The incidence of osteoporotic fracture in mates is approximately one-third
of that observed in women, but information on specific therapies is almost
exclusively limited to bisphosphonate alendronate. The most important study
with this compound included 241 men, randomized to receive either alendron
ate 10 mg/day or placebo. In another study 134 men were given either 10 mg
alendronate or alfacalcidiol 1 mug/day. After 24 months, the treatment with
alendronate bone mineral density (BMD) significantly increased in both stu
dies by 7-10% at the lumbar spine and by 2.5-5.2% at the femoral neck. Thes
e changes were associated with decreases in vertebral fracture rate and in
stature loss, both statistically significant when the data of the two trial
s were meta-analysed. The BMD changes after alendronate therapy were compar
able to those observed in postmenopausal osteoporosis. This was confirmed i
n a trial specifically designed to compare alendronate efficacy in men and
postmenopausal women with either primary or secondary osteoporosis. Gender-
comparative efficacy data can also be inferred from clinical trials in gluc
ocorticoid-induced osteoporosis of alendronate, risedronate, and etidronate
, carried out in both women and men. By combining the results of all these
trials, bisphosphonate efficacy in terms of both BMD changes and fracture i
ncidence appears to be moderate in premenopausal women but quite obvious an
d comparable in males and postmenopausal women.