Approaches to diagnosis and treatment of osteoporosis and prevention of recurrent fractures in men in therapeutic practice: Clinical cases

Low-energy osteoporotic fractures in men, especially of the proximal femur, can cause disability and premature mortality. The authors bring to the discussion the relevance of early diagnosis and treatment of osteoporosis in men. The article presents two clinical cases of severe osteoporosis in men with a detailed analysis of the diagnostic algorithm in accordance with clinical guidelines and a discussion of the choice of zoledronic acid for the treatment of this category of patients. The first clinical case describes the case history of a patient (age 58 years) who underwent total hip replacement of the right hip joint for a low-energy fracture of the proximal femur. The specialist of the Osteoporosis Prevention and Treatment Cabinet identified risk factors contributing to the development of secondary osteoporosis (long history of smoking, alcohol abuse, comorbidities). X-ray osteodensitometry confirmed a decrease in bone mineral density in axial sections of the skeleton. Monitoring of these parameters one year after zoledronic acid infusion showed a 7.5% increase in bone mineral density in the lumbar vertebrae and a 2% increase in the femoral neck. It was decided to continue therapy with zoledronic acid for up to 6 years. The second case demonstrates the efficacy of antiresorptive therapy (zoledronic acid 5 mg/100 ml) in a 68-year-old patient with a severe form (compression fractures of two thoracic vertebral bodies) of primary osteoporosis with an aggravated family history. Observation of the patient for the next two years showed regression of pain, increase of bone mineral density, absence of new fractures, which confirmed the correct choice of zoledronic acid as a first line drug in the treatment of osteoporosis.