Management of osteoporosis in older men: a systematic review of randomized trials of pharmacological and non-pharmacological strategies

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Modest improvements in BMD for bisphosphonates and teriparatide

• Primary Outcome: Fracture risk reduction - inconsistent effects across studies

• Nnt Or Sensitivity: Not calculable from available data - insufficient fracture risk reduction evidence

• Confidence Interval: Not reported in abstract

Clinical Application

Pharmacological interventions readily available; resistance exercise programs require structured implementation and patient compliance Bisphosphonates and teriparatide available on PBS for osteoporosis. RACGP guidelines support bone health assessment in older men. TGA-approved medications align with study interventions Older men (≥60 years) with confirmed osteoporosis (T-score ≤-2.5) in primary care and specialist settings

Abstract

INTRODUCTION: Osteoporosis in older men is often underdiagnosed and undertreated, increasing the risk of fractures and functional decline. Despite its clinical relevance, evidence specific to this population remains limited. This systematic review evaluated the effectiveness of pharmacological and non-pharmacological interventions in reducing fracture risk and improving bone mineral density (BMD) in older men with primary or secondary osteoporosis. METHODS: Searches were conducted in PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, SciELO, PEDro, and LILACS, in addition to gray literature sources. Randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological interventions were included. Analyses were performed using RStudio (v. 4.3.3), and risk of bias was assessed using the RoB 2 tool. Results Twelve RCTs were included (10 pharmacological, one nutritional, and one exercise-based). The mean age was 60.9 ± 5.2 years, with baseline T-scores of - 2.9 ± 0.3 at the lumbar spine and - 2.7 ± 0.4 at the femoral neck. Bisphosphonates and teriparatide showed modest improvements in BMD, while effects on fracture risk were inconsistent. Resistance exercise (60-90 min/day) and L-carnitine supplementation were associated with BMD benefits, although evidence was limited by methodological constraints. Risk of bias varied across studies. CONCLUSION: Pharmacological therapies improve BMD in older men; however, evidence remains insufficient to demonstrate consistent fracture risk reduction. Non-pharmacological interventions show potential benefits but are supported by limited evidence. Larger randomized trials with clinically relevant outcomes are needed.

References

1. 1.da Rocha-Loures, M. A., de Freitas Zerbini, C. A., de Azevedo, E., Martinez, L. C., de Resende Guimaraes, M. F. B., Franco, A. S., Paupitz, J. A., Bezerra, M. C., Szejnfeld, V. L., Pereira Soares, M. R. M., Grizzo, F. M. F., da Silva, A. R. B., da Silva Reis, D. M., da Silva, D. S., & Waclawovsky, G. (2026). Management of osteoporosis in older men: a systematic review of randomized trials of pharmacological and non-pharmacological strategies. Archives of Osteoporosis. https://doi.org/10.1210/jc.2011-3045