Osteoporosis is not just a 'women's disease'

Grand Forks (N.D.) HeraldOctober 14, 2013 

Osteoporosis, which causes bones to weaken and sometimes break, is often thought of as a “women’s disease.” But 2 million men in the U.S. have been diagnosed with the disease and another 12 million are at risk of developing it during their lifetime, according to the National Institutes of Health.

Men, who represent about one-fifth of all osteoporosis cases, tend to be diagnosed later in life, and they are unlikely to recognize the condition until pain sets in or a bone suddenly snaps, said Joshua Patt, an orthopedic surgeon with Carolinas HealthCare in Charlotte.

“That’s because bone density scans are carried out routinely in women, but men aren’t likely to think about osteoporosis until after a fracture has occurred,” Patt said.

Six percent of men age 50 and older will experience a hip fracture at some point, while 5 percent will have a spinal fracture as a result of osteoporosis, the NIH has reported.

And, as the population ages, the number of men dealing with the condition is expected to rise.

Silent disease

Osteoporosis has been called the “silent disease” because patients are not typically diagnosed with it until the condition is advanced, said Bob Schmaltz, radiology assistant with Altru Health System in Grand Forks, N.D.

For men, it’s even more likely to be overlooked – a disease “that’s forgotten, almost,” Schmaltz added.

Women are often referred for scans once they reach 50, an age when bone loss in women tends to develop. Known as Dexa scans, the technology measures bone mineral density, focusing especially on the spine and hips, where most osteoporosis-related fractures occur.

Although men don’t lose significant bone density until they reach their 70s, doctors are starting to see more cases.

“As men live longer, they’re more susceptible,” said Dr. Edwin Cadet of Raleigh Orthopaedic Surgery Center, which is affiliated with Rex Hospital.

“Men over 70 should definitely be screened for osteoporosis.”

But Schmaltz, whose practice scans 10 patients a day on average, said he hasn’t seen a male patient in about two months.

“I don’t see that happening in our practice. We’re not seeing a glut of males” coming in for a scan, he said.

Risk factors

Several things explain why men have a lower risk of osteoporosis, including the fact that they are likely to have thicker bones in their younger years.

“Men tend to have a higher peak bone mass in their 20s and 30s, so they are starting out at a higher level,” Patt said. “And historically, men have done more of the impact activities that are important for building bone mass.”

Walking, running and heavy lifting are among the activities that help build bone mass, because bones strengthen in response to stress, Patt said.

“Exercise is both a preventative measure and a treatment,” he said.

While aging itself is a primary cause of osteoporosis, other factors may raise an individual’s risk, such as extensive alcohol use and smoking.

“Smokers ... have a 55 percent higher risk for hip fractures compared to nonsmokers,” Schmaltz said.

“Couch potatoes” and people who use nicotine and caffeine excessively tend to have lower bone mass than those who don’t, he said.

But the most common cause of early onset osteoporosis in men is a hormone deficiency.

Just as women’s bones weaken with the loss of the hormone estrogen during menopause, men with low testosterone levels are also at risk, Patt explained.

Other known causes are deficiencies of calcium and Vitamin D, the use of steroids and some other medications.

Conditions such as rheumatoid arthritis, digestive and blood disorders, and cystic fibrosis also play a role, Schmaltz added. They can impair the body’s ability to absorb needed nutrients. And bone loss is a common side effect of drugs used to treat asthma and rheumatoid arthritis, according to the NIH.

If Dexa scans reveal that medications are causing major bone loss, a change in treatment may be considered, Schmaltz said.

How bones work

Bone is constantly changing – that is, old bone is removed and replaced by new bone. During childhood, more bone is produced than removed, so the skeleton grows in both size and strength.

“Bones, if they’re healthy, are very, very strong,” Schmaltz said.

For most people, bone mass peaks during their 20s. After this point, the amount of bone in the skeleton typically begins to decline slowly as removal of old bone exceeds formation of new bone.

“Bone continually monitors what stress we put on it,” he said. “With bone mass, it’s a ‘use-it-or-lose-it’ proposition, much like muscle.”

By age 65 or 70, 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, the NIH said. Excessive bone loss causes bone to become fragile and more likely to fracture.

Most commonly, fractures occur in the hip, spine and wrist, and can 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 suffer hip fractures are more likely than women to die from complications, according to the NIH.

Preventing osteoporosis

Early detection of a loss in bone density can alert your doctor to the need for medication or supplements, a balanced diet with a lot of calcium- and vitamin D-rich foods, a program of physical exercise and smoking cessation.

Exercise – such as brisk walking at least 30 minutes a day – is a proven method to strengthen bones, Schmaltz said. And any weight-bearing exercises are helpful.

“In the 25 to 64 age range, only about 35 percent of men are meeting the minimum exercise prescription of what they should be doing,” he said.

Calcium is critical to helping the body build and maintain bone density.

“To make new bone the body needs, it takes plenty of calcium,” Schmaltz said. “In the age range of 19 to 50, it’s recommended that a person get 1,000 milligrams a day. If you’re older than 50, the recommendation is 1,200 milligrams a day.”

To help the body properly use calcium, vitamin D is recommended, he said. “The recommendation used to be 400 to 800 (international) units a day; now it’s 800 units a day. Some take 1,200.”

Some health professionals are including the Dexa scan in their male patients’ annual physical exam, Schmaltz said. “They’ll tell the patient, ‘We’ll check your BMD along with your hemoglobin and cholesterol.’

“It’s better to be proactive than waiting for something to happen.”

Staff writer Renee Elder contributed to this report.

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