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CME: From undertreated to undertaken: bones, bros, and better outcomes in men’s osteoporosis

Activity Description / Statement of Need:

In this online, self-learning activity:

Osteoporosis in aging men is a growing public health problem yet remains under-recognized in primary and specialty care. Population-based cohorts show that adults aged ≥80 years now account for most hip fractures, and in this age group men experience higher perioperative morbidity and mortality than women at comparable ages. Contemporary US trend analyses confirm a high and in some groups increasing prevalence of osteoporosis and low bone mass among adults ≥50 years, with substantial burden among older men. Health-economic models and actuarial reports estimate more than two million osteoporotic fractures annually in the United States, costing about $17 billion in 2005 and rising to an estimated $57 billion over the past two decades, with further growth expected by 2040; men already account for more than one-quarter of this burden. Prospective outcomes work from the ICUROS US study and Medicare claims analyses underscores prolonged quality-of-life loss and markedly higher all-cause costs after fragility fractures, especially hip and vertebral fractures in older adults, including men.

Target Audience:

HCPs including but not limited to: primary care physicians and endocrinologists; physician assistants, nurse practitioners, and pharmacists who practice in endocrinology and internal medicine; and any other HCPs with an interest in or who clinically encounter male patients with osteoporosis.

Commercial Support Disclosure: This program is supported by educational grants from Radius Health, Inc. 

This activity is free of charge.

Release Date: April 30, 2026 -- Expiration Date: April 30, 2028

Faculty: Azeez Farooki, MD

Agenda

Faculty introduction, disclosures

Introductory content 

  • Epidemiology and health economics and outcomes research: trends in osteoporosis prevalence in US men; lifetime fracture risk; mortality and disability after hip and vertebral fractures; direct and indirect costs to Medicare and health systems
  • Disease state and pathophysiology: age-related sex-steroid decline, secondary hypogonadism, glucocorticoid-induced osteoporosis, ADT-associated bone loss, and other secondary causes common in men
  • Risk assessment and imaging: male-specific indications for DXA ± VFA; prioritizing which men to image first (prior fracture, ADT, chronic steroids, very old age, frailty, and high-risk comorbidities)
  • Technical optimization of DXA ± VFA in men: positioning, scan modes in obesity and kyphosis, vertebral fracture assessment, and integrating body-composition data into fracture and falls risk discussions 
  • Interpreting borderline FRAX/Garvan in very old men: when to rely on hip BMD and clinical judgment over risk calculators at traditional thresholds

Treatment of osteoporosis in men

  • Goals of pharmacotherapy and treatment selection in men: aligning fracture risk category with choice of oral vs IV bisphosphonate, denosumab, romosozumab, or anabolic-first strategies (e.g., abaloparatide) and subsequent antiresorptive consolidation 
  • Sequencing and special situations 
      • Anabolic-first approaches (abaloparatide, romosozumab) in very-high-risk men (recent hip/vertebral fracture, multiple fractures, very low T-scores, ongoing ADT or glucocorticoids) and transition to denosumab or bisphosphonates
      • Managing therapy around ADT and other iatrogenic risks; embedding DXA/VFA and treatment orders at ADT initiation
      • Avoiding testosterone as a substitute for osteoporosis pharmacotherapy in men with hypogonadism
      • Navigating originator vs biosimilar options for parenteral osteoporosis therapies: evidence review, formulary considerations, and practical guidance on switching while maintaining fracture protection
  • Post-fracture fast-tracks and FLS as secondary prevention: standing orders for DXA ± VFA, early initiation of bone-directed therapy (within 30 days), and coordination with FLS or equivalent programs
  • Non-pharmacologic care (adjunctive, not substitutive):
      • Calcium and vitamin D sufficiency protocols; nutrition optimization with adequate protein; exercise and lifestyle counseling, including smoking cessation 
      • Fall-risk reduction: home safety, vision/hearing optimization, footwear and assistive devices, and medication review for sedatives/orthostasis 
  • Monitoring, persistence, and emerging topics:
      • Using bone-turnover markers and DXA at 3–6 and 12–24 months to judge response and guide continuation, sequencing, or switching 
      • Integrating GLP-1 receptor antagonist-based weight-loss regimens with osteoporosis therapy; implications for bone density and fracture risk
  • Digital decision-support tools and registries for tracking male osteoporosis quality metrics (DXA/VFA completion, time to treatment, persistence, fracture outcomes)
  • Patient case(s) 

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Identify male-specific triggers warranting DXA ± VFA and prioritize imaging accordingly; Recall when to select different pharmacotherapeutic strategies in men based on fracture risk, comorbidity (including ADT), and practical considerations.
  • Evaluate persistence and revise therapy at 3–6 and 12–24 months using labs/bone-turnover markers and DXA, specifying thresholds that trigger therapeutic adjustment or sequence changes.
  • Develop a treatment plan for a man with osteoporosis taking into account: bone-directed therapy (including within 30 days post-fracture) and calcium/vitamin D sufficiency.
  • Describe risk-interpretation principles in aged men when estimates are borderline, incorporating hip BMD and clinical factors to decide active treatment versus monitoring.
  • Recognize that testosterone therapy for hypogonadal men has not been shown to prevent fragility fractures.

Accreditation

ACCME Activity #203692340

ScientiaCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CME-MOC_badge

ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.75 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

ABIM MOC Credit Type: Medical Knowledge

Physicians: For maintenance of certification (MOC) points, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC points for this activity. By providing this data, you acknowledge that it will be shared with ACCME and the applicable certifying board. Please note: Not all activities on this site provide MOC points. If this activity does not specify that it provides MOC points in this section, then it does NOT provide MOC points. This activity provides MOC points only for ABIM.

Pharmacists

ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 0.75 contact hours  of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-26-013-H01-P. This is an Application (A)-type activity. 

Pharmacists: You must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurses: This activity is designated for up to 0.75 AMA PRA Category 1 Credit(s)™, and the American Nurses Credentialing Center (ANCC) accepts AMA PRA Category 1 Credit(s)™ to meet the continuing education renewal requirements of nursing re-certification for APRNs and RN specialty. Some state nursing boards accept AMA PRA Category 1 Credit(s)™ for re-licensure requirements, some do not. Check your state board of nursing's CE requirements before applying credit from this course to your re-licensure.

Physician Assistants: The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credit™ assigned by organizations accredited by the ACCME as satisfying Category 1 CME for National Commission on Certification of Physician Assistants (NCCPA) national certification maintenance. This activity is designated for up to 0.75 AMA PRA Category 1 Credit(s)™.

Nurse Practitioners: The American Academy of Nurse Practitioners Certification Board (AANPCB) states that continuing education providers accredited by the ACCME may provide acceptable, accredited Advanced Practice Provider content. This activity is designated for up to 0.75 AMA PRA Category 1 Credit(s)™.


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Disclosures of Faculty: Azeez Farooki, MD, Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, has received financial compensation from Ascendis, Parabilis and Novartis for consulting services; as well as speakers bureau work for Ascendis.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.  

Faculty WILL NOT discuss off-label uses of a commercial product. 

All relevant financial relationships have been mitigated. 

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from Radius Health, Inc. 

Instructions

  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

PC
Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
MAC
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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