Osteoporosis: Treatment
If diagnosed early and effective treatments used, bone loss can often be prevented from getting worse. Osteoporosis is similar to some other serious medical conditions, such as high blood pressure in the sense that both may cause long-term damage, without showing any symptoms. Early treatment can prevent serious health issues later on.
Early prevention and treatment of osteoporosis involves making changes to your lifestyle, including recommended calcium supplements (a total calcium intake of 1000–1500 mg per day is commonly recommended in men) and vitamin D (1000 units per day). Men can get enough calcium by eating 3-4 servings of dairy foods such as milk, yogurt and cheese daily. Vitamin D can be taken in tablets or absorbed through sunlight. It is especially important for those living in Northern latitudes to take supplements because most of the year the sun’s rays are not strong enough to cause adequate vitamin D production in the body. It is suggested that vitamin D blood levels should be 30 ng/ml or higher.
Other lifestyle changes include not smoking, limiting alcohol intake and being active; weight-bearing and resistance exercises, such as walking, jogging and lifting weights will help improve muscle tone and muscle strength. Try coordination and balance exercises, in order to reduce the risk of falls.
If a man has had bone fractures or is diagnosed with osteoporosis, there are medications that may stop further bone loss or even improve bone mass, and also prevent further spinal fractures. The most common medication used to treat osteoporosis in men is a bisphosphonate, a non-hormonal drug, which can help increase bone mass and reduce the risk of fractures. A drug known as teriparatide (parathyroid hormone), that helps new bone to grow and increases bone mass, can also be given by daily injections and has been shown to reduce vertebral fractures. In order to maintain the gain of bone mineral density, it is recommended that the usual 18 month course of teriparatide (Forteo) be followed by an oral bisphosphonate such as alendronate (Fosamax) or risedronate (Actonel).
Recent guidelines of the US National Osteoporosis Foundation recommend drug treatment in men 50 or older with a hip or vertebral fracture, men with a T-score below –2.5, and in men with a T-score between –1.0 and –2.5 with either a 10-year hip fracture probability of 3% or more, or a probability of any minimal trauma of 20% or more (based on the FRAX™ algorithm). Earlier guidelines from Osteoporosis Canada were similar, and also included men with a T-score of –1.5 or less who are receiving glucocorticoid therapy for three months or more, or who have clinical hypogonadism. As with women, it is important to stress that these are only guidelines; each patient needs to be considered individually.
Can testosterone therapy be used to reduce the risk of osteoporosis?
Testosterone replacement has been shown to increase spinal bone mineral density and improve the architecture of the bone (on MRI), but has not been shown to reduce fractures. Muscle mass also increases, which may benefit elderly men with muscle wasting.
In a large Osteoporosis Study conducted in Australia on 609 men older than 60 years, researchers found that the risk of bone fracture in older men was more than doubled in men with lower testosterone levels compared with men with higher testosterone levels. In addition to directly affecting bone density, testosterone deficiency may reduce muscle mass, thereby decreasing muscle strength and impairing balance, both of which also may increase the likelihood of falls and fractures.
Such an observational study can’t prove that mild lowering of blood testosterone directly causes bone loss so more research is needed before we know for sure whether testosterone treatment of any, or all, older men with “low testosterone” is helpful.
Questions to ask your healthcare provider:
- Do I have an increased risk of bone fracture if my mother or father has osteoporosis?
- Should I have my bone mineral density (BMD) measured?
- What is my risk of fracturing a bone, especially my hip?
- Can diet (calcium and vitamin D) and exercise prevent or reverse osteoporosis?
- If I need drug treatment, which drug should I be given (e.g. bisphosphonate, raloxifene (Evista), teriparatide (Forteo) (PTH), or strontium ranelate when available, etc)?
- What follow-up should be planned, should the bone mineral density test be repeated, and if so, when?
- Assuming clinical and bone mineral density response is good, how long should the drug be continued?
- If clinical or bone mineral density response is not good, should a change of drug therapy be considered, and if so, when?
