The pathogenesis, treatment and prevention of osteoporosis in men.
Study Goal
The researchers aimed to evaluate the role of calcium in bone health, fracture risk, and its potential adverse effects, particularly in relation to cardiovascular complications and renal stones.
Results Summary
The study found that calcium supplementation should be tailored to habitual daily intake due to associations with increased cardiovascular and renal risks, while also highlighting its importance in preventing secondary hyperparathyroidism and maintaining bone strength.
Population
Males, particularly hypogonadal younger and older adults, and those with osteoporosis or glucocorticoid-induced osteoporosis.
Effective Dosage
Not specified (dose should be tailored to habitual intake).
Duration
Not specified.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Testosterone | increase | longitudinal and appositional growth | during childhood | - | stimulates | #1 |
Estrogen | increase | epiphysial closure | - | - | induces | #2 |
Testosterone | increase | periosteal growth | during adulthood | - | stimulates | #3 |
Estrogen | no change | trabecular bone mass and structure | during adulthood | - | is important for the maintenance of | #4 |
free and bioavailable plasma levels of testosterone and estradiol | decrease | levels | males | - | decrease | #5 |
low estradiol levels | increase | fracture risk | - | - | is associated with | #6 |
Testosterone | increase | muscle mass | - | - | may increase | #7 |
Testosterone | decrease | fractures related to falls | - | - | may prevent | #8 |
testosterone | increase | peak bone mass | Younger hypogonadal males | - | to attain | #9 |
testosterone | increase | bone mineral density (BMD) | Younger hypogonadal males | - | increase | #10 |
Secondary hyperparathyroidism caused by calcium and vitamin D insufficiency | decrease | bone mass and strength | - | - | may reduce | #11 |
Secondary hyperparathyroidism caused by calcium and vitamin D insufficiency | increase | fracture risk | - | - | increase | #12 |
calcium supplementation | increase | cardiovascular complications and renal stones | - | - | has been associated with an increased risk of | #13 |
antiresorptive and anabolic treatment for osteoporosis | no change | antifracture efficacy | in larger randomized controlled studies | - | has not been documented | #14 |
bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid), nasal calcitonin, denosumab and teriparatide (parathyroid hormone [1-34]) | no change | changes in BMD and bone markers | males and females | - | suggest similar effects | #15 |
Testosterone stimulates longitudinal and appositional growth during childhood, whereas estrogen induces epiphysial closure. During adulthood, testosterone continues to stimulate periosteal growth, whereas estrogen is important for the maintenance of trabecular bone mass and structure. In males, testosterone is aromatized to estradiol. Both free and bioavailable plasma levels of testosterone and estradiol decrease with age in males, and fracture risk is associated with low estradiol levels. Testosterone may increase muscle mass and prevent fractures related to falls. Younger hypogonadal males should be treated with testosterone to attain peak bone mass and increase bone mineral density (BMD). Older hypogonadal males should be treated in cases of osteoporosis, reduced muscle strength and increased risk of falling. Secondary hyperparathyroidism caused by calcium and vitamin D insufficiency may reduce bone mass and strength and increase fracture risk and should be avoided. Since calcium supplementation has been associated with an increased risk of cardiovascular complications and renal stones, the dose should be tailored to the habitual daily calcium intake. Lifestyle-related risk factors (smoking, alcohol consumption, lack of physical activity and low body weight) should be addressed. The antifracture efficacy of antiresorptive and anabolic treatment for osteoporosis has not been documented in larger randomized controlled studies. However, changes in BMD and bone markers suggest similar effects in males and females of bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid), nasal calcitonin, denosumab and teriparatide (parathyroid hormone [1-34]). The antiresorptive drugs should be used in males with BMD T-score less than -2.5 and one or more risk factors, or with hip and vertebral fractures. It seems appropriate to recommend a higher cut-off T-score (e.g. less than -1.0 standard deviation [SD]) in glucocorticoid-induced osteoporosis and in patients receiving androgen deprivation therapy because of the fast initial bone loss. Anabolic treatment should be used in more severe spinal fracture cases, including glucocorticoid-induced osteoporosis.