Osteoporosis and Bone Density - It's Not Just A Woman's Disease

Osteoporosis
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Osteoporosis is often thought of as “A Woman’s Disease,” when in fact, loss of bone density resulting in osteoporosis affects millions of men in the U.S. as well. While the causes of decreased bone density differ some between men and women, the good news is that male osteoporosis is sometimes attributable to lifestyle habits that can be changed and thereby delay - if not avoid - the onset of osteoporosis in men.

Recent news stories report the finding from the New England Journal of Medicine that millions of older women may not really need frequent bone mineral density scans to detect osteoporosis. The consensus is that women with a healthy initial test can wait as long as 15 years before their next bone density exam; women at moderate risk should be tested every 5 years; and, women of high risk every one to two years.

Bone mineral density exams are typically done through X-rays focused on the hip and lower spine regions where fractures and the early signs of osteoporosis manifest as bones begin to thin from the disease. The seriousness of this condition is revealed by the fact that osteoporosis causes long-term loss of mobility that requires extensive patient care. Six months after a hip fracture, only 15 percent of hip fracture patients can walk across a room on their own.

As “a woman’s disease,” osteoporosis places a significant health burden on the female sex. According to the National Osteoporosis Foundation, women can lose up to 20 percent of their bone density in the first five to seven years after menopause, making them more susceptible to osteoporosis than men. Recent numbers show that 80% of women and 20% of men are affected by osteoporosis.

However, in other ways, men narrow the gap: While one in two women age 50 and older will have an osteoporosis related fracture, the number for men is one in four. Furthermore, the rate of hip fractures is two to three times higher in women than men; however, the one year mortality following a hip fracture is nearly twice as high for men as for women. Clearly osteoporosis is not just “a woman’s disease.”

Osteoporosis differs between the sexes. First, by their thirties, men have accumulated significantly more bone mass than women have. As both sexes age, bone loss gradually outpaces new bone growth. Following menopause, women lose significantly more bone than men do; however, by age 65-70, both sexes lose bone mass at the same rate. In other words, women have a distinct bone-loss disadvantage over men.

The most common type of osteoporosis is age-related bone loss. While age plays a major role in bone loss, secondary causes such as lifestyle behaviors, disease and medications also contribute to the disease in men. In men, the most common causes include low levels of testosterone, alcohol abuse, smoking, glucocorticoid medications, hypoercalcuria (calcium lost in the urine) and immobilization.

Part of the difficulty facing men and osteoporosis is detection before the disease causes too much damage. With women, physicians typically watch for signs of osteoporosis once menopause happens. With men, however, osteoporosis is not discovered until after a man approaches his physician with a complaint of back pain or a fracture.

As such, physicians recommend that men inform their doctors if they have any of the aforementioned secondary causes as well as a loss in height, a change in posture, a recent fracture or sudden back pain.

Like women, men suspected of having osteoporosis are given a medical workup that includes a complete medical history, x rays, and urine and blood tests, and a bone density screening called a dual-energy x-ray absorptiometry, or DXA test that measures bone density at the hip and spine.

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Once a diagnosis is made, treatment can include medications, hormone therapy, mineral supplements, physical activity and recommendations for lifestyle changes.

For men to lessen their risk of developing osteoporosis, the NIH’s Osteoporosis and Related Bone Diseases National Resource Center recommends the following practices:

• Avoid smoking, reduce alcohol intake, and increase your level of physical activity.

• Ensure a daily calcium intake that is adequate for your age.

• Ensure an adequate intake of vitamin D. Dietary vitamin D intake should be 600 IU (International Units) per day up to age 70. Men over age 70 should increase their uptake to 800 IU daily. The amount of vitamin D found in 1 quart of fortified milk and most multivitamins is 400 IU.

• Engage in a regular regimen of weight-bearing exercises in which bones and muscles work against gravity. This might include walking, jogging, racquet sports, climbing stairs, team sports, weight training, and using resistance machines. A doctor should evaluate the exercise program of anyone already diagnosed with osteoporosis to determine if twisting motions and impact activities, such as those used in golf, tennis, or basketball, need to be curtailed.

• Discuss with your doctor the use of medications that are known to cause bone loss, such as glucocorticoids.

• Recognize and seek treatment for any underlying medical conditions that affect bone health.

The recognition that osteoporosis and bone density is not just “a woman’s disease” is slowly coming around to giving guys their needed support for a serious medical condition. Currently, research is going on to determine just how sex-specific the treatment for osteoporosis is needed to insure that men receive the appropriate level of medical care.

Image source: Courtesy of Wikipedia

Reference: National Institute of Arthritis and Musculoskeletal and Skin Diseases

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