Effectiveness of alendronate and etidronate in the treatment of osteoporosis in men: a prospective observational study

Abstract

The prevalence of osteoporosis in men is higher than previously assumed; consequently, numerous therapies are being investigated to treat these patients. The Canadian Database of Osteoporosis and Osteopenia patients (CANDOO) was analyzed to examine changes in bone mineral density (BMD) in consecutively seen osteoporotic men administered alendronate, etidronate or no bone-active drugs (control) over 1 year. A total of 244 men attending six Canadian osteoporosis clinics were included in the study (42 alendronate, 102 etidronate and 100 control). Multiple imputation was used to model missing data to provide a more robust statistical model. The imputed datasets (five) were analyzed using multivariable linear regression to determine differences between groups in the percent change of lumbar spine (LS) and femoral neck (FN) BMD from baseline to 1 year. Differences in the percent change in BMD from baseline were most notable at the LS in favor of alendronate (4.3%; 95% CI: 2.1, 6.6 ) and etidronate (2.1%; 95% CI: 0.3, 4.0) therapy when compared with controls. At the LS, alendronate therapy led to significantly greater (2.2%; 95% CI: 0.2, 4.2) gains in BMD as compared to etidronate therapy. Compared to controls, there were no significant differences in FN BMD with alendronate (2.1%; 95% CI: -0.4, 4.7) or etidronate therapy (0.9%; 95% CI: -1.1, 2.8), nor were there significant differences between bisphosphonate groups (1.3%; 95% CI: -1.1, 3.6, in favor of alendronate). While both alendronate and etidronate significantly increased LS BMD in osteoporotic men after 1 year in real-world settings, alendronate therapy resulted in significantly superior gains in LS BMD. The effect of these two bisphosphonates on fractures and FN BMD in osteoporotic men is likely positive, but requires further study.

Characteristics Associated with Bone Mineral Density Responses to Alendronate in Men

“…In one study of 41 men receiving alendronate in a clinical practice setting, any decrease in spine or hip BMD occurred in 10% and 24%, respectively [18], in comparison to 20% and 38% in our study. Veterans’ mean spine D-BMD was 4.2%, similar to a reported one-year increase of 4.2% [19].…”

“…With a mean baseline spine BMD of 1.072g/cm 2 , two-thirds of veterans had ≥3% (0.032g/cm 2 ) improvement between DXAs (mean 1.6 year interval) compared to 87% with ≥3% gain over two years [5]. In veterans, mean hip D-BMD was 0.8% compared to a reported one year increase of 1.6% [18]. With a mean baseline hip BMD of 0.836g/cm 2 , 35% of veterans had ≥3% (0.025g/cm 2 ) improvement between DXAs compared to 63% of men with ≥3% increase in hip BMD over three years [6].…”

Role of Alendronate in Managing Osteoporosis in Celiac Disease – Illustrative Case Report

“…These expert recommendations have been based on several studies primarily established in postmenopausal women [22-27]. Alendronate treatment had been reported in several studies to be effective in improving BMD in men with osteoporosis, similar to its efficacy in women [28-32]. In all the studies, improvement of BMD was observed higher in lumbar spine as compared to femoral neck.…”

“…The efficacy of alendronate in improving BMD was showed in either case of secondary osteoporosis or idiopathic osteoporosis [29, 30]. Compared to etiodronate, alendronate therapy led to significantly greater gains in BMD of lumbar spine [32]. In 1-year observation of alendronate therapy, the mean BMD improvement of lumbar spine was 5.4% - 7.0% and the mean improvement of femoral neck was 2.6% - 4.5% [28, 29].…”

Response of Postpoliomyelitis Patients to Bisphosphonate Treatment

“…Three oral bisphosphonates are used for the prevention or treatment of osteoporosis: etidronate, alendronate, and risedronate. Among these, alendronate and risedronate have been conclusively demonstrated to reduce the number of vertebral and hip fractures in postmenopausal women and to increase bone density in men in the general population [9‐11].…”