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MEN’S
HEALTH

• Markers of bone formation and resorption – only confirm
accelerated bone loss may be useful in monitoring response
to therapy

Treatment
Includes life style measures and drug / hormone therapy
Lifestyle measures
• Weight–bearing exercises
• Limit /Avoid smoking and excess alcohol use
• Adequate Calcium intake: 1000 to 1200mg /day and Vitamin
D 600–800 IU /day
Treatment of secondary causes and avoiding offending agents

where possible: glucocorticoids, smoking and alcohol

Candidates for pharmacotherapy:
• Men with osteoporosis ( T–score ≤ –2.5 or fragility fracture )

without symptomatic hypogonadism or when testosterone ther-

apy contraindicated

• High risk men with low bone mass T–score –1.0 to –2.5 based

on Fracture Risk Assessment Tool (FRAX) with a 10–year prob-

ability of hip fracture or combined major osteoporotic fracture
of ≥3.0 or ≥205 respectively. www.shef.ac.uk/FRAX/

Choice of therapy

BISPHOSPHONATES

• Oral weekly alendronate or risedronate are initial therapy of

choice based on efficacy cost and longterm safety data and an-

nual IV Zolendronic acid for those intolerant or with con-

traindication to oral therapy.

• Effective in reducing risk of vertebral fractures

• Administration first thing in the morning, fasting improves

Evaluation bioavailability. Calcium and Vitamin D that can interfere
• Hypogonadism, Glucocorticoid excess may be apparent in the
initial history and physical examination. with absorption should be delayed at least one hour.
• Routine biochemical evaluation should include
• Hepatic and renal function • Should be taken alone on an empty stomach first thing in
• Complete blood count
• Serum testosterone the morning with at least eight ounces of water
• Calcium/albumin
• Phosphorus and Alkaline phosphatase • Should remain upright and not eat any food or drink for at
• 25 OH Vitamin D
• 24hr urine calcium and creatinine least 30 min to an hour
• Additional testing guided by abnormal results or unexplained
bone loss • Enteric coated delayed risedronate is taken immediately after
• Parathyroid hormone
• Estradiol breakfast with four ounces of water
• Tissue transglutaminase antibodies, especially if Vitamin D
or Urinary calcium levels are low) Side effects and precautions
• Serum and urine electrophoresis prompted by anemia or
vertebral fractures • Reflux, esophagitis and ulcer if improperly administered
• 24hr urine free cortisol
• Serum Tryptase to rule out Mastocytosis • Should not be given to patients with active Upper GI disease

• Should be stopped if patients develop symptoms of

esophagitis

• Esophageal cancer – conflicting data

• Follow up of 46,000 bisphosphonate uses in a case co-

hort study did not find an increased risk of esophageal

or gastric cancer

• Nested Case control analysis of 15,000 adults with GI

cancer, found an increased risk esophageal cancer with

bisphosphonate use at 1.3 relative risk.

• FDA recommendation to not use in patients with Bar-

rett’s esophagus

continued on page 24

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