporosis should partake in physical exercise and diet regimens, and all those aged 65 years and older should receive vitamin D and calcium repletion.
“We hope that these guidelines will assist clinicians in their clinical practice and encourage them to be proactive in managing osteoporosis in their male patients,” emphasized senior guideline author Nicholas Harvey, MB, BChir, MRCP, PHD, CCT, FRCP, Chairman of the International Osteoporosis Foundation Committee of Scientific Advisors.