How To Manage Osteoporosis Caused By Hypogonadism?

Osteoporosis refers to weakening or demineralization of bones due to age related hormonal changes. According to latest statistics, millions of men in the US suffers from osteoporosis or related bone mineral deficits that makes them more vulnerable to injuries or bone fractures. Depending upon the T scores and medical history, pharmacological therapies vary from person to person.

Most Appropriate Pharmacological Options For Osteoporosis Management

Currently four medicines have been approved in the United States for the treatment of osteoporosis in men:

• Teriparatide injection (once daily, under the skin)
• Alendronate tablets (daily or weekly)
• Risedronate tablets (daily, weekly, or monthly)
• Alendronate tablets (daily or weekly)

Teriparatide stimulates the formation of new bone but it is prescribed in severe osteoporosis only because it is expensive and requires to be injected on daily basis. The three other drugs listed above belongs to class bisphosphonates which increases the bone mass; thereby reducing the bone loss. Zoledronic acid and Risedronate are also approved by FDA to prevent glucocorticoid-induced osteoporosis.

Men who receive ADT for treating prostate cancer are at high risk of developing bone fractures with minimal trauma. In such cases, a new medicine called Denosumab can be given. It is injected beneath the skin to increase the bone density.

Men who have low testosterone (less than 200 nanograms per deciliter) can increase their bone mass density by receiving testosterone therapy. Unless a man needs testosterone therapy for health conditions other than bone health, osteoporosis medications are usually considered the first choice of treatment.

Who Should Seek Treatment For Osteoporosis?

Treatment for osteoporosis depends on the risk of bone fractures. Fracture risk calculator is a web based diagnostic tool which evaluates the future risks of developing bone fractures. A drug is prescribed when:

• T- score at hip or spine is -2.5 or less
• T-score is between -1 to -2.5 with very high risk for having fractured bones in future
• History of hip or spine fracture without any serious trauma
• Long term glucocorticoid therapy
• Individuals who are receiving ADT (androgen deprivation therapy) for prostate cancer and are at high risk of developing bone fractures

How To Prevent Osteoporosis?

Osteoporosis can be prevented by modifying the lifestyle in a healthy manner, such as:

• Daily intake of vitamin D supplements (in a dose of 1,000 - 2,000 IU) if serum levels of vitamin D are less than 20 to 30 ng/ml
• Take 1,000 to 1,200mg of calcium through calcium fortified food. If required, calcium supplements can also be taken
• Physical activities such as running, walking and weight lifting exercises for 30 to 40 minutes, three to four times a week can also significantly boost bone health
• Avoid smoking
• Do not consume more than 10 alcoholic beverages a week (in United States, 1 alcoholic drink is equal to 1.5 ounces of hard liquor, 5 ounces of wine or 12 ounces of beer)

Individuals should consume 1,000 to 1,200 mg of calcium on daily basis along with vitamin D as suggested by doctor. Take medicines as prescribed by doctor and get DXA scans as advised.

Boost Testosterone Naturally

As suggested earlier, weight loss is the most effective non-pharmacological method of boosting testosterone levels. Though, any physical activity can be helpful but weight training and other resistance exercises can prove very beneficial in delivering prompt results.

• Men who lose weight through low calorie diet (maintained for a year) reports persistent increase in the testosterone. While men who undergo weight loss surgery (bariatric) reports marked elevation in the testosterone levels, says a new research.
• Obese middle aged men experience moderate increase in testosterone when they lose weight moderately via exercise and diet program, says another research.

References

• Funaro, M., Bolyakov, A., Gimenez, E., Herman, M., & Paduch, D. A. (2013). Low testosterone—An important predictor of low mineral bone density in young men—Our own experience and a review of literature. Advances in Sexual Medicine, 2013.
• Finch, P. M., Price, L. M., Pullan, P. T., & Drummond, P. D. (2015). Effects of testosterone treatment on bone mineral density in hypogonadal men receiving intrathecal opioids. Pain Practice, 15(4), 308-313.
• Laurent, M., Gielen, E., Claessens, F., Boonen, S., & Vanderschueren, D. (2013). Osteoporosis in older men: recent advances in pathophysiology and treatment. Best practice & research Clinical endocrinology & metabolism, 27(4), 527-539.