Contrary to popular perception, osteoporosis is not a women’s disease only. Many men get it. It is estimated that 2 million men in the United States have osteoporosis, and millions more have osteopenia or are at risk for developing osteoporosis. About a quarter of men past age 50 will suffer an osteoporic fracture at some point. Hip and spinal fractures are about one-third as common in elderly men as in women. The mortality rate for people past age 75 who have had hip fractures is higher for men than for women. Men in this age range are more likely to have a bone fracture than a heart attack. Further, 80,000 American men suffer broken hips every year and a third of those die within a year. Another third suffer a broken hip at another time.
Obesity is known to be a risk factor for osteoporosis, new findings show that belly fat - the kind more typical in overweight men - is particularly detrimental when it comes to raising the risk for osteoporosis. Researchers at Harvard Medical School found visceral (deep belly) obesity is the worst type of body fat, as it increases the risk for heart disease and diabetes as well as for osteoporosis. Men whose fathers had poor bone health tend to have smaller bones.
One obstacle is diagnosis. Women are much more likely to be given bone density tests than men. Doctors often don’t find male osteoporosis until the patient comes in for pain, often back pain. If small fractures are detected, that’s a clue for osteoporosis. The diagnostic techniques are the same as those used for women.
The National Health and Nutrition Examination Survey found that only 1 percent of men past age 65 reported they had osteoporosis, even though 2 percent of men in this age range had suffered a hip fracture. So even men with a history of fractures did not know, or want to admit, that they had osteoporosis. By contrast, 11 percent of women said they had osteoporosis, more than the 6 percent with a history of fractures. Women seem much more willing to admit to themselves and others they have osteoporosis. This may be misplaced male pride or a genuine failure to understand that men can get osteoporosis. Further, an estimated 50 percent of osteoporosis cases in men are are secondary osteoporosis with an obvious cause such as corticosteroids. Secondary osteoporosis is more commen in men than in women.
The standard definition of osteoporosis relies on a deviation from a statistical mean in bone density. This poses a little bit of a problem for osteoporosis in men as the bone densitometry numbers are not as well defined in men as they are in women. There is sexual dimorphism when it comes to bones in young adults. Bone mineral density measurements are useful for predicting fractures in men, although men have a lower absolute risk for fracture than women at any bone density T-score. The World Health Organization (WHO) recommends using the same classification of BMD. (2.5 standard deviations below the mean being osteoporosis, and between 1.0 and 2.5 standard deviations below the mean being osteopenia.) Doctors pay less attention to osteopenia in men than in women and are less likely to prescribe bisphosphonates for it.
Younger adult men tend to break bones more often than women, because they tend to be more active. Among older adults, fractures are more common in women, because osteoporosis is more common in women. It should be noted, however, that when older men do suffer hip fractures, those fractures are more likely to lead to death than the same fractures in women. (Both mortality and morbidity are higher for men following fractures than for women of the same age.) When men suffer fractures in the wrist bones, there is a a greater chance they will be followed by hip or spine fractures than is true for women with the same wrist fracture. Obesity seems associated with higher risk of osteoporosis in men.
Should men get bone density mineral tests even if they have not had fractures? Authorities differ on this question. The U.S. Preventive Services Task Force (federal government) says routine screening is not called for if men show no signs of risk. The National Osteoporosis Foundation (NOF), International Society for Clinical Densitometry (ISCD), and the Endocrine Society recommend BMD testing for all men older than 70 years, and in men 50 to 70 years when risk factors are present. Obvious symptoms or indications that might suggest osteoporosis include a loss of height (over an inch), several fractures due to low trauma, and visible osteopenia showing up on an X-ray. Long-term glucocorticoid (GC) therapy is known to induce osteoporosis. People with hyperparathyroidism are often checked as the two disorders are correlated. Some insurers do not pay for DEXA scans in men, which may account for underdiagnosis.
The initial evaluation includes blood and urine tests to rule out kidney or liver disease, a complete blood count, serum testosterone, calcium, alkaline phosphatase, and 25-hydroxyvitamin D (calcidiol).
Surveys have shown that middle-aged women know more about and worry more about bone health than men in the same age range. One reason men (and their doctors) need to be careful is that the mortality rate for men who get bone fractures (hips, vertebrae) is higher than the rate for women. A 2010 study estimated 16.6% of men in the EU past age 80 had osteoporosis.
NIH Osteoporosis and Related Bone Diseases webpage on men and osteoporosis.
When cases are secondary osteoporosis, the treatment involves addressing causitive pathologies. For primary osteoporosis, the treatment for men is largely the same as for women: bisphosphonates are considered the standard first-line therapy. Men are sometimes given testosterone replacement therapy, although the results for stopping osteoporosis with this method have been disappointing. Androgens (which include testosterone) stop the loss of cancellous bone. It might sound like a paradox, but the prostate drugs pamidronate and zoledronic acid are given as part of androgen deprivation therapy and they have a side effect of preventing bone loss.
Related: Juvenile osteoporosis
Partial Myths About Osteoporosis
Osteoporosis in Males (National Library of Medicine)
Sources for information on this page: National Health Service of Scotland, National Osteoporosis Foundation, National Library of Medicine, MedPageToday, NIH Osteoporosis and Related Bone Diseases National Resource Center
