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Question answered:07/05/08
The CKS guidance on osteoporosis [1] highlights a lack of evidence in men but does suggest referring all men with osteoporosis for specialist assessment and advice on treatment:
“Consider referring all men with osteoporosis for specialist assessment and advice on treatment.
Exclude secondary causes of osteoporosis.
Assess the risk of falls, particularly in the elderly (see How do I identify and manage risk of falls? for further information).
Give lifestyle advice on dietary calcium and vitamin D intake, exercise, stopping smoking, and alcohol.
Treatment in men is best initiated after specialist assessment. However, if there is likely to be considerable delay before seeing a specialist, it may be appropriate to start drug treatment.
Treat with alendronate and give calcium + vitamin D if dietary intake is low. Seek specialist advice for other treatment options if alendronate is contraindicated or not tolerated.”
eMedicine has a chapter on osteogenesis imperfecta [2] and this states:
“Medical Care: Because OI is a genetic condition, it has no cure.
- Cyclic administration of intravenous pamidronate reduces the incidence of fracture and increase bone mineral density, while reducing pain and increasing energy levels. Doses vary from 4.5 to 9 mg/kg/y depending on the protocol used.
- Current evidence does not support the use of oral bisphosphonates in patients with OI.
- Nutritional evaluation and intervention are paramount to ensure appropriate intake of calcium and vitamin D. Caloric management is important, particularly in adolescents and adults with severe forms of OI.”
Mentor also have a section on OI [3] and this reports:
“Recent advances have shown the use of growth hormone and bisphosphonate to be beneficial
Bisphosphonate therapy is used under specialist centre guidance and is particularly useful for pain and recurrent fractures in type 3. (Bisphosphoantes bind to, and stabilise bone by inhibiting osteoclast activity, whilst stimulating osteoblast activity.)
Cyclical intravenous pamidronate administration can reduce bone pain and fracture incidence, and increase bone density and level of mobility, with minimal side effects.”
References
1) http://cks.library.nhs.uk/osteoporosis_treatment/view_whole_topic
2) http://www.emedicine.com/ped/topic1674.htm
3) http://www.patient.co.uk/showdoc/40001118
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