Clinical practice guidelines for management of osteoporosis in men

The Endocrine Society releases new clinical practice guideline on the management of osteoporosis in men

Osteoporosis in men causes significant morbidity and mortality. Today, the Endocrine Society released clinical practice guidelines (CPG) for management of this condition in men. "Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline," is published in the June 2012 issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of The Endocrine Society.

Osteoporosis is a silent disorder characterized by reduced bone strength predisposing to increased fracture risk. Approximately 20 percent of Americans with osteoporosis or low bone density are men and studies show this condition increases mortality rates in men between the ages of 50 and 69. Risk factors for osteoporosis in men include low body weight, prior fracture as an adult and smoking.

"For men age 50, one in 5 will experience an osteoporosis-related fracture in their lifetime," said Nelson Watts, MD, of Mercy Health Osteoporosis and Bone Health Services in Cincinnati, OH and chair of the task force that authored the CPG. "Mortality after fracture is higher in men than in women. Of the 10 million Americans with osteoporosis, 2 million are men. Of the 2 million fractures due to osteoporosis that occur each year, 600,000 are in men."

Recommendations from the CPG include:

• Men at higher risk for osteoporosis (including men aged 70 years or older and men between the ages of 50 and 69 who have risk factors) should be tested using dual-energy x-ray absorptiometry (DXA);
• Men with low vitamin D levels [<30 ng/ml] should receive vitamin D supplementation to achieve levels of at least 30 ng/ml;
• Pharmacologic treatment should be given to men aged 50 or older who have had spine or hip fractures and men at high risk of fracture based on low bone mineral density and/or clinical risk factors;
• Clinicians should monitor bone mineral density by DXA at the spine and hip every one to two years to assess the response to treatment; and
• Men who are at risk for osteoporosis should consume 1000 - 1200 mg of calcium daily, ideally from dietary sources, with calcium supplements added if dietary calcium is insufficient.