Although most men think of osteoporosis as a "woman's disease," the truth is that bone mass peaks in everyone during the third decade of life and then gradually starts to decline.
Because women accumulate less bone mass when they're young, and often experience rapid bone loss in the years following menopause, they're much more likely than men to develop the first signs of osteoporosis in their fifties. But by age 65 or 70, both women and men lose bone mass at the same rate.
In the United States, more than 2 million men are at high risk of developing osteoporosis, and a man over age 50 has a 25% chance of having an osteoporosis-related fracture during his remaining lifetime.
Osteoporosis-related fractures most commonly affect the hip, spine, and wrist. Men who sustain a hip fracture -- which is especially likely to cause permanent disability -- are usually older than their female counterparts and are significantly more likely to die from its complications. More than 50% of men who sustain a hip fracture are transferred from the hospital to a nursing home. Of those who survive for one year, nearly 80% continue to live in nursing homes or intermediate-care facilities.
Risk factors for osteoporosis in men include:
- Unhealthy habits such as smoking, excessive alcohol use, low calcium intake, and a sedentary lifestyle. Throughout life, regular weight-bearing exercise such as walking, jogging, dancing, racquet sports, team sports, weightlifting, and using resistance machines is essential for bone health.
- A low level of the sex hormone testosterone.
- Prolonged use of some medications. These include glucocorticoids, other medications that suppress the immune system, and anticonvulsants.
- Chronic diseases. These include chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, ankylosing spondylitis, rheumatoid arthritis, systemic mastocytosis, and hypercalciuria; conditions affecting hormone production; and gastrointestinal disorders that impair absorption of essential nutrients for bone health such as calcium, magnesium, phosphorous, and vitamins D and K.
- Immobilization. Prolonged bed rest due to illness, surgery, fracture, or spinal cord injury can result in rapid bone loss.
Diagnosing osteoporosis involves a medical workup including a complete medical history, x-rays, urine and blood tests. Your doctor also may order a bone mineral density test such as dual-energy x-ray absorptiometry (DXA), which can identify osteoporosis, estimate fracture risk, and measure response to osteoporosis treatment.
The National Osteoporosis Foundation recommends routine DXA screening for women over age 65 and men over age 70. But screening for men may or may not be covered by insurance.
In July 2010, the U.S. Preventive Services Task Force (USPSTF) issued a draft update which expands its 2002 screening recommendations to call for increased screening of women over age 65, and in younger women whose fracture risk is at least as great as that of 65-year-old women with no additional risk factors. Although the draft update acknowledges that men with certain conditions are at higher risk of osteoporosis, it states that there is insufficient evidence to support general screening in older men.
The USPSTF's final recommendations won't be released until after a period of public comment. Organizations such as The Endocrine Society are urging the USPSTF to revise its update to recommend that women and men with clinical risk factors for osteoporosis be screened at the same rate.
The USPSTF recommendations are important because they determine which services are covered by Medicare and Medicaid. Life Line Screening uses ultrasound to measure bone mineral density at the heel and identifies three levels of risk: low, mild/moderate, and high. Most men who are found to have abnormal results during a Life Line Screening are able to get a DXA test covered by their insurance.
Treatment for osteoporosis in men may include one of the prescription medications approved by the U.S. Food and Drug Administration. These include oral bisphosphonates such as alendronate (Fosamax) and risedronate (Actonel), and the injection drug teriparatide (Forteo). If prolonged glucocorticoid use is responsible for bone loss, your doctor may prescribe a medication approved to prevent or treat glucorticoid-induced osteoporosis.
Other treatment strategies may include calcium and/or vitamin D supplements, nutritional counseling, and lifestyle recommendations to stop smoking, reduce or discontinue alcohol consumption, and increase weight-bearing exercise.
Learn more about osteoporosis
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SOURCES:
http://www.niams.nih.gov/
http://www.nih.gov/
http://www.kevinmd.com/blog
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