Osteoporosis in Men
Today, the lack of awareness of osteoporosis and fractures as a disease in men is similar to the lack of awareness in women 50 years ago. Men do not realize that the 'silent epidemic' of osteoporosis affects them and that their bones are becoming thinner, more porous and brittle during adult life.
Traditionally thought of as a women's disease, in the last decade the notion that bone loss is also an inevitable consequence of ageing in men has finally emerged. Although fragility fractures are less common in men than in women, when they occur, these fractures can be associated with higher morbidity and death than in women. Overall, one in five men over the age of 50 will have an osteoporosis related fracture in their remaining lifetime.
Risk factors for osteoporosis
The following risk factors are associated with osteoporosis in men:- Prolonged exposure to certain medications, such as steroids used to treat asthma or arthritis, anticonvulsants, certain cancer treatments and aluminum containing antacids
- Chronic disease that affects the kidneys, lungs, stomach, and intestines and alters hormone levels
- Undiagnosed low levels of the sex hormone testosterone
- Lifestyle habits such as:
- Smoking
- Excessive alcohol use
- Low calcium intake (see Calcium page)
- Inadequate physical exercise
The size of the problem
Over a man's lifetime just under half of his bone mass achieved during growth to young adulthood is lost. This loss of bone is the same as the amount lost in women but men compensate better by laying down more new bone on the outer surface of the bone as part of the natural process of bone remodeling. However, this addition of new bone on the outside surface does not entirely compensate for the loss of bone on its inside surface and so about one in five men over 50 will have a bone fracture that reduces the quality of their lives, and reduces the length of their lives. The lifetime risk of a man suffering an osteoporotic fracture is greater than his likelihood of developing prostate cancer.
Men with spine fractures have smaller bones, and the shell of the bone is thin and porous. The honeycomb or sponge-like bone that functions like a spring or shock absorber is thinned, resulting in the honeycomb connections making the bone 'spring-like' being lost, so that when a force is placed on the bone it does not 'give' but rather cracks under the load and may collapse completely, which causes a fracture of the spine. If fractures occur there may be severe pain, loss of height, and severe curvature of the spine. If there is severe curvature this can impair the function of the lungs and impair normal breathing.
Fewer approved treatments for men than for women
Only a handful of osteoporosis treatments have been approved for use by men - the others have not been subjected to the lengthy and expensive clinical trials that are required. Drugs have been less studied in men than in women with osteoporosis. At present the best studied drug for men is from the bisphosphonate drug group, alendronate.
There is evidence also for other drugs such as risedronate and etidronate and the bone building drug parathyroid hormone, which makes new bone on the outside and inside surfaces of the bone, helping to reconstruct the skeleton and rejoin the disconnected trabeculae (struts and plates) in the spongy bone.Testosterone increases bone density in men with low levels of this male hormone.
Calcium supplements have not been well studied in men but probably should be administered in men taking less than one gram of calcium daily.
Role of the individual
Osteoporosis is one of the more preventable diseases associated with ageing. Paying attention to bone health throughout life, from childhood onwards, is the most effective way of building and maintaining bone strength, thus decreasing bone loss and brittleness that can lead to the first fracture.
What you can do to reduce the risk of fracture
- Assess your risks and seek advice from your doctor.
- Diet: a balanced diet rich in the essential nutrients for bone health, includes calcium, which strengthens bone, and vitamin D, which helps the body to absorb calcium.
- Between 25 and 65 years of age, men need at least one gram of calcium a day, increasing to 1.5 grams daily for the over 65s. Sunlight is a natural source of vitamin D and exposure to as little as ten minutes a day can be sufficient or vitamin-rich foods can be recommended.
- Physical activity: weight-bearing exercise, such as walking, tennis and jogging may assist in maintaining bone density and muscle strength, coordination and flexibility and reduce the risk of falls. Resistance training and lifting weights may help maintain bone density.
- Diet, exercise, lifestyle and - if osteoporosis is diagnosed, the use of certain medications - are the major ways of maintaining and restoring bone health.
For elderly men
- Learn about fall prevention programs including muscle strengthening through exercise and medical assessment including balance and vision
- Check for potential dangers in the home, such as poor lighting, clutter and slippery rugs
- If osteoporosis has been diagnosed, consider protective garments such as hip protectors.
For further information about osteoporosis and men, see the IOF report "Osteoporosis in Men: The 'Silent Epidemic' strikes men too"
Celebrities speak out
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When I found out that I had osteoporosis, I was pretty shocked. I thought it was, you know, for old ladies basically…but I got diagnosed when I was 37. Osteoporosis has affected my life in many ways. Mainly I’m a lot more aware of my health now. I’m aware of just taking it a little more easy with physical activities, I exercise regularly, I gave up smoking… in fact, I probably feel better now than I have ever felt!
Kirk Pengilly has been with the band INXS since its founding in 1977 |
