Osteoporosis Treatment in Kitchener-Waterloo

Osteoporosis in men is common and often underdiagnosed until a fracture occurs. It can be driven by aging, low testosterone, vitamin D deficiency, steroid exposure, alcohol/smoking, or secondary causes such as hyperparathyroidism, malabsorption, chronic kidney/liver disease, and certain medications. Diagnosis is typically made with a DEXA scan (bone density) plus a focused lab workup to identify reversible contributors. Treatment combines lifestyle measures (protein, calcium/vitamin D, resistance training, fall prevention) with medication when fracture risk is high—most commonly bisphosphonates, and in selected cases anabolic therapies or denosumab.

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Osteoporosis Diagnosis and Treatment

Osteoporosis in men is a “silent” condition where bone strength gradually declines, raising the risk of fragility fractures (hip, spine, wrist) that can lead to major disability. Men are frequently diagnosed later than women, so it’s important to think about osteoporosis when there’s a history of a low-trauma fracture, significant height loss, chronic back pain, long-term glucocorticoid use, or risk factors like smoking, heavy alcohol use, low body weight, low calcium/vitamin D intake, or suspected hypogonadism. A DEXA scan estimates bone mineral density, while tools like FRAX can help quantify 10-year fracture risk; however, the most valuable step is often identifying and treating secondary causes that are common in men. A comprehensive treatment plan usually includes:

Lifestyle and foundations
- Adequate protein intake and a bone-supportive diet
- Calcium (diet first; supplement if needed) and vitamin D repletion when low
- Progressive resistance training + weight-bearing exercise, balance training, and fall-risk reduction
- Smoking cessation and moderating alcohol
Evaluate and treat secondary causes
- Lab work often includes 25-OH vitamin D, calcium, creatinine/eGFR, CBC, TSH, PTH, liver tests, and in many men morning testosterone (with follow-up testing when indicated)
- Address contributors such as glucocorticoids, anticonvulsants, malabsorption, hyperparathyroidism, chronic kidney disease, and untreated hypogonadism
Medications (when fracture risk is elevated)
- Bisphosphonates (e.g., alendronate, risedronate, zoledronic acid) are first-line for many men and reduce fracture risk
- Denosumab can be considered when bisphosphonates aren’t appropriate, with an exit/transition plan to prevent rebound bone loss
- Anabolic therapy (e.g., teriparatide/abaloparatide, and in some settings romosozumab) may be preferred for very high risk patients (multiple fractures, very low T-score), typically followed by an antiresorptive to “lock in” gains
- Testosterone therapy may improve bone density in men with confirmed hypogonadism, but it’s not a stand-alone osteoporosis drug if fracture risk is high—bone-specific therapy is often still needed