Andropause in older men and 5-year risedronate safety
Risks of testosterone replacement therapy in ageing men. Hypogonadal men with osteoporosis are generally treated with testosterone therapy with or without another approved medication, such as one of the bisphosphonates. This therapy has been shown to be both effective and safe. There has been some concern that such therapy for "male menopause," andropause, may not be warranted or safe. A recent paper indicates that these safety concerns are probably of little or no concern and that older men who undergo andropause should receive supplemental testosterone to relieve symptoms and improve quality of life. See: Expert Opin Drug Safe. 2004 Nov;3(6):599-606, Tan RRS and Salazar JA. PMID: 15500418. The authors note there is a greater degree of depression, coronary heart disease, osteoporosis, fracture rates, frailty and dementia that accompanies low testosterone states in older males. One of the main concerns is prostate cancer in men taking testosterone. The authors note: "Current evidence suggest no causal relationship between prostate cancer and physiological dosing of testosterone, especially with careful selection and monitoring of patients." In summary, before starting older men on testosterone therapy they should have a full prostate cancer screen with digital rectal exam, PSA and other tests as warranted. Then they should be followed closely, especially for the first year. Testosterone doesn't cause prostate cancer, but it does exacerbate the condition if cancer is present when testosterone therapy is started. Thus, frequent testing during the early stages of treatment will uncover any latent prostate cancer that wasn't detected before treatment began or assure the patient and physician that there was no latent cancer. The authors note that the one common side effect of testosterone supplementation is an increase in red blood cells, erythrocytosis. They state that thromboembolic events have rarely been noted due to this condition, so it doesn't appear to be a major problem. Editor's comments: It is good to see that positive papers are appearing to give older men confidence in asking for testosterone therapy. We only go this way once, might as well enjoy it. If testosterone can give all the benefits from preventing or treating the complications outlined above with almost no side effects, it is something that older men should definitely consider and discuss with their care providers. There are many methods of treatment available today, including patches, gels and injections.
Bone safety after five years of treatment with risedronate (Actonel). This study looked at various histological factors of bone safety and quality on a group of postmenopausal women who had taken 5 mg risedronate during a three-year study which was followed by a two-year extension. See: Calcif Tissue Int. 2004. Oct 14 [Epub ahead of print], Ste-Marie LG, and others. PMID: 15478000. Included were such studies as paired transiliac bone biopsies with histomorphic analysis comparing the risedronate group to the placebo group. No pathological findings were noted. Additionally bone turnover markers and bone density were measure, also with positive results for the risedronate group compared to the placebo group. There were two fractures in the treatment group compared to seven placebo group fractures. The authors conclude, "The findings from this study are consistent with the antiremodeling effect of risedronate and support long-term bone safety and antifracture efficacy of risedronate treatment." Editor's comments: This is another reassuring study showing positive benefits of long-term risedronate therapy, particularly that biopsy specimens were normal after five years.