title: Osteoporosis Treatment Efficacy for Men: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To evaluate the efficacy of treatment options to reduce osteoporotic fracture risk in men.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Randomized clinical trials that evaluated the efficacy of a treatment for osteoporosis or low bone mineral density for adult men and reported fracture outcomes.
  
  
  METHODS
  Men.
  
  
  METHODS
  PubMed, Embase, and the Cochrane Library databases were searched for relevant studies. Information was extracted from included studies on participant sociodemographic characteristics, number of male participants, treatment evaluated, comparator for evaluated treatment, study duration, and fracture outcomes. Risk of bias of individual studies was assessed using measures recommended by the Cochrane Collaboration.
  
  
  RESULTS
  Twenty-four articles reporting results for 22 studies (including 4,868 male participants) met strict inclusion criteria. Fixed-effects meta-analyses using the Mantel-Haenszel method demonstrated significantly lower risk of vertebral fractures with alendronate (relative risk (RR) = 0.328, 95% confidence interval (CI) = 0.155-0.692) and risedronate (RR = 0.428, 95% CI = 0.245-0.746) but not with calcitonin (RR = 0.272, 95% CI = 0.046-1.608) or denosumab (RR = 0.256, 95% CI = 0.029-2.238) than in controls. For bisphosphonates as a treatment category, meta-analyses demonstrated significantly lower risk of vertebral fractures (RR = 0.368, 95% CI = 0.252-0.537) and nonvertebral fractures (RR = 0.604, 95% CI = 0.404-0.904) than in controls. The meta-analysis finding that bisphosphonates significantly reduce nonvertebral fracture risk was not robust to sensitivity analysis.
  
  
  CONCLUSIONS
  Bisphosphonates reduce the risk of vertebral and possibly nonvertebral fractures for men with osteoporosis. Further studies are needed to evaluate the efficacy of bisphosphonates for reducing nonvertebral fracture risk and the efficacy of nonbisphosphonates for reducing vertebral and nonvertebral fracture risk in men with osteoporosis.
authors.affiliation: Swedish Center for Research and Innovation, Swedish Health Services, Swedish Medical Center, Seattle, Washington.
authors.forename: Smita
authors.initials: S
authors.lastname: Nayak
authors.affiliation: School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Greenspan
mesh_terms: D019386:Alendronate / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002116:Calcitonin / Q000627:therapeutic use; D000069448:Denosumab / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D000068296:Risedronic Acid / Q000627:therapeutic use; D016103:Spinal Fractures / Q000517:prevention & control
chemical_list: D050071:Bone Density Conservation Agents; D000069448:Denosumab; D002116:Calcitonin; D000068296:Risedronic Acid; D019386:Alendronate
keywords: fractures; meta-analysis; osteoporosis; systematic review