Causes, consequences, and treatment of osteoporosis in men

Figures & data

Figure 1 Factors that cause bone loss in men.

Abbreviations: IGF-1, insulin-like growth factor-1; SHBG, sex hormone binding globulin; OPG, osteoprotegerin; ADT, androgen deprivation therapy; ↑, increase; ↓, decrease.

Table 1 Pharmacological options available for treating osteoporosis in men

Drug	Dosage/Frequency	Advantages	Side effects	References
Hormones
Testosterone		⬆ Hypogonadal men, BMD at lumbar vertebrae	Fluid retention, increased blood pressure	59,81,84
Intramuscular	200 mg/every 2 weeks
Skin patch	5 mg daily
Gel	50 mg/5 g daily
Parathyroid hormone		⬆ BMD, bone formation markers	Dizziness, nausea, palpitations, hypercalcemia	85–88
Calcitonin		⬆ BMD of lumbar and femoral neck	Dizziness, nausea, pain	92,93,109
Selective estrogen receptor modulator
Raloxifene		⬆ Bone mass		94,95
Bisphosphonates
Alendronate	10 mg daily or 70 mg weekly	⬆ BMD in vertebrae, femoral neck	GI tract intolerance	88,91
Risendronate	5 mg daily or 35 mg weekly or 75 mg monthly (2 consecutive days) or 150 mg monthly	⬆ Bone mass	GI tract intolerance	14
Etidronate	400 mg daily	⬆ BMD in lumbar vertebrae	GI tract intolerance, joint, bone, and muscle pain, severe diarrhea, jaw pain, numbness or swelling, hives, swelling of mouth and throat	98
Ibandronate	2.5 mg daily or 150 mg monthly or 3 mg every 3 months (IV)	⬆ BMD spine, trochanter, femur neck	GI tract intolerance, fu-like symptoms, osteonecrosis of jaw	99,102
Zoledronate	5 mg yearly (IV)	⬆Bone mass	Flu-like symptoms, osteonecrosis of jaw	101,103,104,118

Abbreviations: IV, intravenously; GI, gastrointestinal; BMD. bone mineral density; ⬆, increase.

Figure 2 Treatment options for osteoporosis in men.

Abbreviations: BP, bisphosphonates; CLA, conjugated linoleic acid; SERMs, selective estrogen receptor modulators; ↑, increase.

Table 2 Biological therapy possibilities for treating osteoporosis in men

Antibodies	Target	Advantages	Disadvantages	References
Denosumab	RANKL	⬇ Bone resorption	Reduces immunity, skin rashes, high cholesterol	14,94,105,106
Odanacatib	Cathepsin K	⬇ Bone resorption markers, ⬆ BMD spine and hip	Not known	94,107,108
Inhibitors
AMG 785	Sclerostin	⬆ Bone formation markers, BMD	Oncogenic, calcium homeostasis, uncontrolled bone formation leading to complications	105,109–112
Specific to DKK1	DKK1	⬆ Bone formation
Specific to Frp	Frp	May ⬇ bone loss
Lithium	GSK-3	⬆ BMD
603281-31-8	GSK-3	⬆ Bone formation markers, bone strength
6-bromoindirubin-3′-oxime	GSK-3	⬇ Glucocorticoid-induced bone loss
AR28	GSK-3	⬆ Bone mass

Abbreviations: BMD, bone mineral density; DKK1, Dickkopf 1; Frp, frizzled-related proteins; RANKL, receptor activated nuclear factor kappa B ligand; ⬆, increase; ⬇, decrease; GSK-3, glycogen synthase kinase 3.

Table 3 Possible nutritional supplements for the prevention and treatment of osteoporosis in men

Supplements	Evidence	References
Calcium	Men, postmenopausal women	4,14,80,97,113–120
Vitamins
vitamin D	Men, postmenopausal women	16,56–58,113–120
Fatty acids
n-3 fatty acids	Preclinical	121,122,125
Conjugated linoleic acid	Preclinical (males, females)	126,127
Herbal products
Soy isoflavones	Preclinical, postmenopausalwomen	116,128
Black cohosh		116,129
Fructus linguistri lucidi	Preclinical
Cissus quadrangularis	Preclinical
Prunes	Preclinical, Postmenopausal women	130,131

Table 4 Nonpharmacologic therapies available for men

Therapies	Benefits	References
Exercise	⬆ Muscle and bone mass	80
Muscle strengthening	⬆ Muscle strength, ⬇ frailty, ⬆ bone mass	80
Fall prevention
Vision	⬆ Visibility, ⬇ falls	132,133
Hearing	Improved hearing ability ⬇ accidents
Neurologic factors	Treatment for depression improves health condition and ⬇ falls and accidents
Safety features	Installing hand rails ⬇ falls
Healthy lifestyle
Diet	Balanced nutrition ⬇ bone loss	132,133
Tobacco	⬇ Bone mineral density
Alcohol	⬇ Bone mass

Abbreviations: ⬆, increase; ⬇, decrease.