Professor University of Rhode Island, Rhode Island, United States
Background: Evidence on the effectiveness of osteoporosis medications in men is limited, as existing studies mainly focus on postmenopausal women. The characteristics of male patients treated with osteoporosis medications and the real-world effectiveness of these treatments remain unclear.
Objectives: This study aims to examine the characteristics of men treated with osteoporosis medications under real-world conditions and assess the impact of these treatments on fracture rates.
Methods: This retrospective cohort study utilized data from the national Veterans Affairs Healthcare System. We included active male users aged 50 years and older with at least one osteoporosis medication dispensed (alendronate, risedronate, denosumab, teriparatide, zoledronate) between January 1, 2018, and December 31, 2023. Patients with osteoporosis medications in the 18 months before the index date or diagnosed with cancer or Paget's disease within 18 months before and 3 months after the index date were excluded. We assessed change in fracture rates between the early treatment period (0-3 months) and the subsequent follow-up period (4-15 months), with incidence rate ratios calculated for all fractures, vertebral fractures, hip fractures, and other fractures using Poisson regression. Subgroup analyses within the alendronate cohort were conducted by age ( <75, ≥75 years) and fracture history in the year prior to the index date.
Results: A total of 33,387 patients were included in this study. The denosumab cohort, with an average age of 78.2 years (±9.2), was significantly older than the other groups. The teriparatide cohort had the highest proportion of patients with a fracture history in the past year (27%) and the highest fracture rate during early treatment (13.17 per 100 person-years). In terms of longitudinal changes in fracture rates, none of the treatment cohorts demonstrated a significant reduction in the incidence of all types of fractures—including all fractures, hip fractures, vertebral fractures, and other fractures. In the subgroup analysis of the alendronate cohort, alendronate significantly reduced the all-fracture rate in patients under 75 years (IRR=0.82, 95% CI: 0.71–0.94), and in those without a fracture history in the year prior to treatment initiation, it significantly reduced all fractures (IRR=0.71, 95% CI: 0.61–0.82) and vertebral fractures (IRR=0.47, 95% CI: 0.38–0.60).
Conclusions: This study found that osteoporosis treatments were not effective in reducing fracture rates in men. However, subgroup analyses showed that alendronate significantly reduced the rate of all fractures in men under 75 years, and significantly reduced both all fractures and vertebral fractures in those without a fracture in the year prior to treatment initiation.
