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Drug Insight: the use of bisphosphonates for the prevention and treatment of osteoporosis in men

Nature Clinical Practice Urology volume 4, pages 310–320 (2007)Cite this article

Abstract

Osteoporosis has long been recognized as a disease affecting postmenopausal women but it has become increasingly clear that men are affected by low bone density and suffer the consequences of osteoporotic fractures. Men attending clinical urological practices might be at raised risk of bone loss due to hypogonadism, either identified during work-up of erectile dysfunction or induced by androgen deprivation therapy for treatment of prostate cancer. The availability of bisphosphonate drugs with proven efficacy in fracture reduction has revolutionized osteoporosis therapy in the past decade. The use of these agents has been traditionally based on data obtained predominantly from postmenopausal women and cases of glucocorticoid-induced osteoporosis, but data are becoming increasingly available to justify their use in men. Despite the availability and favorable safety profile of bisphosphonates, many patients are not receiving therapy. This article serves to review the data regarding bisphosphonate use in men, discussing particularly the pharmacology and mechanisms of action of these agents, and findings from clinical studies supporting their use for fracture prevention.

Key Points

  • Men, particularly those with secondary causes of low BMD, such hypogonadism or long-term glucocorticoid use, are at risk of osteoporosis and fractures

  • Bisphosphonates have proven efficacy in reducing vertebral fracture risk in men with primary and glucocorticoid-induced osteoporosis

  • Bisphosphonates suppress bone resorption by inhibition of osteoclast function

  • Bisphosphonates are well-tolerated drugs that have convenient dosing schedules

  • Men at high risk of fracture, such as elderly men, are often underdiagnosed and undertreated

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Figure 1: Incidence of radiographic, vertebral and hip fractures according to age and sex in European cohorts
Figure 2: Mechanism of action of nitrogen-containing bisphosphonates
Figure 3: Bone mineral density (measured by DXA) response to alendronate treatment in men with osteoporosis, by region
Figure 4: Effect of zoledronic acid on bone mineral density in patients with nonmetastatic prostate cancer receiving androgen deprivation therapy

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Acknowledgements

We thank the following institutions for providing support in the form of grants: National Institutes of Health; University of Virginia; Aurbach Endowment and Mellon Institute at the University of Virginia; V-Foundation, Mary Kay Ash Foundation, Prostate Cancer Foundation, Department of Defense.

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  1. and TA Guise is the Gerald D Aurbach Professor of Endocrinology in the Department of Medicine, SA Brown is an Assistant Professor of Medicine, University of Virginia, Charlottesville, VA, USA.,

    Sue A Brown & Theresa A Guise

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Correspondence to Sue A Brown.

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Sue A Brown declared she has no competing interests.

Theresa A Guise has been a consultant, and has served on speaker's boards, for Amgen, Novartis and Merck.

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Brown, S., Guise, T. Drug Insight: the use of bisphosphonates for the prevention and treatment of osteoporosis in men. Nat Rev Urol 4, 310–320 (2007). https://doi.org/10.1038/ncpuro0816

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