For Your Patients: Men Get Osteoporosis, Too

You may be under the impression that the bone-thinning disease known as osteoporosis affects only older women, but men get osteoporosis, too. Of the more than 10 million Americans age 50 and older with osteoporosis, an estimated two million are men.

And an additional 16 million men have low bone mass, putting them at increased risk for a low-trauma fragility fracture due to weakened bone.

A man's risk of having an osteoporotic fracture over his lifetime is estimated to be about 13% to 25%. In fact, men over 50 are more apt to break a bone because of osteoporosis than to develop prostate cancer.

Because men have higher bone mass at their peak and do not experience the abrupt drop in sex hormone levels that women do at menopause, they develop age-related osteoporosis about 10 years later. But by then the various health problems of older age can cause complications when men do have fractures.

Yet a general misperception persists – even among some doctors – that this condition affects only women. The result is that osteoporosis is under-diagnosed and under-treated in men.

Men's Greater Risk After Surgery

As in women, the most common site of fracture is the spine, but each year about 80,000 U.S. men break a hip. Older men who sustain a hip fracture have a more than 1 in 3 chance of dying within a year, which is twice the risk of death faced by women.

In addition, men experience greater disability after hip fracture than women do. More than half of male patients will never regain the same level of daily independence they had before, and men have a greater chance of having to be admitted to a long-term care facility.

Recommendations for Treatment and Prevention

• By age 70, all men should be screened with dual-energy x-ray absorptiometry (DXA) to evaluate bone mineral density -- that is, the amount of bone mineral divided by the area of the bone scanned.

• Screening is especially important for men age 80 and older. Unfortunately, though, Medicare does not cover testing for all men, possibly because there is not complete agreement from guidelines, so access to DXA screening may be challenging for some men.

• Screening should also be done in younger men who have known risk factors. These include delayed puberty, low muscle mass, malfunctioning testes with low testosterone production (hypogonadism), a history of fractures, and lengthy use of glucocorticoids.

• Osteoporosis in men is more often due to secondary factors related to exacerbating health conditions and the drugs used to treat them rather than to the natural aging process that causes osteoporosis in older women. Medical care, therefore, includes ruling out secondary causes, such as hypogonadism, diabetes, digestive disorders such as celiac and liver disease, inflammatory conditions such as rheumatoid arthritis and inflammatory bowel disease, cancer, and neurologic disease.

• The most common cause of osteoporosis in older men is low testosterone, for which testosterone-replacement therapy is often prescribed.

• Except for testosterone, the medications used to treat osteoporosis in men are generally the same as those for women, and they are equally effective in both sexes.

• Men with low bone mass or a broken bone resulting from low-level trauma should have comprehensive lab tests, including measurements of blood counts, vitamin D status, and testosterone levels, as well as levels of calcium excreted in the urine.

• There are many safe and effective treatment options, ranging from older drugs such as bisphosphonates, which act to reduce the breakdown and resorption of old bone, to newer anabolic or bone-building drugs that actively stimulate new bone production as well as slow the loss of old bone.

• In addition to taking appropriate medications, men should follow a bone-friendly diet rich in calcium and vitamin D, and reinforce those nutrients with calcium and vitamin D supplements.

• Men should engage in regular weight-bearing exercise and avoid smoking and excess consumption of alcohol. Fall prevention is also critical to lowering the risk of broken bones.

Read previous installments in this series:

For Your Patients: Osteoporosis -- the 'Silent Thief'

For Your Patients: What to Know About Osteoporosis Diagnosis and Treatment

For Your Patients: Osteoporosis and Fractures

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.