Two male osteoporosis studies, kyphoplasty, and need for follow up after tests done
Alendronate for osteoporosis in men with androgen-repleted hypogonadism. See Osteoporos Int. 2005 Mar 15; [Epub ahead of print], Shimon I and others. PMID: 15768312. (See the Merriam-Webster online dictionary for the definition of replete, a word not commonly used that might be misunderstood. Basically, it means the hypogonadism in the men with osteoporosis has been treated with testosterone replacement therapy.) It is possible to treat osteoporosis in young hypogonadal males with nothing but testosterone replacement therapy, i.e., no bisphosphonates, or other approved osteoporosis therapies. But it is not as effective in older men. This study looked at the effect of adding alendronate (Fosamax), 10-mg daily, along with the testosterone therapy, in 22 osteoporotic hypogonadal men aged 29-69 years. You can check the abstract from the PMID link to see all the results. In summary, there was considerably more improvement in bone mineral density (BMD) in the alendronate group (alendronate plus testosterone) than the placebo group (placebo plus testosterone). There was also an open-label two-year continuation with all subjects using 70-mg once-weekly alendronate. These results showed no significant increase in BMD in the original alendronate group, but significant improvement in the original placebo group now taking alendronate. The authors conclude, "Our results support the long-term administration of alendronate along with testosterone replacement to men with hypogonadism-induced osteoporosis." Editor's comments: This study is very timely. I have an appointment with my endocrinologist tomorrow at which time I was going to discuss the possibility of maintenance therapy using only testosterone (stopping my current maintenance dose of 35-mg once-weekly Fosamax) since my BMD is now in the normal range everywhere. My thinking was that, now that my BMD is normal, testosterone should be effective at keeping it there since there is no other obvious reason for my osteoporosis other than hypogonadism. This study has me changing my thinking, although I will discuss it and all my options at tomorrow's appointment.
Bone resorption and osteoporotic fractures in elderly men: the dubbo osteoporosis epidemiology study. See J Bone Miner Res. 2005 Apr;20(4):579-87. Epub 2004 Dec 6. Meier C and others, PMID: 15765176. Generally the main risk factor for fracture would be BMD. This study, however, shows that bone turnover rate is also a significant factor--one that should be considered and tested for. This was a case-cohort control study with 50 men with low-trauma fractures and 101 men of similar age without fractures followed for 6.3 years. BMD of the lumbar spine (LSBMD) and femoral neck (FNBMD) were evaluated at baseline and bone resorption was measured with a biochemical marker of resorption, S-ICTP. Bone formation was also measured with a biochemical marker for formation, S-PINP. The most important finding was that, "The incidence of osteoporotic fractures was 10 times higher in men with high S-ICTP and low FNBMD compared with men with low S-ICTP and high FNBMD." Editor's comments: It appears that elderly men with low BMD would also benefit from having biochemical tests that show their bone resorption/turnover. Knowing how serious the risk of fracture is could lead to better compliance when taking medications and more caution when trying to prevent fractures.
Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. See J Bone Miner Res. 2005 Apr;20(4):604-12. Epub 2004 Dec 6. Kasperk C and others, PMID: 15765179. (There is a segment on vertebroplasty and kyphoplasty on this Website where you can get details on the two techniques). This article includes 60 patients with osteoporosis and painful vertebral fractures presenting for chronic pain for greater than 12 months. (Note that kyphoplasty is normally suggested during the acute phrase of a fracture, thus this study is using a different patient pool than most other studies). Forty of the patients decided to have kyphoplasty while twenty decided to act as controls and have no therapy. Each group was assessed before therapy and at 3 and 6 months after therapy with several tests to help determine effectiveness of therapy. The results showed a very significant improvement in vertebral height of the treated vertebral bodies compared to the loss of height in the controls. As well there was a reduction in back pain, improvement in the VAS pain score, and EVOS score in the kyphoplasty group, with less or no significant improvement in the control group. The authors concluded, "Kyphoplasty performed in appropriately selected osteoporotic patients with painful vertebral fractures is a promising addition to medical treatment." Editor's comments: These results are promising, and indicate that kyphoplasty can be helpful. Patients should be careful to evaluate the physician and center where they expect to have therapy. You want someone with experience and a history of many satisfied patients. As mentioned in the article on this topic on this Website, the procedure can have negative results, so you must be prepared for that.
Failure to recognize and act on abnormal test results: the case of screening bone densitometry. See Jt Comm J Qual Patient Saf. 2005 Feb;31(2):90-7. Cram P and others. PMID: 15791768. This study found that, of 48 newly diagnosed osteoporosis patients, 16 did not receive a recommendation for treatment. There was no evidence the the scan results were reviewed in 11 of 16 cases, and 5 patients had scans reviewed but no treatment was recommended. This study highlights why there is a continuing theme on this Website about being careful to evaluate your own tests and therapy. Don't leave everything to your physician who simply can't be as interested in your health as you are. If you have lab, X-ray, DXA, or other tests done, mark your calendar for a week or so down the line and then call to get the results if you haven't heard. Don't assume the results are normal just because no one called. It is your life and health, do everything you can to assure yourself you are getting the best care possible.