Doctor examining x-rayThis week, the Endocrine Society issued guidelines on managing osteoporosis in men. Published in the June 1, 2012 issue of Journal of Clinical Endocrinology & Metabolism, the guidelines recommend the following:

Men at increased risk for osteoporosis should be tested by measurement of bone mineral density (BMD).
Men at high risk for osteoporosis should be screened with dual-energy x-ray absorptiometry (DXA). This includes those aged 70 and older and younger men with risk factors.

Risk factors for osteoporosis in younger men (aged 50-69) include:

– History of fracture after age 50
– low body weight
– Diseases such as delayed puberty, hypogonadism, hyperparathyroidism, hyperthyroidism, or COPD
– Drugs such as glucocorticoids or GnRH agonists
– Life choices such as alcohol abuse or smoking

Measure forearm DXA (1/3 or 33% radius) when spine or hip BMD cannot be interpreted and for men with hyperparathyroidism or receiving androgen-deprivation therapy for prostate cancer.
FRAX, Garvan, or other fracture risk calculators can improve the assessment of fracture risk and the selection of patients for treatment.
Men with low levels of vitamin D (less than 30 ng/mL) should take vitamin D supplements.
Those with or at risk for osteoporosis should consume 1,000 to 1,200 mg of calcium every day, ideally from dietary sources.
Men aged 50 and older with prior spine or hip fracture, low bone mineral density, or other clinical risk factors (eg, those receiving long-term glucocorticoid therapy in pharmacological doses) should receive drug therapy.
Those receiving treatment should have their bone mineral density assessed by DXA at the spine and hip every 1 to 2 years.
Pharmacological therapy is recommended for all men at high risk for fracture including, but not limited to:

– Men who have had a hip or vertebral fracture without major trauma
– Men whose BMD of the spine, femoral neck, and/or total hip is 2.% SD or more below the mean of normal young white males
– Men who have a T-score between -1.0 and -2.5 in the spine, femoral neck, or total hip plus a 10-yr risk of experiencing any fracture 20% or greater or 10-yr risk of hip fracture 3% or less using FRAX.
– Men who are receiving long-term glucocorticoid therapy in pharmacological doses

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to view the Journal of Clinical Endocrinology & Metabolism article (free).

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