Treating Osteoporosis in Men

Treating osteoporosis is often done through a combination of lifestyle changes, including diet and exercise, and medication. Men with osteoporosis, however, may consider discussing with their doctor additional options available to them, including testosterone replacement therapy.

Testosterone Replacement Therapy and Bone Density

Testosterone replacement therapy, or TRT, is hormone replacement therapy for men with low testosterone. It may be administered orally, as an injection, transdermally through a gel or patch, as a sublingual serum, or via an implant device. TRT is used to treat a wide range of conditions caused or affected by low testosterone, including low bone mass, sexual dysfunctions, and metabolic dysfunctions.

In some studies, osteoporotic men undergoing TRT have been shown to have increased bone density, ¹ Amory JK, Watts NB, Easley KA, et al. Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone. J Clin Endocrinol Metab. 2004;89(2):503-10. though BMD does not reach normal adult male levels. ² Saggese G, Bertelloni S, Baroncelli GI. Sex steroids and the acquisition of bone mass. Horm Res. 1997;48 Suppl 5:65-71. Despite these and other positive results, there are a lack of long-term, large-scale studies on the effectiveness of TRT on osteoporosis and other conditions. ³ Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag. 2009;5(3):427-48.

Men who elect to undergo TRT may be monitored by their doctors for symptom improvement and have treatment discontinued if no improvement is found, due to the still unknown effects of long-term TRT.

Lifestyle Changes for Osteoporosis Symptom Maintenance

Treating osteoporosis involves many of the same steps as preventing osteoporosis, including:

Diet and nutrition

Patients can strive for proper calcium and vitamin D intake, as well as avoidance of foods with excessive sodium, caffeine, or protein, which may reduce calcium absorption.

Nicotine use and alcohol abuse

Reducing the use of nicotine and limiting the number of alcohol drinks to a more moderate level is an important step for preserving bone health.

Exercise

Weight bearing exercise will increase bone strength and promote good balance, helping to avoid falls.

Regular exams

Regularly scheduled doctor appointments allow for monitoring the condition and treatment progress.

Osteoporosis prevention would best begin in the first 30 years of a man’s life, when bones are in the process of growing and strengthening. Addressing risk factors within one’s control at an early age can prevent osteoporosis and loss of bone density. Once osteoporosis has developed, following these steps will still help prevent symptoms from worsening.

Other Medications for Men with Osteoporosis

The FDA has approved the following medicines specifically to treat men with osteoporosis:

• Alendronate (Fosamax)
• Risedronate (Actonel)
• Zoledronic acid (Reclast IV)
• Teriparatide (Forteo SQ), for men whose osteoporosis is caused by low testosterone
• Denosumab (Prolia)

A doctor familiar with a man’s health history will select the most effective course of treatment based upon whether or not low testosterone is the root cause of the bone loss, current medications, and other lifestyle factors.