Osteoporosis affects millions of adults globally, but most research is focused on females due to their increased risk following menopause. A recent study investigates treatment options for men specifically, who also have a high risk of developing osteoporosis and actually have higher mortality rate than women following hip fractures, a common injury in osteoporotic individuals.
Osteoporosis is a degenerative disease that can result in serious injury and loss of quality of life. It is a gradual decrease in bone density and strength, leading to an increased risk of fracture, particularly in large, weight bearing bones such as the femur and the hip. Treatment for osteoporosis is one of the largest health care expenditures and changes in activity level following osteoporotic injury can increase mortality risk.
Women are at greater risk of osteoporosis due to hormonal changes following menopause, but men also have a significant risk of osteoporotic injury and their treatment is under researched. Hip fractures are common in individuals with osteoporosis, and nearly one in three men die within a year after sustaining a hip fracture. The significant mortality risk associated with osteoporosis in men and their lack of representation in research led researchers to conduct a review of treatments.
In this study published in the Journal of American Geriatrics Society, Nayak and Greenspan conducted a systematic review of osteoporosis treatment in men. Studies were examined first based on title and abstract, followed by full text reviews to investigate the efficacy of different treatments. A total of 24 articles reporting results from 22 studies were used to assess various medications. Common study outcomes were vertebral and non-vertebral fractures, with the ultimate goal of evaluating fracture risk.
The findings examined a number of different medications used to treat osteoporosis, which can be grouped into a category called bisphosphonates. Bisphosphonates act by binding to bone and slowing the bone resorption activity of osteoclasts. Different bisphosphonates demonstrated slightly different effects, but in general, bisphosphonates significantly reduced the risk of vertebral and non-vertebral fractures, but not for clinically relevant fractures (symptomatic). The non-vertebral fracture risk reduction was sensitive to one study which had a particularly strong decrease in non-vertebral fracture risk, which makes this conclusion suspect. Further research is needed to confidently determine bisphosphonates’ effects on non-vertebral fracture risk.
The results of the review were limited by differences between studies examined and a quantitative lack of research in the field. This highlights the efficacy of bisphosphonates in reducing risk of fracture, as well as the need for more comprehensive and higher quality research on osteoporosis in men.
Written By: Wesley Tin, BMSc