Listen, men, this is important, important to your current and future health and perhaps your life. Osteoporosis is not just a woman’s disease. Men get it too, albeit some years later in life than most women.
Men experience about half as many osteoporotic fractures as women. But when a man breaks his hip because of osteoporosis, he is more likely than a woman similarly afflicted to be permanently disabled and twice as likely to die within a year.
Unfortunately, men are far less likely than women to get the health of their bones checked when they are at significant risk of an osteoporotic fracture. This is true even if they have such prominent risk factors as a previously broken bone — any bone — from something as “nontraumatic” as tripping and falling from a standing height, a so-called fragility fracture.
That’s because doctors, too, are often unaware of the many factors that put men at risk of osteoporosis, including disorders like celiac disease and chronic obstructive pulmonary disease (C.O.P.D.) and treatments for other health problems, like depression, gastric-esophageal reflux disease (GERD) and prostate cancer.
With men now living longer and their life expectancy increasing faster than women’s, many more “men will be living long enough to fracture,” Dr. Robert A. Adler, an endocrinologist at the Veterans Affairs Medical Center in Richmond, Va., and Virginia Commonwealth University School of Medicine, has written.
“We need to pay a lot more attention to osteoporosis in men,” Dr. Adler said in an interview. “It’s erroneous to think it’s a lady’s disease. And because many men and their doctors think that, men are less likely than women to be evaluated and treated after a low-trauma fracture.”
Men remain inadequately tested and treated after low-trauma fractures “even though their risk of a subsequent fracture is markedly increased,” said Dr. Sundeep Khosla, an endocrinologist at the Mayo Clinic College of Medicine, echoing Dr. Adler’s concerns. In fact, Dr. Khosla said, there is now evidence that even following a “high-trauma fracture,” as might happen in a car accident, they should have the strength of their bones checked.
“Just because men escape the sudden bone loss women experience at menopause, that doesn’t mean men don’t lose bone as they get older,” he said.
“Aging men lose bone mineral density at a rate of approximately 1 percent per year, and one in five men over the age of 50 years will suffer an osteoporotic fracture during their lifetime,” Dr. Khosla wrote in The Journal of Clinical Endocrinology and Metabolism. “Almost 30 percent of all hip fractures occur in men.”
His advice: “Every man over 70 should have a bone density test, and if they have other risk factors, depending on which ones, they should be tested soon after 50.”
Here’s what men should know about their risks. Yes, nearly all of you start adult life with stronger bones than women have. But like women, your bones start to gradually weaken in your mid-20s. Women lose both the cells and struts, the framework of mineral deposits within spongy bone, that keep bones strong, whereas in men the primary loss is thinning of the struts, which probably explains why osteoporotic fractures tend to occur later in life in men.
Common risk factors for osteoporotic fracture in men, as well as in women, are age (over 60 for women and over 70 for men); being thin or underweight; current smoking; consuming more than three alcoholic drinks a day; a parental history of osteoporosis; or having a previous fracture or a recent fall.
Health conditions that increase risk include rheumatoid arthritis, mobility disorders like Parkinson’s disease, multiple sclerosis or stroke. Chronic use of many medications also increases risk, including glucocorticoids like prednisone; androgen deprivation therapy for prostate cancer; proton pump inhibitors for GERD; antidepressants that affect serotonin (S.S.R.I.s like Prozac and Zoloft); immunosuppressants like cyclosporine; some cancer drugs, like cyclophosphamide; and anti-seizure drugs like phenytoin.
Dr. Adler is especially concerned about men with prostate cancer who are on androgen deprivation therapy, often used when a man’s PSA level begins to rise. However, “by five years of treatment, almost 20 percent of white males and 15 percent of African-Americans will suffer an osteoporotic fracture,” he said. “They should be given standard therapy for osteoporosis.”
A man’s risk of an osteoporotic fracture can be evaluated using a score called the fracture risk assessment tool (FRAX) that was developed by the World Health Organization. It combines the results of a bone density test with other clinical risk factors, like many of those listed above. The score assesses the 10-year chance of a hip fracture or any osteoporotic fracture and can be used to decide who should take measures and medications to help prevent them.
Lifestyle factors that can help keep osteoporosis at bay include regular weight-bearing and resistance exercises and adequate consumption of calcium (1,200 milligrams a day for men over 70) and vitamin D (800 to 1,000 international units a day), as well as not smoking. Muscle strength both helps protect bones from injury and diminishes the risk of a fall that could break them.
The same drugs used to treat osteoporosis in women have also been approved for use in men. The ones most often prescribed are called bisphosphonates, like Fosamax, Boniva, Reclast and Actonel, that block the resorption of bone by cells called osteoclasts. The drugs are administered in different ways, including by pill or injection, and the choice depends on effectiveness and side effects as well as patient preference.
Publicity about the risk of a femur fracture linked to long-term use of bisphosphonates has scared many consumers, who now refuse to take them. However, Dr. Adler said, “these fractures are very rare, and for most patients with osteoporosis, the benefit greatly outweighs the risk.” Patients are usually advised to take the drug for five years, take a two-year break and then have another bone density test to determine if more treatment is needed.
A drug in a different class called denosumab, and sold as Prolia, is more expensive. A monoclonal antibody, it is given by injection twice a year. Still another drug, called Forteo, is a man-made form of parathyroid hormone, which Dr. Adler said is especially useful for people with osteoporosis related to glucocorticoid therapy.