No Bones About It: Osteoporosis Drug Effective For Men, Too
While women generally experience rapid bone loss in the years after menopause, men and women lose bone mass at the same rate by the age of 65 or 70. Men and women of any age are also at increased risk for osteoporosis if they take steroids for extended periods to treat chronic diseases such as asthma and rheumatoid arthritis.
Men can also be at increased risk for osteoporosis if they have low levels of the sex hormone testosterone. Approximately one-third of the men enrolled in this study had low testosterone levels, and they fared equally well on therapy as those with normal levels of the hormone.
While acknowledging that the results were impressive in this group of patients, Kleerekoper says testosterone replacement therapy may still be the better choice for them. He says that half of the male patients with osteoporosis he treats in his practice have low testosterone levels.
"I personally think that if a man is testosterone deficient, he should have testosterone replacement therapy," Kleerekoper says. "This article proves that Fosamax is good for their bones, but there may be other reasons why a man needs testosterone therapy. Testosterone is good for men, just as estrogen is good for women."
Both experts acknowledge that early treatment of osteoporosis in men is complicated because men are not routinely tested for the disease. Still, both Orwoll and Kleerekoper agree that more aggressive testing is needed for men.
"This is very much a disease of risk, like high blood pressure or cholesterol, and you have two ways of detecting it -- either by screening for it or by waiting until you have a complication like a fracture," Kleerekoper says. "Women past menopause are routinely given bone density tests, because their risk for osteoporosis is so high. But men are not given the test routinely because the cost is so high. When bone density measurements become as inexpensive as blood pressure measurements, then perhaps all older men should have them, but we aren't there yet."
As the population ages, the incidence of osteoporosis in men is likely to explode. Currently, one in eight men over the age of 50 will experience an osteoporosis-related fracture in his lifetime. Orwoll predicts that by the year 2030 the incidence of osteoporosis-related hip fractures in men will have doubled.