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Osteoporosis in Men Often Overlooked

Men's Health

Millions of men have osteoporosis, yet most of them are undiagnosed. Although the perception that this potentially debilitating disease only affects women still persists, the facts prove otherwise. Too often, men discover they have the disease when they suffer a fracture from a fall.

According to the National Osteoporosis Foundation, 2 million men have the bone disease and six times that number are at risk. Overall, 4 to 6 percent of men older than 50 have osteoporosis, and 33 to 47 percent have osteopenia (a condition in which bone loss is substantial but has not met the diagnostic criteria for osteoporosis). About 30 percent of hip fractures occur in men, and one in eight men older than 50 years will have a fracture associated with osteoporosis.

The presence of osteoporosis in men varies according to ethnicity. Among men aged 50 and older, 7 percent of non-Hispanic Caucasian and Asian men, 4 percent of non-Hispanic black men, and 3 percent of Hispanic men are estimated to have the disease. Among those at risk of osteoporosis (those having osteopenia), the estimates are 35 percent of non-Hispanic Caucasian and Asian men, 19 percent of non-Hispanic black men, and 23 percnet of Hispanic men.

In both men and women, factors that affect bone health and bone density include heredity, diet, sex hormones, physical activity, use of certain medications, and lifestyle choices. Many women begin to see signs of osteoporosis when they are in their 40s and 50s. Yet because men generally have larger, stronger bones than women, the impact of these factors on them can be less severe until they are in their late 60s or 70s.

The risk factors for osteoporosis in men are of significant concern. They include:

* Undiagnosed low levels of the sex hormone testosterone
* Long-term use of certain medications, including steroids (not uncommon among athletes), some cancer treatments, and anticonvulsants
* Chronic disease that affects the intestines, kidneys, lungs, and stomach and changes hormone levels
* Smoking
* Excessive alcohol use
* Inadequate exercise
* Low intake of calcium

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Because osteoporosis is often overlooked in men, it is important for men to inform their physician about any change in posture, sudden back pain, or loss of height. Men older than 50 who have risk factors for the disease should be evaluated for the osteoporosis and may be orderd to undergo a bone mineral density test, a type of x-ray that can diagnose osteoporosis. The most widely recognized bone mineral density test is the dual-energy x-ray absorptiometry (DXA), which measures bone density at the hip and spine.

Men can take steps to prevent bone mineral loss and osteoporosis:

* Concentrate on calcium: Men 50 and older need 1,200 mg daily.

* Don’t Forget D: Vitamin D3 (cholecalciferol) is the form in supplements that best supports bone health. Men 50 and older need 800-1,000 IU daily.

* Monitor medications: If you are taking any medications, talk to your healthcare professional to identify whether any of them are known to cause bone loss

* Change unhealthy habits: Smoking, excessive alcohol use, and a sedentary lifestyle contribute to the development of osteoporosis

The Food and Drug Administration has approved several drugs to treat osteoporosis in men. Two that fall into the category of antiresorptives (which slow bone loss) are alendronate (Fosamax®) and risedronate (Actone®). Another medication, called teriparatide (Forteo®) is an anabolic, which speeds up bone formation. Another possible treatment option is testosterone replacement therapy. Low levels of testosterone contributes to bone loss, and so men should consider having their testosterone levels checked to see if replacement therapy is needed.

Bilezikian JP. J Clin Endocrinol Metab 1999; 84:3431-34.
Geusens P et al. Nat Rev Rheumatol 2009 July 28
National Institutes of Arthritis and Musculoskeletal and Skin Diseases
National Osteoporosis Foundation