Does medicine perform differently?

Dear Dr. Roach: I am 65 and get very little exercise due to a below-the-knee amputation I had 27 years ago. Although I have a prosthesis, I experience open sores. I have been diagnosed with severe arthritis and severe osteoporosis. My doctor has me taking alendronate, calcium and vitamin B. A recent column of yours and the info in the box of alendronate refer primarily to how it works in women. What about men? — G.K.

Although women get osteoporosis earlier than men do, older men are also prone to developing osteoporosis. Eight million men in the U.S. have low bone mass or osteoporosis, and they are less likely to be either diagnosed or treated than women are.

The first step in treatment is related to lifestyle: diet, exercise, reduction of alcohol if indicated and tobacco cessation. Unfortunately, because of your leg amputation and sores, exercise is going to be difficult for you. Calcium (1,200 mg daily) and vitamin D (800 IU daily) are recommended.

All men with osteoporosis should be evaluated for low testosterone, and treated if levels are low. Low testosterone is the most common identifiable cause. Other conditions that should be considered include celiac disease, Crohn’s disease and use of glucocorticoids.

If medication treatment is needed, a bisphosphonate, such as the alendronate (Fosamax) you are taking, is considered first-line treatment for men. It works the same way in men as it does in women. As in women, treatment should be re-evaluated after five years. Pausing or stopping medication is often appropriate at that time.

The recent column I think you are referring to was on raloxifene, an estrogen-like drug that is not appropriate in men. Denosumab or teriparatide are alternatives to bisphosphonates for use in men with osteoporosis.