Efficacy of osteoporosis pharmacological treatments in men: a systematic review and meta-analysis

Abstract

Introduction The objective of this systematic review and meta-analysis is to systematically identify and review the efficacy of pharmacological treatments in men with osteoporosis. Methods Medline (via Ovid) and Cochrane CENTRAL were searched up to May 2023 for any randomized controlled trial (RCT) evaluating the efficacy of osteoporotic treatment on the evolution of Bone Mineral Density (BMD) and incidence of fractures of men suffering from primary osteoporosis. If at least two studies used the same pharmacological treatment and evaluated the same outcome, a random effect model meta-analysis was applied to reported pooled mean difference (MD) and 95% confidence interval (CI). Results From the 1,061 studies identified through bibliographic search, 21 RCTs fitted the inclusion criteria. Bisphosphonates (k = 10, n = 2992 men with osteoporosis) improved all three BMD sites compared to placebo; lumbar spine: MD + 4.75% (95% CI 3.45, 6.05); total hip: MD + 2.72% (95% CI 2.06; 3.37); femoral neck: MD + 2.26% (95% CI 1.67; 2.85). Denososumab (k = 2, n = 242), Teriparatide (k = 2, n = 309) and Abaloparatide (k = 2, n = 248) also produced significant improvement of all sites BMD compared to placebo. Romosozumab was only identified in one study and was therefore not meta-analysed. In this study, Romosozumab increased significantly BMD compared to placebo. Incident fractures were reported in 16 RCTs but only four reported fractures as the primary outcome. Treatments were associated with a lower incidence of fractures. Conclusions Medications used in the management of osteoporosis in women appear to provide similar benefits in men with osteoporosis. Therefore, the algorithm for the management of osteoporosis in men could be similar to the one previously recommended for the management of osteoporosis in women.

Comparison of the cost-effectiveness of sequential treatment with abaloparatide in US men and women at very high risk of fractures

“…First, a direct comparison of the cost-effectiveness between men and women could be limited by the lack of fracture risk studies in men. In line with regulators accepting a bridging study with a placebo for approval in men, similar treatment efficacy is commonly assumed between men and women with osteoporosis [ 14 , 45 ]. Second, certain relevant detailed data (such as fracture costs or increased risks of subsequent fracture after fractures) were only available for women, and adjustments needed to be done to consider expected differences between men and women.…”

Hormoontherapie voor prostaatkanker: gevolgen voor de botgezondheid

“…Door de inzet van een DEXA-scan kunnen mannen die osteoporose hebben (uitslag van T < -2,5 of T < -1,0 bij risicofactoren) opgespoord en preventief behandeld worden. De medicamenteuze therapie met bisfosfonaten of rank-ligandremmers is gericht op botopbouw en is effectief in het verhogen van de BMD en het verlagen van het fractuurrisico [6,25].…”