Osteoporosis in Men Poses Higher Mortality Risk Than in Women, Spurring New Treatment Guidelines

In patients 60 and older, inpatient mortality following a hip fracture was 10.2 percent for men compared to 4.7 percent for women, according to a new study.

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The number of hip fractures is expected to have risen by 310 percent between 1990 and 2050 because of osteoporosis. Although one in five men older than 50 have the degenerative bone disease, men are often underdiagnosed and undertreated. These findings were recently published in Nature Reviews Rheumatology and establish new evidence-based guidelines for managing osteoporosis in men.

“It’s important to recognize that osteoporosis in men carries substantial morbidity and mortality, with rates comparable to or even exceeding those in women with the condition,” professor Jean-Yves Reginster, senior author of the study and president of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), said in a statement.

ESCEO is the organization that established the new recommendations for treating osteoporosis in men and provided the international multidisciplinary working group for the study.

The working group found that although osteoporosis still affects women at a higher rate, the difference between the rate of hip fractures in men and the rate in women narrows as the population ages. For example, from ages 60 to 69, the ratio is 1 to 4.5 (men to women), then the ratio drops to 1 to 1.9 after age 80.

However, mortality rates were substantially higher for men than women following a fracture. In a group of patients 60 and older, inpatient mortality following a hip fracture was 10.2 percent for men compared with 4.7 percent for women. The one-year mortality rate was 37.5 percent for men versus 28.2 percent for women. This trend continued for at least a decade, the researchers found.

New Guidelines Establish Standard of Care

Unlike women’s bones, which lose trabecular, or spongy, connectivity as they age, men’s bones grow thicker, which causes spongy bone loss. This bone loss reduces bone mineral density, the working group reported, putting these men at risk of fractures.

New standards of care are needed after initial diagnosis for men with osteoporosis to reduce fracture risk. Anti-osteoporosis medications should be prioritized and individualized to a person’s baseline fracture risk. That fracture risk should be established by a female reference database called FRAX, according to the working group. This diagnostic can help set intervention thresholds in men with osteoporosis, the statement noted.

The go-to treatment for osteoporosis should be oral bisphosphonates, while second-line treatment options include denosumab and zoledronate.

“Following an approach similar to that advocated for women with osteoporosis, we recommend the use of oral anti-resorptive agents as first-line agents in men at a high risk of fracture and the use of bone-forming agents followed sequentially by anti-resorptive agents in men at a very high risk of fracture,” professor Nicholas Harvey, a senior author of the study, said in the statement.

The working group also recommended that men older than 65 take vitamin D and calcium to reduce the risk of osteoporosis. Men should also continue to engage in physical exercise and maintain a balanced diet. Serum testosterone levels should also be checked, and, if necessary, hormone replacement therapy could be considered.

“We hope that these guidelines will assist clinicians in their clinical practice and encourage them to be proactive in managing osteoporosis in their male patients,” Mr. Harvey said.