Guidance on the management of osteoporosis in men has been published by an international group in a bid to standardise clinical practice and improve outcomes for this often underserved patient population.
“Since the operational definition of osteoporosis was established in the 1990s there has been relative uncertainty regarding the disease in men, which has led to under-diagnosis of the condition and consequent under-treatment of this population,” the authors noted, in a paper published in Nature (link here).
“This under-diagnosis persists, despite a backdrop of a considerable and increasing global burden of osteoporosis in men, which is associated with not only substantial morbidity but also excessive mortality compared with women with osteoporosis”.
To address gaps in care an international multidisciplinary working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) reviewed latest clinical evidence and expert opinion to develop a new set of evidence-based recommendations for clinicians to follow.
In the first instance, the group strongly recommended that a female reference database is used for densitometric diagnosis of osteoporosis in men.
There was also strong backing for FRAX as the appropriate tool for assessing fracture risk and setting intervention thresholds for men, which should be age dependent, they said.
On the treatment side, oral bisphosphonates (alendronate or risedronate) should be first-line treatment options for men at high risk of fracture, followed by denosumab or zoledronate in the second-line setting.
In men at very high risk of fracture clinicians should consider sequential therapy, starting with a bone-forming agent followed by an anti-resorptive agent (with abaloparatide supported by the strongest evidence regarding BMD changes), according to the paper.
Vitamin D and calcium repletion was strongly recommended for all men above the 65 years of age.
The authors also noted that the recommendations “should be taken as a whole, and not in isolation”, and that treatment should also be “strongly considered in those who have sustained a fracture”.
Commenting on the guidelines, Dr Philippe Halbout, Chief Executive of the International Osteoporosis Foundation (IOF), said that “osteoporosis in men poses an enormous global burden, and must be urgently addressed by healthcare providers as well as health authorities,” and that the IOF welcomed publication of the new guideline “which we hope will contribute to better patient care and to reducing the devastating consequences of osteoporosis in older men around the world.”
While it is hoped that the new guidelines will have an impact on outcomes its authors also highlighted the need for more research to further drive progress, particularly with regard to the efficacy of anti-osteoporosis medications.
“Osteoporosis in men is an area of relative neglect, and further research, investment and focus is required to address some fundamental areas of the disease in this patient group”, they stressed.