Making Bones Stronger in Men
Is testosterone replacement the answer to stronger bones in men?
By D. L. M.
If men older than 60 have low levels of the male sex hormone testosterone, they are more likely to break a bone due to osteoporosis, according to a new study in the Archives of Internal Medicine. In fact, one-third of all fractures caused by brittle bones occur in men. Newly released guidelines call for testing bone mineral density (BMD) in all men aged 70 and older, as well as in younger men who have risk factors for bone loss.
The risk factors include gender, age, history of a previous fracture, parental fracture history, smoking, alcohol use, corticosteroid use, and the presence of certain diseases, including RA, that increase risk of osteoporosis. A guide just released by the National Osteoporosis Foundation (NOF), takes BMD and those risk factors into account to estimate risk for fracture within the next 10 years.
“If a man’s BMD test result is significantly low, we can use the new fracture risk prediction model and determine if he should be treated with testosterone or another medication to lower his fracture risk,” says NOF President Ethel S. Siris, MD, director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center in New York City.
“If the man is young and otherwise healthy, many people would put him on testosterone therapy. But if he is elderly, the decision to do so would be based on cholesterol profile and prostate health,” she says. Some research suggests that testosterone replacement therapy may raise levels of low-density lipoprotein – the “bad” cholesterol. And, since testosterone may “feed” prostate cancer, men who have prostate cancer are likely to take medications that deplete testosterone production.
“If we can’t give testosterone, three drugs are approved for male osteoporosis, says Dr. Siris: Alendronate (Fosamax), risedronate (Actonel) and teriparatide (Forteo), which stimulates cells that build new bone.
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