Short answer: Six US osteoporosis medicines are approved for men: alendronate (Fosamax), risedronate (Actonel), zoledronic acid (Reclast), denosumab (Prolia), teriparatide (Forteo) and abaloparatide (Tymlos). Romosozumab (Evenity) is approved only for postmenopausal women. The men's approvals are worded as treatment "to increase bone mass" or bone density, based on trials that measured bone density.
| Medicine | How it is given | Approved for men |
|---|---|---|
| Fosamax (alendronate) | Tablet, daily or weekly | Yes, to increase bone mass in men with osteoporosis |
| Actonel (risedronate) | Weekly tablet for men | Yes, to increase bone mass in men with osteoporosis |
| Reclast (zoledronic acid) | Once-yearly IV infusion | Yes, to increase bone mass in men with osteoporosis |
| Prolia (denosumab) | Injection every 6 months | Yes, men at high risk of fracture; also men on hormone therapy for prostate cancer |
| Forteo (teriparatide) | Daily injection | Yes, men with primary or low-testosterone osteoporosis at high risk of fracture |
| Tymlos (abaloparatide) | Daily injection | Yes, men at high risk of fracture |
| Evenity (romosozumab) | Monthly injections | No, postmenopausal women only |
Fosamax, Actonel, Reclast, Prolia and Forteo are also approved for steroid-induced osteoporosis in men and women. Prolia's prostate cancer approval covers men with nonmetastatic cancer on androgen deprivation therapy who are at high risk of fracture.
| Medicine | Trial | Spine bone density |
|---|---|---|
| Fosamax 10 mg daily | 241 men, 2 years | 5.3% higher than placebo |
| Fosamax 70 mg weekly | 167 men, 1 year | 2.8% higher than placebo |
| Prolia | 242 men, 1 year | 4.8% higher than placebo |
| Prolia, on prostate cancer hormone therapy | 1,468 men, 2 years | 6.7% higher than placebo; fewer new spine fractures at 3 years |
| Reclast | 302 men, 2 years | 6.1% vs 6.2% on a weekly oral bisphosphonate |
| Tymlos | 228 men, 1 year | 8.5% vs 1.2% on placebo |
| Forteo | 437 men, median 10 months | Rose in 94% of treated men; 53% gained at least 5% |
Apart from the Prolia prostate cancer trial, these men's trials measured bone density as the main result rather than fractures. The Fosamax label says results were similar regardless of age or baseline testosterone, and the Prolia label says the same for testosterone levels.
The NIAMS says osteoporosis is the major cause of fractures in older men as well as postmenopausal women, and that many men wrongly think they are not at risk. Women have the higher risk, but men are still at risk, especially after age 70.
On testosterone, the NIAMS says men with conditions that cause low testosterone are at risk for osteoporosis, but the gradual fall in testosterone with age is probably not a major reason for bone loss. The Fosamax and Actonel labels add that before treating steroid-induced osteoporosis, the hormone status of both men and women should be checked and replacement considered.
Which medicine fits is a decision for the prescriber. Each one has its own warnings, such as jaw problems and what happens when Prolia is stopped.
Weekly tablets, yearly infusions and twice-yearly injections are easy to lose track of. Dose Track can remind you of each one and keep bone density results on the same timeline.
Read more on Dose Track: Fosamax side effects · Prolia side effects · Forteo vs Tymlos · Fosamax vs Prolia · Bone mineral density