Osteoporosis in men

By: Grant Cooper, MD
May 17, 2007

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Although osteoporosis is generally thought of and discussed as a disease that strikes post-menopausal women, the incidence of osteoporosis in men is also substantial. The National Osteoporosis Foundation estimates that nearly 2 million males in the US have osteoporosis, with another 12 million at risk of developing the disease if medical and lifestyle interventions are not adopted.

What’s more, a recent study conducted of over 4000 Australian men and women concluded that after an initial osteoporosis-related fracture, the absolute risk of a subsequent fracture within ten years of the first was similar in men and women. So while a larger percentage of women are initially twice as susceptible to osteoporosis, after osteoporosis takes hold and results in a fracture, the long-term impact for men is roughly equivalent, with 40% of surviving women and 60% of surviving men experiencing another fracture.

These figures may strike many as both surprising and alarming. Together, they underscore the need for men to become more educated about osteoporosis generally – its risk factors and treatments – as well as adopt changes that could prevent or mitigate the risk of fractures. The highest risks of a subsequent fracture were in people who had a hip or spine fracture (e.g. vs. a wrist fracture) as their initial osteoporotic break. Government researchers have found that after age 50, nearly 6% of men will experience a hip fracture and nearly as many (5%) will suffer a spinal (vertebral) fracture caused by osteoporosis.

Preventative osteoporosis care in teenagers and young men

As boys move through their teen years they achieve maximum height and bone length, but the density of their bones continues to increase until they reach about 30 years of age, after which time bones tend to start losing density. This makes the first three decades of life the best time to focus on building strong bones. While many unalterable factors affect bone density (e.g. genetic disposition) many other factors that add to or subtract from bone strength are within an individual male’s control.

What lifestyle changes can a man, or adolescent boy, do to stack the deck in favor of better bone health and increased bone density later in life?

• Stop smoking. Smoking weakens bones by reducing the blood supply for bones, slowing the production of bone-growing cells (osteoblasts), and hurting the body’s ability to absorb calcium. Over time, smoking weakens bones to the point of increasing the risk of fracture.

• Moderate alcohol consumption. A drink or two every now and then is fine, but excessive drinking presents a number of health risks. Although it is not known exactly how significant alcohol intake affects bone health, the correlation is clear. Moreover, alcohol has little if any nutritional benefits and, because it is a depressant, may undercut the motivation to exercise or eat healthfully.

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• Engage in weight-bearing, strengthening exercise or activity. Bones, like muscles, need stress and exercise to make them strong. High impact activities such as jogging and running, skiing, or most of the ball sports such as –- basketball, football and soccer, tennis and handball -- adequately stress bones, provided a player’s physical condition can tolerate this level of activity. If not, walking or some kinds of weightlifting can provide the stress needed to test and maintain bone strength. Physicians typically recommend 3 to 5 sessions of at least 20- to 25 minutes a week to get the benefits needed.

• Ensure diet includes adequate calcium and Vitamin D. Drinking about 3 glasses of milk each day, or eating other low fat dairy products like yogurt and cheese, or other foods rich in calcium, will help build and maintain bone strength. As a possible backstop, a multivitamin that contains calcium will also help. A daily calcium intake of 1000mg is recommended for men ages 25-65. Vitamin D is necessary for absorption of calcium; a 10 to 15 minute stroll in the sun provides adequate exposure, but supplements of 400 or 600 IU a day will work also.

• Make sure to attend regular check-ups with the doctor. Certain factors in one’s medical history or physical examination may prompt the doctor to do further testing. For example, a history of a pituitary tumor or testicular disease may require further testing that may reveal a low plasma testosterone level. A low testosterone level left untreated may lead to early osteoporosis as well as other problems.

Medications and hormones therapy can treat male osteoporosis

As the incidence and knowledge of osteoporosis has grown over the last decade, so has the interest and investment in developing drugs that treat the disease. However, where there are several medications that have been approved by the FDA to treat osteoporosis in women, only two have been specifically approved for men:

• Alendronate (brand name Fosamax)

• Risedronate (brand name Actonel)

Both of these medications are in a category of drugs called bisphosphonates and are approved for use for those who have steroid-related osteoporosis. This condition is usually caused by long-term use of steroid medications such as prednisone or cortisone, which are frequently prescribed to treat asthma and rheumatoid arthritis. Bone loss from these medications is usually most evident in the ribs and vertebrae, making the spine of people undergoing glucocorticoid treatment particularly susceptible.

To counteract the effects of steroids, patients are advised to:

• Obtain a bone mineral test so that any degradation can be tracked and addressed.

• Work with their doctor to ensure that they are taking the minimum, productive amount of steroids, as opposed the maximum

• Make extra effort to get adequate calcium and vitamin D, through food and/or dietary supplements

• Work with their doctor to design an exercise program that is safe and effective in order to strengthen the bones and surrounding muscles as much as possible.

Osteoporosis is a serious medical problem. It is the most common bone disease in humans and, while traditionally thought of as a problem primarily of post-menopausal women, it is also, in truth, a significant problem for men. There are many treatments for osteoporosis, and for fractures that occur as a result of osteoporosis. The best treatment, however, is prevention. Lifestyle changes made as early as possible, including quitting smoking, moderating alcohol use, participating frequently in weight-bearing exercise, and eating foods rich in calcium and vitamin D can go a long way to prevent osteoporosis later in life.

References:

National Osteoporosis Foundation website, nof.org/men, 2/10/2007.

Center, J.R., et al. Risk of Subsequent Fracture After Low-trauma Fracture in Men and Women. The Journal of the American Medical Association (JAMA). 2007; 297:397-394.