Management of male osteoporosis

The objective of this study was to evaluate the efficacy of treatments for male osteoporosis selected based on the cause of the disease. Methods. Sixt y-three men with osteoporosis (T-score at the lumbar spine and/or femoral n eck lower than -2.5) with a mean age of 53 +/- 11 years were studied. Forty -three (68.3%) had a history of fracturing without trauma (vertebral fractu res, 37 patients, 57%). Treatments were as follows: idiopathic osteoporosis : calcium and vitamin D supplements (N =10) or cyclical etidronate for 2 we eks followed by calcium and vitamin D supplements for 76 days (N = 29); mod erate idiopathic phosphate diabetes: calcitriol and phosphate (N = 15); idi opathic hypercalciuria: hydrochlorothiazide (N = 6); and hypogonadism: test osterone (N = 3). Results. Percentage change in bone mineral density (mean +/- standard error of the mean) after 18 months: calcium and vitamin D (lum bar spine: 0.6 +/- 2; femoral neck: 2.2 +/- 2.2); etidronate (lumbar spine: 3.6 +/- 1.4*; femoral neck: 0.5 +/- 1), calcitriol (lumbar spine: 7.0 +/- 3.5*; femoral neck: 0.0 +/- 1.4); thiazide diuretic (lumbar spine: 1 +/- 3. 2; femoral neck: -2.3 +/- 3.7); and testosterone (lumbar spine: 6.8 +/- 6.4 ; femoral neck: 2.5 +/- 2.7), where *P < 0.05 versus baseline. Gastrointest inal side effects occurred in three patients (4.8%), including two on calci triol-phosphate therapy and one on etidronate therapy. Of the six (9.5%) pa tients who experienced incident fractures, four were on etidronate, one on calcitriol-phosphate, and one on calcium-vitamin D, No patients discontinue d their treatment because of side effects. Conclusion. Etidronate and the c ombination of calcitriol-phosphate produce a significant increase in lumbar spine bone mass in men with idiopathic osteoporosis or moderate idiopathic phosphate diabetes. Joint Bone Spine 2001 ; 68 : 252-6. (C) 2001 Editions scientifiques et medicales Elsevier SAS.