Men and Osteoporosis
Women traditionally experience bone and spine issues after menopause and receive a confirmed diagnosis with a DEXA (bone) scan. However, men are normally not screened for osteoporosis, and don’t learn they have the condition until they experience a fracture. People who have rheumatoid arthritis or who smoke, consume more than three alcoholic drinks a day, have had prolonged prednisone treatment or previously experienced a fracture from only minimal impact should talk to their doctor about starting screening earlier.
Be proactive and don’t wait until you experience pain or height loss, before seeking help. Here are some questions to ask yourself.
- Have I broken a bone since age 50?
- Do I have a family history (female or male) of osteoporosis?
- Do I appear shorter, or have a change in posture?
- Do I have low levels of testosterone?
- Do I consume more than three alcoholic drinks every day?
- Have I had any prolonged steroid treatment?
Risk factors linked to osteoporosis in men:
- Chronic diseases affecting the lungs, kidneys, stomach and intestines, or altered hormone levels
- Undiagnosed low levels of testosterone
- Unhealthy lifestyle habits including smoking, excessive alcohol use, low calcium intake, and inadequate physical exercise
- Age: Risk increases with age
- Heredity: A son is almost four times as likely to have low bone mineral density (BMD) if his father has low BMD; nearly 8 times as likely if both parents have it
- Race: All men can develop the disease but Caucasian men are at high risk
Osteoporosis can be effectively treated if detected before significant bone loss has occurred. A medical work-up to diagnose osteoporosis includes a complete medical history, x-rays, and urine and blood tests. The doctor may also order a BMD (bone mineral density of DEXA scan) test, which can be used to detect low bone density, predict the risk for future fractures, diagnose osteoporosis and monitor the effectiveness of treatments.
Primary and Secondary Osteoporosis
There are two types of osteoporosis: primary and secondary. Primary osteoporosis is either caused by age-related bone loss (men age 70, and over), or have an unknown cause. At least half of men with osteoporosis have at least one secondary cause (sometimes more). In cases of secondary osteoporosis, the loss of bone mass is caused by lifestyle behaviors, diseases or medications. The most common causes of secondary osteoporosis in men include exposure to glucocorticoid medication, hypogonadism (low levels of testosterone), alcohol abuse, smoking, gastrointestinal disease, hypercalciuria and immobilization.
Causes of Secondary Osteoporosis in Men
- Glucocorticoid excess (Asthma and rheumatoid arthritis medications)
- Immunosuppressive drugs
- Hypogonadism (Low testosterone levels)
- Alcohol abuse
- Chronic obstructive pulmonary disease and asthma (COPD)
- Cystic fibrosis
- Gastrointestinal disease
- Hypercalciuria (Loss of too much calcium)
- Anticonvulsant medications
- Thyrotoxicosis (Excess thyroid hormone)
- Hyperparathyroidism (Enlarged parathyroid glands)
- Immobilization (Prolonged bed rest or immobilization)
- Osteogenesis imperfecta (Genetic disorder called “Brittle bone disease”)
- Homocystinuria (Metabolism disorder)
- Neoplastic disease (Benign or malignant tumor growth)
- Ankylosing spondylitis and rheumatoid arthritis
- Systemic mastocytosis (Accumulated mast cells in organs)
Osteoporosis management includes eating foods high in calcium (i.e. dairy products) and taking vitamin D (1,000 mg daily for men age 50-70; 1,200 mg over age 71), regular weight-bearing exercise, no smoking, limitation of alcohol and caffeine consumption, and fall-prevention.
Main Line Rheumatology sees many patients with osteoporosis. At least 95% are women, yet statistics looking at people over age 65, find the ratio closer to 50%. Why is that? Most women see their gynecologist for a yearly exam, and those doctors are very good about ordering DEXA (bone density) scans. There is no equivalent for men! Perhaps primary care physicians and urologists should be cautioned that men are at risk for osteoporosis as their testosterone levels fall, just the same as estrogen plummets in women after menopause.