The first step in the prevention and treatment of osteoporosis is increasing one's intake of calcium to 1200-1500 mg daily, along with 800 IU (international units) of vitamin D.
Medications called bisphosphonates are the most effective treatments for osteoporosis and osteopenia for both men and women. Two bisphosphonates, alendronate (Fosamax) and risedronate (Actonel), are approved for the treatment and prevention of osteoporosis in men.
A third drug, a preparation of parathyroid hormone called teriparatide (Forteo), is also approved for use in men for this purpose. Men who are on androgen-deprivation therapy for treatment of prostate cancer or who take steroid medications like prednisone long-term should take these medications to help prevent osteoporosis.
At first, bisphosphonates had to be taken every day to be effective. Later studies showed that a larger dose of either Fosamax or Actonel was effective when taken only once a week. In 2005 the FDA approved ibandronate (Boniva), a bisphosphonate that can be taken once a month. These newer dosing possibilities should overcome the major reason why bisphosphonates do not work: many people fail to take them on a regular basis.
Of course, unless they are undergoing androgen-deprivation therapy for prostate cancer, men with very low levels of testosterone should be treated with testosterone replacement, either with injections every other week or with a testosterone patch or gel.
Another critical element in the management of osteoporosis in both men and women is the prevention of falls, which increase the danger of hip fractures.
The National Osteoporosis Foundation recommends osteoporosis screening for all women 65 years or age or older, but there are no official guidelines for when to screen men for osteoporosis. In addition, most men and many doctors are unaware of the frequency of osteoporosis in men.
As a result, men often do not get screened for osteoporosis, and testosterone levels are not always measured even when younger men have symptoms of low testosterone (hypogonadism) such as loss of libido, impotence, decreased stamina, and diminished strength.
