Osteoporosis: Often overlooked and undertreated in men

Mention osteoporosis and immediately an image of an elderly woman slumped over walking with a cane tends to come to mind.  However, osteoporosis is not just a “woman’s disease.”  Men also are at risk of developing this brittle bone disease significantly threatening their mobility and independence – and often with worse effects than women.

What is osteoporosis and why are men also at risk?

Often referred to as the “silent disease” osteoporosis can progress with few if any symptoms until a bone is broken.  It’s a disease that causes bones to become thin, weak, and easier to break.  A person will not feel or see their bones getting thinner and most men will not know they have thin bones until a fracture occurs.

Men are less likely to develop the disease than women for several reasons – they have a larger skeleton, bone loss begins at a later age and progresses more slowly in men than in women and men face no period of rapid hormonal change as women do during the transition to menopause. 

But, as the lifespan of men continues to rise, the incidence of osteoporosis in men is rising right along with it.  Overall, one in five men over the age of 50 will have an osteoporosis related fracture which is greater than the likelihood of developing prostate cancer. This means millions of men have low bone mineral density putting them at risk of developing osteoporosis and the consequences of it. 

One consequence is that more men than women will die within a year as a result of a hip fracture and are more likely than women to require care in a long-term facility after such a devastating break.  Not only are hip fractures worse for men than women, men are also less likely to be assessed for osteoporosis or to receive treatment for it after they break a bone.

Risk factors of osteoporosis in men

Men, like women, have several risk factors jeopardizing their likelihood of developing osteoporosis. These determinants are often caused by certain lifestyle behaviors, diseases, or medications which may include:

·      Glucocorticoid medications

·      Other immunosuppressive drugs

·      Hypogonadism (low testosterone levels)

·      Smoking

·      Excessive alcohol consumption

·      Chronic obstructive pulmonary disease and asthma

·      Cystic fibrosis

·      Poor diet with low calcium intakes

·      Lack of physical exercise

·      Hyperparathyroidism

·      If a man is white or Asian, small and thin, or has had a close relative with osteoporosis

·      Any man who has lost more than 1 ½ inches of height or has a stooped posture

How is osteoporosis diagnosed in men?  

A medical workup to diagnose osteoporosis will include a complete medical history, x-rays, along with urine and blood tests.  A bone mineral density test should also be ordered.  This test can identify osteoporosis, determining a man’s risk for fractures and can measure response to osteoporosis treatment.  The most widely recognized bone mineral density test is called a central dual-energy x-ray absorptiometry or central DXA test.  It is painless and is simply a matter of lying on a table as the machine measures bone density. 

Prevention and treatment of osteoporosis for men

If osteoporosis is detected before significant bone loss has occurred it can be effectively treated.

But currently there are no official recommendations for osteoporosis screening in men.  This leaves screening decisions in the hands of men’s physicians or the man himself in asking about whether he should be screened for osteoporosis or not.  The Endocrine Society which represents physicians and scientists specializing in hormonal issues does have guidelines for men when it comes to osteoporosis:

·      All men 70 and older should have a bone density test of the hip and spine.  Any man between the ages of 50 to 69 who have additional risk factors such as low body weight, hypogonadism, long-term use of corticosteroids or a history of alcohol abuse, should be screened. 

·      Men found to be at high risk for fractures based on their bone density and clinical risk factors should be treated with medication and monitored with repeat testing every one to two years.

·      At-risk men should consume 1,000 to 1,200 milligrams of calcium a day – from food first then supplements if needed.  The calcium found in food is much better absorbed than the calcium from a supplement.  The best food sources of calcium are dairy foods such as milk, yogurt, cheese, and cottage cheese.  Plant sources of calcium are not absorbed as well but they include dark green, leady vegetables (bok choy, broccoli, collard greens, kale, and turnip greens).  Other sources of calcium are canned salmon and sardines eaten with the bones and calcium-fortified foods such as orange or grape juice. 

·      All men should do at least 30 minutes of weight-bearing exercise four or five times a week.  Bones become stronger and denser when a man uses his body against gravity such as when he walks, climbs stairs, dances, jumps rope, jogs, or lifts weights. 

·      Alcohol intake should be kept at moderate consumption of no more than 2 drinks a day and men who smoke should quit.

·      Adequate vitamin D is absolutely necessary for the body to be able to absorb and store calcium in bone.  Men with low blood levels of vitamin D should take a vitamin D3 supplement.  Doses of 1,000 to 2,000 IU a day are usually enough to get blood levels to 30 ng/ml or above which is considered optimal.  Some men, however, may need larger doses. 

·      Men should also consume foods containing vitamin D which include milk, cheese, eggs, salmon and some yogurts. 

·      Be proactive in preventing falls.  Most broken bones occur as a result of a fall that could have been prevented.  Prevent falls at home by using nightlights, removing or securing throw rugs, and getting rid of clutter.