Severity of the osteoporosis problem in men: diagnostic and treatment challenges

Severity of the osteoporosis problem in men: diagnostic and treatment challenges

L.E. Sivordova, Yu.V. Polyakova, E.V. Papichev, Yu.R. Akhverdyan, B.V. Zavodovsky

A.B. Zborovsky Research Institute of Clinical and Experimental Rheumatology, Volgograd

Background: osteoporosis (OP) in males is a significant medical and social concern, which is frequently underestimated in routine clinical practice.

Aim: to assess the prevalence of OP among men in the Southern Federal District of the Russian Federation and to evaluate their therapy adherence.

Patients and Methods: a retrospective analysis of the outpatient records of 18,120 patients fr om the regional Center for the Diagnosis and Treatment of Osteoporosis in Volgograd, combined with a three-year prospective evaluation of therapy adherence.

Results: of all patients attending the Center, women made up 91.03%, while men accounted for 8.97%. Osteoporosis was diagnosed in 34% of female patients and in 15.5% of male patients. Overall, 14% of patients experienced fractures, with fracture occurrence showing a statistically significant (p<0.05) association with increasing age (p<0.001). In those diagnosed with OP, men had a significantly higher fracture rate (60.31%) compared to women (48.52%). All patients with osteoporosis and/or high fracture risk based on FRAX were advised to start pathogenetic therapy. Yet, 12% of women and 27% of men did not commence treatment. Of those prescribed therapy, 4935 women and 184 men began treatment, with response rates of 88% for women and 73% for men. The majority of men selected zoledronic acid (65.22%) or alendronates (17.9%) as their therapy. However, only 30% of men adhered fully to alendronates therapy, 50% to denosumab and teriparatide, and 72% to zoledronic acid.

Conclusion: male patients are ten times less likely than female to attend the OP Center and demonstrate lower adherence to therapy. In situations wh ere patient compliance is likely to be low, zoledronic acid is preferable due to its annual administration schedule, which, when monitored by healthcare staff, enables full treatment compliance and high therapeutic efficacy.

Keywords: osteoporosis in men, fractures, bone metabolism, bone remodeling, anti-resorptive therapy, zoledronic acid, denosumab, alendronates.

For citation: Sivordova L.E., Polyakova Yu.V., Papichev E.V., Akhverdyan Yu.R., Zavodovsky B.V. Severity of the osteoporosis problem in men: diagnostic and treatment challenges. RMJ. 2025;7:19–25. DOI: 10.32364/2225-2282-2025-7-4