Elsevier

Endocrine Practice

Volume 28, Issue 3, March 2022, Pages 250-256
Endocrine Practice

Original Article
Effects of Bisphosphonates on Bone of Osteoporotic Men With Different Androgen Levels: A Case-Control Study

https://doi.org/10.1016/j.eprac.2021.12.013Get rights and content

Abstract

Objective

Osteoporosis in men has been neglected despite its association with disability and mortality. We evaluated the effect of bisphosphonates (BPs) on bone mineral density (BMD) and bone turnover biomarkers of osteoporotic men with different androgen levels.

Methods

This case-control study included 136 osteoporotic men who were divided into normal group (n = 75) and hypogonadism group (n = 61) (patients treated with testosterone were excluded) according to their serum testosterone levels (cutoff value, 350 ng/dL). BMD, serum testosterone, total alkaline phosphatase, and cross-linked C-telopeptide of type I collagen were detected. The relationship between testosterone levels and BMD at baseline was evaluated. All patients were treated with BPs for 2 years. We compared the effects of BPs on BMD and bone turnover biomarkers between the 2 groups.

Results

At baseline, there were no significant differences in BMD and bone turnover biomarkers between the 2 groups. Testosterone levels were positively correlated with BMD in the hypogonadism group. After treatment, the lumbar BMD increased by 7.65% ± 1.54% and 7.47% ± 1.88% in normal and hypogonadism groups, respectively (both P < .01 vs baseline) and hip BMD increased without significant differences between the 2 groups. Serum cross-linked C-telopeptide of type I collagen and alkaline phosphatase levels decreased without significant differences between the 2 groups (all P < .01 vs baseline).

Conclusion

Testosterone level is positively correlated with BMD in men with hypogonadism. In osteoporotic men, BPs significantly increase spine and hip BMD and decrease bone resorption. The efficacy of BPs is similar in men with or without hypogonadism.

Introduction

Although progress has been made in osteoporosis research, the disease continues to be underrecognized and untreated in men.1 Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and deterioration of the bone microarchitecture, leading to increased fracture risk.2 Although osteoporosis is more common in women, it also occurs in men. The number of cases of bone fractures among men and women is rising,3 and men tend to have more complications and higher mortality after fragility fractures.4 The quality of life of men is significantly impaired by osteoporosis and fragility fractures.5

However, the diagnosis and treatment of osteoporosis in men are usually neglected, even after bone fractures.6,7 Compared with female osteoporosis, male osteoporosis is frequently found to be secondary to other diseases and is often associated with comorbidities.8 Androgen deficiency is the most common cause of osteoporosis in men.9 In men with hypogonadism, testosterone therapy has limited efficacy. Although bisphosphonates (BPs) are part of the primary therapy for osteoporosis in men, zoledronic acid (ZOL) and alendronate (ALN) also significantly increase BMD and reduce the risk of fractures in men with osteoporosis,10,11 it is unclear if they are more or less effective in men with or without hypogonadism. Very few studies have evaluated the effects of BPs on osteoporotic men with different androgen levels.

Herein, we aim to evaluate and compare the efficacy of BPs on BMD and bone turnover in Chinese men with osteopenia or osteoporosis and with different androgen levels.

Section snippets

Participants

This was a single-center, open-label, case-controlled study. The study was approved by the Scientific Ethics Committee of Peking Union Medical College Hospital, Beijing, China.

Participants were enrolled from the Endocrinology Department of Peking Union Medical College Hospital from December 2010 to September 2018. Eligible patients were men aged 18 years or above who were diagnosed with osteopenia or osteoporosis according to the World Health Organization criteria.12 Patients were excluded if

Characteristics of the Patients

Originally, a total of 150 men with osteopenia or osteoporosis were included in this study (Fig. 1). They were assigned either to the normal androgen group (n = 75) or the hypogonadism group (n = 75). If the hypogonadal men were treated with testosterone, they were functionally eugonadal men and may have affected the results. Therefore, 14 patients in the hypogonadism group who received treatment of testosterone were excluded (Fig. 1). Thus, only 61 patients without testosterone treatment were

Discussion

In this study of patients with osteoporosis, treatment with BPs for 2 years increased BMD of the spine and proximal hip of men with osteopenia or osteoporosis. The effects of BPs were evident after 12 months of therapy and were independent of baseline serum testosterone concentrations. The decrease in bone turnover biomarkers was consistent with the effects of BPs. BPs were generally well tolerated in these men with osteopenia or osteoporosis.

Together, Primary osteoporosis (which includes

Acknowledgment

This work is supported by National Key R&D Program of China (2018YFA0800801), National Natural Science Foundation of China (No.81873668, 82070908), and Beijing Natural Science Foundation (7202153). We appreciate the patients for their participation in the study.

Disclosure

The authors have no multiplicity of interest to disclose

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