title: Osteoporosis in men: epidemiology and treatment with denosumab.
abstract: Osteoporosis is a major public health care concern. Although often described as a disease affecting postmenopausal women, researchers and clinicians have emphasized its prevalence in men in recent years. The National Osteoporosis Foundation has stated that up to 25% of men over the age of 50 years will experience a fracture due to osteoporosis. Men who suffer from a major fracture have higher mortality rates than women. Pharmacologic therapy options for treating osteoporosis are limited for men as compared with women, so each medication approved for use in this population represents an important clinical option. In September 2012, the US Food and Drug Administration approved a new indication for denosumab to increase bone mass in men with osteoporosis at high risk for fracture. Denosumab is a fully human monoclonal antibody and novel antiresorptive agent that works by binding receptor activator of nuclear factor kappa-β ligand (RANKL) and inhibiting the signaling cascade that causes osteoclast maturation, activity, and survival. Ultimately, denosumab suppresses bone turnover and increases bone mineral density in both trabecular and cortical bone. Approval for treating osteoporosis in men was based on data from the ADAMO trial which displayed efficacy in increasing bone mineral density at the lumbar spine, total hip, femoral neck, hip trochanter, and one-third radius. Studies indicate that denosumab is effective and safe, and has superior adherence rates and patient satisfaction. Although long-term data and further research on fracture reduction rates in men should be explored, at this time denosumab is one of several appropriate first-line treatment options for men with osteoporosis.
authors.affiliation: Albany College of Pharmacy and Health Sciences-Vermont Campus, Colchester, VT, USA.
authors.forename: Kristel M
authors.initials: KM
authors.lastname: Sidlauskas
authors.affiliation: Albany College of Pharmacy and Health Sciences-Vermont Campus, Colchester, VT, USA.
authors.forename: Emily E
authors.initials: EE
authors.lastname: Sutton
authors.affiliation: Albany College of Pharmacy and Health Sciences-Vermont Campus, Colchester, VT, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Biddle
mesh_terms: D015502:Absorptiometry, Photon; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D000069448:Denosumab; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D000069448:Denosumab
keywords: denosumab; men; osteoporosis; treatment
references.citation: Osteoporos Int. 2005 May;16(5):510-6
references.pmid: 15322742
references.citation: Ann Intern Med. 2008 May 6;148(9):680-4
references.pmid: 18458281
references.citation: Rheumatol Int. 2014 May;34(5):727-32
references.pmid: 23334374
references.citation: Osteoporos Int. 1997;7(5):407-13
references.pmid: 9425497
references.citation: Lancet. 1999 Mar 13;353(9156):878-82
references.pmid: 10093980
references.citation: Bone. 2010 Apr;46(4):970-6
references.pmid: 20060082
references.citation: Bone. 2008 Apr;42(4):606-15
references.pmid: 18280232
references.citation: J Bone Miner Res. 2008 Feb;23(2):205-14
references.pmid: 17937534
references.citation: Clin Pharmacokinet. 2011 Dec 1;50(12):793-807
references.pmid: 22087866
references.citation: Rev Endocr Metab Disord. 2001 Jan;2(1):45-64
references.pmid: 11704979
references.citation: JAMA. 2009 Feb 4;301(5):513-21
references.pmid: 19190316
references.citation: N Engl J Med. 2000 Aug 31;343(9):604-10
references.pmid: 10979796
references.citation: N Engl J Med. 1997 Sep 4;337(10):670-6
references.pmid: 9278463
references.citation: J Clin Endocrinol Metab. 2005 Mar;90(3):1583-7
references.pmid: 15613428
references.citation: Endocr Rev. 2008 Apr;29(2):155-92
references.pmid: 18057140
references.citation: J Bone Miner Res. 2003 Jan;18(1):9-17
references.pmid: 12510800
references.citation: J Bone Miner Res. 2006 Jan;21(1):124-31
references.pmid: 16355281
references.citation: N Engl J Med. 2009 Aug 20;361(8):756-65
references.pmid: 19671655
references.citation: Arch Intern Med. 2005 Aug 8-22;165(15):1743-8
references.pmid: 16087822
references.citation: BMC Musculoskelet Disord. 2005 Jul 11;6:39
references.pmid: 16008835
references.citation: J Clin Endocrinol Metab. 2012 Jun;97(6):1802-22
references.pmid: 22675062
references.citation: J Clin Endocrinol Metab. 2001 Oct;86(10):4576-84
references.pmid: 11600506
references.citation: Acta Paediatr Suppl. 1992 Sep;383:11-3; discussion 14
references.pmid: 1458004
references.citation: N Engl J Med. 2008 Apr 3;358(14):1474-82
references.pmid: 18385499
references.citation: J Bone Miner Res. 2013 Apr;28(4):746-52
references.pmid: 23109251
references.citation: Endocrine. 2013 Aug;44(1):40-6
references.pmid: 23354727
references.citation: Age Ageing. 2010 Mar;39(2):203-9
references.pmid: 20075035
references.citation: J Clin Endocrinol Metab. 1998 May;83(5):1414-9
references.pmid: 9589631
references.citation: J Bone Miner Res. 2007 Mar;22(3):465-75
references.pmid: 17144789
references.citation: J Bone Miner Res. 2012 Jul;27(7):1471-9
references.pmid: 22461041
references.citation: J Bone Miner Res. 2009 Apr;24(4):719-25
references.pmid: 19049326
references.citation: J Clin Endocrinol Metab. 2006 Oct;91(10):3908-15
references.pmid: 16849417
references.citation: Osteoporos Int. 2012 Jan;23(1):317-26
references.pmid: 21927922
references.citation: Rheumatol Int. 2006 Mar;26(5):427-31
references.pmid: 16001181
references.citation: Expert Rev Pharmacoecon Outcomes Res. 2013 Feb;13(1):19-28
references.pmid: 23402442
references.citation: N Engl J Med. 2007 Nov 1;357(18):1799-809
references.pmid: 17878149
references.citation: Clin Orthop Relat Res. 1987 Feb;(215):260-71
references.pmid: 3802645
references.citation: Ann Intern Med. 2008 Sep 16;149(6):404-15
references.pmid: 18794560
references.citation: Endocr Rev. 2008 Jun;29(4):441-64
references.pmid: 18451258
references.citation: Osteoporos Int. 2011 Mar;22(3):967-82
references.pmid: 20936401
references.citation: Am J Clin Nutr. 2006 Jul;84(1):18-28
references.pmid: 16825677
references.citation: Bone. 2008 Aug;43(2):222-9
references.pmid: 18539106
references.citation: Am Fam Physician. 2010 Sep 1;82(5):503-8
references.pmid: 20822086
references.citation: Osteoporos Int. 2010 Jun;21(6):1041-5
references.pmid: 19597911
references.citation: N Engl J Med. 2009 Aug 20;361(8):745-55
references.pmid: 19671656
references.citation: J Bone Miner Res. 2010 Oct;25(10):2239-50
references.pmid: 20499357
references.citation: J Clin Endocrinol Metab. 2012 Sep;97(9):3161-9
references.pmid: 22723310