Men's Osteoporosis Support Group

Does osteoporosis treatment prevent fractures in men?

J Osteoporos. 2011;2011:259818. Epub 2011 Jun 24. The evidence for efficacy of osteoporosis treatment in men with primary osteoporosis: a systematic review and meta-analysis of antiresorptive and anabolic treatment in men. Schwarz P and others. PMID: 21776371. This is a review and meta-analysis of the literature regarding men being treated for osteoporosis and if that treatment reduces fracture risk. The authors indicate there is a 13% lifetime fracture risk for men due to osteoporosis. And obviously the goal of treatment is to prevent those fractures. Men were aged 50 or older to be included in the review.

There were five studies that used antiresorptive therapy such as one of the bisphosphonates (Fosamax or Actonel, or instance). “All studies showed an increase in BMD [bone mineral density], but there was only a nonsignificant trend in the reduction of clinical fractures.” There were three studies using anabolic therapy (teriparatide, Forteo). “These showed a significant mean increase in spine BMD and for vertebral fractures a non-significant trend towards a reduction was seen.”

The authors concluded there is minimal and inconclusive evidence for fracture reduction in men. Rather evidence is more related to increased BMD from using FDA-approved therapies that coincides with the fracture reduction found in women with equal improvement in BMD from osteoporosis medications.

Editor's comments. Fracture reduction presumably comes from increased BMD and reduced falls, or a combination of them. There is no reason to expect there to be a difference due to gender. So women and men with normal BMD would not be expected to fracture from minor falls. And men or women with low BMD would be expected to fracture even due to low-trauma falls. Until some research shows that men fracture at different BMD levels or differently from falls that lead to the same trauma, we should be able to relate the results from women's studies to men.

So, for men or women, your goals should be to increase BMD to the normal level by taking FDA-approved osteoporosis medications. And you want to be in the range of 1 SD from the normal bone density level. Additionally you should use every effort to prevent falls. This could be either through exercise to improve balance, not taking medications that lead to loss of balance, and keeping your surroundings free from rugs, or other items that could make you fall. And remember, the most common location in the home where people fall is the bathroom. Be extra cautious there.

I prefer controlled clinical trials to anecdotal evidence, but I will cite my own case regarding the effectiveness of bisphosphonate therapy to prevent fractures as anecdotal evidence anyway. I was originally diagnosed with osteoporosis in 1994 and started Fosamax in 1996. I eventually reached the normal 1 SD level of BMD. About six or seven years ago I fell from a step ladder onto my concrete patio, falling directly on my back, without fracturing anything. This in spite of the fact that I had thoracic spinal fractures when first diagnosed which had occurred spontaneously. Additionally, about two years ago, I fell very hard on the pavement when jogging up a hill. Again I suffered no spinal or other fractures.

There is no doubt in my mind that, had I not increased my BMD with the Fosamax, or some other approved medication, either or both of those falls would have lead to one or more spinal or other fractures. They were serious, major falls onto very hard surfaces with nothing to break my fall in either case.

Bottom line: Do all you can to increase your BMD to within the normal range if you have been diagnosed with osteoporosis. And, take all precautions to prevent yourself from falling.

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