More than 10 million Americans have osteoporosis, according to the National Institute on Aging. Eighteen million more have lost enough bone to make them likely to develop the disease. The majority of these 28 million are women. But men are at risk for the bone-thinning disease too.
Osteoporosis gradually weakens bones and can lead to painful and debilitating fractures. It is characterized by low bone density (how solid bones are) and structural deterioration of bone tissue. Often called the "silent disease," osteoporosis usually progresses without symptoms until it is diagnosed following a fracture.
Osteoporosis is seen less often in men than in women because men generally have larger, stronger bones, and because men don't usually experience the abrupt and substantial hormonal changes that women do following menopause. Also, bone loss begins later and advances more slowly in men than it does in women. However, the National Institutes of Health says that the problem of osteoporosis in men recently has been recognized as an important public health issue, especially in light of estimates that the number of men above age 70 will double by 2050.
Today, more than two million American men have osteoporosis, and another 12 million are at risk for the disease, according to the National Osteoporosis Foundation. Each year, men suffer one-third of all hip fractures, and one-third of these men will not survive more than one year. In addition to hip fractures, men most often experience fractures of the spine and wrist due to osteoporosis.
But changing attitudes and improved technology are brightening the outlook for men with osteoporosis. Although some bone loss is expected as men age, osteoporosis is no longer viewed as an inevitable consequence of aging. Diagnosis and treatment need no longer wait until bones break. New products are becoming available specifically to treat men with osteoporosis.
Risk Factors/Prevention Measures
|
Factors that increase the risk of osteoporosis include:
|
|
|
|
|
|
|
|
|
| |
|
Measures to take to prevent osteoporosis include:
|
|
|
- Drink only in moderation.
|
- Exercise regularly, especially doing weight-bearing activities.
|
- Get adequate vitamin D. (Men under age 50 need 400-800 IU of vitamin D daily. Men age 50 and over need 800-1,000 IU of vitamin D daily.)
|
-
Eat a balanced diet rich in calcium.
|
Bone Life
Bones grow in length and density during a person's younger years. Bone density relates to the mineral content of the tissue. People reach their maximum height during their teens, but bone density continues to increase until about age 30. After that point, bones slowly start to lose density and strength. Throughout life, bone density is affected by heredity, sex hormones, physical activity, diet, lifestyle choices, and the use of certain medications.
In their 50s, men do not experience the rapid loss of bone mass that women have in the years following menopause. "But some men do have a hormonal drop-off in testosterone, with skeletal consequences that are similar to those seen in women following reduction of estrogen," explains Bruce Schneider, of the FDA's Division of Metabolic and Endocrine Drug Products.
Testosterone may diminish as a result of hypogonadism, a condition marked by decreased function of the testicles. Testosterone levels will also decrease naturally as a man ages. Eventually, this loss of sex hormone can accelerate bone loss. Whether bone loss at this point translates into osteoporosis, however, depends on how much bone a man has when the loss begins, and how quickly he loses it.
By age 65 or 70, men and women lose bone mass at similar rates, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes.
Prevention and Diagnosis
In men, there are two main types of osteoporosis: primary and secondary. In primary osteoporosis, there might be no identifiable cause (idiopathic) or it could be the result of age-related bone loss. Often, these two conditions overlap, and distinguishing between them is arbitrary.
Secondary osteoporosis in men has a variety of causes. Low testosterone (hypogonadism), excessive use of medications such as the steroid prednisone, and alcoholism are notable causes of secondary osteoporosis in men.
Once bone is lost, it cannot be completely replaced using currently available therapies. Therefore, it is essential that men be evaluated and treated before significant bone loss has occurred. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. Although it cannot be cured, osteoporosis can be slowed down, and steps can be taken to help prevent the disease.
A special kind of X-ray, the bone mineral density (BMD) test, is a safe, accurate, quick, painless, and noninvasive way to diagnose osteoporosis, detect low bone density, monitor the effectiveness of treatments, and predict the risk for future fractures. Mone Zaidi, MD, PhD, at the Mount Sinai School of Medicine in New York, says that men should get a BMD test if they have a bone fracture, experience lower back pain, or notice height loss. "If one falls on an outstretched hand, that shouldn't break the wrist," says Zaidi. "If it does, there's a problem."
Treatments
Tailored to the particular reason for bone loss, the treatment plan for men with osteoporosis will include proper nutrition, exercise, and lifestyle modifications for preventing more bone loss and, if needed, one of the FDA-approved osteoporosis medications.
The FDA-approved drugs Fosamax® (alendronate) and Actonel® (risedronate) are used to increase bone mass in men with osteoporosis. They work by reducing the activity of the cells that cause bone loss. Both of these drugs have come under scrutiny by the FDA because of some isolated but serious related side effects.
An anabolic steroid medication – Forteo® (teriparatide) – has been FDA-approved to treat osteoporosis in men. But it, too, can cause some serious side effects. Talk with your doctor if you are taking these medications or are considering it.
For their male patients with osteoporosis, doctors might want to monitor bone density and testosterone levels, and recommend testosterone replacement if it's called for. They might also suggest changes to any current steroid dosage if they feel bone loss is due to steroid use. Finally, they will likely point out that maintenance of adequate calcium and vitamin D intake is very important in the treatment and prevention of osteoporosis. |
