• July 18, 2012 – 07:09

    New Male Osteoporosis Guidelines

    The US Endocrine Society's Clinical Guidelines Subcommittee published the first guidelines specific to men and osteoporosis in June 2012.  Key recommendations are as follows:

    • Screen men at increased risk for osteoporosis by measurement of bone mineral density (BMD) via dual-energy x-ray absorptiometry (DEXA) at age 70; men ages 50-69 should be tested if additional risk factors are present (e.g. low body weight, prior fracture as an adult, smoking)
    • Screen men ages 50-69 for osteoporosis if they have delayed puberty, hypogonadism, hyperparathyroidism, hyperthyroidism, chronic obstructive pulmonary disease, use chronic glucocorticoids or GnRH agonists, or have a history of smoking and/or alcohol abuse
    • If history and physical examination do not suggest a specific cause of osteoporosis, further testing should include bioavailable testosterone, sex hormone binding globulin, serum and urine protein electrophoresis, tissue transglutaminase antibodies, thyroid function tests, and parathyroid hormone levels
    • Men should take 1000-1200mg calcium daily ideally from dietary sources, supplemented if necessary
    • Men with vitamin D levels < 30ng/ml should receive supplementation
    • Men at risk of fracture who are receiving testosterone supplementation should take agents proven to reduce fracture risk (e.g. bisphosphonate or teriparatide)
    • Hypogonadal men with serum testosterone levels < 200ng/dl should receive testosterone replacement therapy unless contraindicated (e.g. prostate cancer)
    • Clinicians should monitor (BMD) via DEXA scan at the femoral neck and lumbar spine every 1-2 years to assess response to treatment
    • Men with osteoporosis should quit smoking, consume no more than 1 alcoholic beverage daily, and engage in weight-bearing exercise 30-40 minutes per session for 3-4 sessions per week

    Reference: Watts NB, Adler RA, Bilezikian JP, et al.  Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline.  J Clin Endocrinol Metab 2012;97:1802-1822.