Osteoporosis and Men
A “Frank” Talk About Osteoporosis: New Guidelines for MenPrint This Post
While still considered a “woman’s disease,” osteoporosis is indeed a problem for men, too. Moreover, among men whose lifestyle habits put them at increased risk, few recognize the disease as a significant threat to their mobility and independence.
Osteoporosis is called a “silent disease” because it often progresses without symptoms until a fracture occurs. It develops less often in men than in women because men have larger skeletons, their bone loss starts later and progresses more slowly, and they have no period of rapid hormonal change and bone loss. However, in the past few years the problem of osteoporosis in men has been recognized as an important public health issue, particularly in light of estimates that the number of men older than 70 years will continue to increase as life expectancy continues to rise.
The Endocrine Society has just released a clinical practice guideline for management of osteoporosis in men. Osteoporosis is characterized by reduced bone strength predisposing to increased fracture risk. Approximately 20% of Americans with osteoporosis or low bone density are men; studies show this condition increases mortality rates in men between 50 and 69 years. Risk factors for osteoporosis in men include low body weight, prior fracture as an adult, low levels of testosterone, and smoking. Additionally, white men appear to be at higher risk compared with black men. Data suggest that 1 in 4 men older than 50 will experience an osteoporosis-related fracture in their lifetime, with mortality after fracture occurring more often in men than in women.
Men in their 50s do not experience the rapid loss of bone mass that women do in the years following menopause. By age 65 or 70, however, men and women are losing bone mass at the same rate, and the absorption of calcium–an essential nutrient for bone health throughout life–decreases in both sexes. Excessive bone loss causes bone to become fragile and more likely to fracture.
Fractures resulting from osteoporosis most commonly occur in the hip, spine, and wrist, and can often be permanently disabling. Hip fractures are especially dangerous. Perhaps because such fractures tend to occur at older ages in men than in women, men who sustain hip fractures are more likely than women to die from complications.[1,3]
There are two main types of osteoporosis: primary and secondary. In cases of primary osteoporosis, either the condition is caused by age-related bone loss (sometimes called senile osteoporosis) or the cause is unknown (idiopathic osteoporosis). The term idiopathic osteoporosis is used only for men younger than 70 years; in older men, age-related bone loss is assumed to be the cause.
The majority of men with osteoporosis have at least one (sometimes more than one) secondary cause. In cases of secondary osteoporosis, the loss of bone mass is caused by certain lifestyle behaviors, diseases, or medications. The most common causes of secondary osteoporosis in men include exposure to glucocorticoid medications, hypogonadism, alcohol abuse, smoking, gastrointestinal disease, hypercalciuria, and immobilization.
The new recommendations from the clinical practice guideline include
- Men at higher risk for osteoporosis (including men aged 70 years or older and men between ages 50 and 69 who have risk factors) should be tested using dual-energy X-ray absorptiometry (DXA).
- Men with low vitamin D levels (<30 ng/ml) should receive vitamin D supplementation to achieve levels of at least 30 ng/mL.
- Clinicians should monitor bone mineral density by DXA at the spine and hip every one to two years to assess the response to treatment.
- Men who are at risk for osteoporosis should consume 1000-1200 mg of calcium daily from dietary sources, with calcium supplements added if dietary calcium is insufficient. Good dietary sources of calcium include dairy products, calcium-fortified orange juice, fresh salmon, and tofu.
- Pharmacologic treatment should be given to men aged 50 or older who have had spine or hip fractures and men at high risk of fracture based on low bone mineral density and/or clinical risk factors. Any drug approved by the U.S. Food and Drug Administration for the treatment of osteoporosis is recommended, and the selection of agent should be determined based on fracture history, severity of osteoporosis, hip fracture risk, and comorbid conditions.
Jill Shuman, MS, ELS
Published June 25, 2012
- Osteoporosis in men. National Institutes of Health Website. http://www.niams.nih.gov/health_info/bone/osteoporosis/men.asp. Updated January 2012. Accessed June 19, 2012.
- Watts NB, Adler RA, Bilezekian JP, et al. Osteoporosis in men: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97(6):1802-1822.
- Richards JS, Young HA, DeSagun R, Kerr GS. Elderly African-American and Caucasian men are infrequently screened for osteoporosis. J Natl Med Assoc. 2005;97(5):714-717.
- Bliuc D, Nguyen N, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513-521.