An international working group has released a new, evidence-based guideline to address the significant health burden of osteoporosis in men, providing clear recommendations for diagnosis, monitoring, and treatment.

In a significant development for men's health, a new evidence-based guideline for the diagnosis, monitoring, and treatment of osteoporosis in men has been released by an international multidisciplinary working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). The guideline, published in the journal Nature Reviews Rheumatology, addressed a condition which has historically been underdiagnosed and undertreated.

The working group, comprised of clinicians, epidemiologists, public health experts, and regulatory experts from 18 countries, conducted a comprehensive review of the latest research related to osteoporosis in men. Using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, the group developed a set of recommendations for healthcare professionals.

Key recommendations included the use of a female reference database for the densitometric diagnosis of osteoporosis in men, the use of the FRAX tool (Fracture Risk Assessment Tool) for fracture risk assessment, and the consideration of treatment for all men with a prior fragility fracture. The guideline also provided recommendations for pharmacological interventions, with oral bisphosphonates as first-line treatments for men at high risk of fracture, and denosumab or zoledronate as second-line treatments. For men at very high risk of fracture, the group recommended combination therapy starting with a bone-forming agent followed by an anti-resorptive agent.

The guideline also emphasized the importance of ensuring vitamin D and calcium repletion in men aged > 65 years, as well as the role of physical exercise and a balanced diet in osteoporosis management. Additionally, the group recommended assessing serum total testosterone levels as part of the pre-treatment assessment and considering hormone replacement therapy in men with low levels of total or free serum testosterone.

The authors noted that while the guideline is based on robust methods, further research is needed to address limitations in the current understanding of osteoporosis in men, particularly in terms of treatment efficacy and the role of testosterone in osteoporosis management.

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