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

  • 2026-05-22
  • Archives of osteoporosis 21(1)
    • Marco Antonio Araújo da Rocha-Loures
    • Cristiano Augusto de Freitas Zerbini
    • Elaine de Azevedo
    • Laura Christina Martinez
    • Maria Fernanda Brandao de Resende Guimaraes
    • André Silva Franco
    • Juliane Aline Paupitz
    • Mailze Campos Bezerra
    • Vera Lucia Szejnfeld
    • Maria Roberta Melo Pereira Soares
    • Felipe Merchan Ferraz Grizzo
    • Alex Rocha Bernardes da Silva
    • Denise Manjurma da Silva Reis
    • Diego Silveira da Silva
    • Gustavo Waclawovsky

Study Design

Type
Systematic Review
Population
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.

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.

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