The Dangers of Overlooking Osteoporosis in Men

Osteoporosis involves low bone mass, microarchitectural deterioration of bone tissue, and increased bone fragility, which increase susceptibility to fracture. These changes don’t produce symptoms, especially early in the disease process. Generally, osteoporosis manifests itself and comes to the attention of health care providers only after a fracture occurs. Even then, doctors may not screen or prescribe osteoporosis treatments for male patients. Statistics on men and this condition are alarming because osteoporosis remains undiagnosed and untreated in men too often. Learn the hazards of ignoring this critical problem so you can make this silent disease a priority, receive prompt care, and avoid dangerous complications.

Staggering Statistics

The National Osteoporosis Foundation (NOF) estimates that 2 million American men have osteoporosis and 12 million more are at risk of developing this disease. Some three to six percent of U.S. men have osteoporosis of the hip while osteopenia, its precursor, affects 28-47 percent. One in eight men older than age 50 is likely to experience an osteoporosis-related fracture during his lifetime. The NOF projects the worldwide incidence of hip fractures in men to increase 310 percent by 2050. According to the International Osteoporosis Foundation (IOF), one-third of all hip fractures worldwide occur in men. IOF president John Kanis noted that the lifetime risk of having an osteoporotic fracture in men over 50 years old is up to 27 percent, which is higher than their prostate cancer likelihood. Research links hip and vertebral fractures to increased morbidity and mortality in men. Men are less likely than women to survive their injuries or regain mobility. The mortality rate is up to 37 percent in the first year following a fracture. In 2008, a five-year study revealed that 90 percent of men who’d sustained fragility fractures hadn’t received osteoporosis screening or treatment. According to a , men are twice as likely as women to die after fractured hips. All fracture types led to higher death rates in men than women, yet the researchers found that less than 20 percent of men received assessments or treatments.

Determining Why

Historically, the medical community and general public mistakenly believe bone loss is a woman’s disease. Another reason for overlooking this condition in men is that osteoporosis-induced fractures occur generally 10 years later in men than women. Even as health care providers begin to realize that osteoporosis is an important condition affecting the male population, not enough men receive treatment. Most osteoporosis research, literature, and clinical guidelines focus on women. This has made managing skeletal health in these male patients challenging. The identified osteoporosis as an under recognized and undertreated disease in men in 2008. It issued guidelines to assess risk factors and use screening tools to diagnose osteoporosis. In 2012, the Endocrine Society published similar guidelines regarding osteoporosis management in men. Still, general knowledge of these guidelines is lacking in clinical practice. Increasing osteoporosis awareness, diagnoses, and treatment in men will lead to fewer fractures and improve morbidity and mortality rates and quality of life significantly.

Risk Factors in Men

• Age 70 and older
• Family history.
• Testosterone deficiency is the most frequent cause of osteoporosis in men. Men with lower testosterone and estradiol levels combined with higher sex hormone-binding globulin levels also have higher bone density loss rates over time.
• Lifestyle factors like smoking, alcohol use, obesity, low body weight, weight loss, physical inactivity, and low dietary vitamin D and calcium intake
• History of hyperthyroidism, hyperparathyroidism, hyperadrenalism, prostate cancer, and fractures

Osteoporosis Timing in Men

In general, adults reach peak bone density between the ages of 25 and 30. Thereafter, bone loss increases slowly while bone-building rates decrease. Estrogen is necessary for bone strength in both women and men. When people experience a loss of estrogen, osteoporosis develops. This occurs in women around menopause. But in men, bone thinning begins when they lose estradiol, a metabolite of testosterone. It may start between the ages of 45 and 50 as men’s testosterone levels decline. Estradiol loss increases osteoclastic resorption and eventually leads to osteoporosis. Throughout life, your bones remodel constantly, enabling them to adapt and change to your external environment. Millions of constituents or bone-remodeling units maintain the integrity of your skeleton. As you age, however, you experience a loss of minerals and changes in your bone matrix. Men lose bone mass density (BMD) at an estimated rate of one percent per year. Eventually, they reach the point where they are resorbing more bone than they are producing, which leads to decreased bone strength and increased fracture risk.

Diagnosis and Treatment

Prompt diagnosis and treatment are essential to reducing morbidity and mortality while improving quality of life significantly. The NOF recommends bone density testing for all men over age 70, those between 50 and 69 with risk factors, and men who have experienced previous fractures. Painless, noninvasive, and safe DXA scans of your spine, hip, and/or forearm can identify osteopenia or osteoporosis. Actonel is a prescription bisphosphonate that prevents bone breakdown and slows and/or stops bone loss progression. Supplement your diet with 1000-1200 milligrams of calcium and 800-1000 international units (IU) of vitamin D daily. Also engage in regular physical activity including weight-bearing and muscle-strengthening exercises, limit alcohol consumption, and don’t smoke. These lifestyle interventions can reduce bone damage while improving your overall health.