GUYS GET IT TOO!

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One in five victims of osteoporosis is a man-sometimes in his 40s or 50s. Here's important advice so men can prevent this silent killer

Ed Farrell suffered with back pain for years. But in the summer of 1996, the pain became so intense for the athletic Farrell, then 46, that he could barely ride his bicycle. Though he used to compete in 100-mile cycling events, Ed now grew weak and suffered excruciating pain after a 10-mile workout.

"Just coughing would send pain shooting across my chest," he recalls.

Frustrated to explain the pain, his doctor finally ordered a bone-density test of Ed's back. It revealed the astonishing problem: osteoporosis-a disease that men incorrectly think only women get. It didn't look good: Ed had lost 41% of his bone density at the hip and 35% at the spine. The fragile vertebrae of his back were now riddled with microfractures.
More Than You Think

Ed's story is not unusual. Despite the myth that osteoporosis is a woman's disease, an estimated 2 million American men have osteoporosis, and another 3 million are at risk.

"Osteoporosis is a bigger problem in men than anyone believed," says John Bilezikian, MD, director of the Metabolic Bone Diseases Program at Columbia-Presbyterian Medical Center in New York City. "It can happen to anybody."

Including younger men. Although men with osteoporosis can be 65 and older, among Dr. Bilezikian's many male patients with osteoporosis, the average age is a shocking 51!
No More Golf?!!!

Thanks to quick and aggressive treatment of Ed's osteoporosis, he's back on his bike 4 years later-with stronger bones and almost no back pain. And that's what men need to know: "If you find osteoporosis early and treat it, you can preserve your active, independent lifestyle," says Dr. Bilezikian.

The problem is, men's bones have been largely ignored until now, says endocrinologist Michael Kleerekoper, MD, an expert in male osteoporosis at Wayne State University in Detroit. "Because there's a myth that guys don't get osteoporosis, many men who are clearly at risk are not being counseled about it."

And with sobering consequences. When this silent disease progresses far enough, men with osteoporosis can lose the ability to be independent and enjoy life. Goodbye golf, mowing the lawn, and sometimes even standing up straight. Or maybe goodbye life. Although a man is only about half as likely as a woman to suffer a broken hip, he is nearly twice as likely to die in the following year, says Dr. Kleerekoper. In fact, according to the National Osteoporosis Foundation, 36% of men die within 1 year of a hip fracture.
It Only Takes a Minute

The key to preventing all this suffering? Early detection via a special test called a bone-density test. How do you know if you need one? The quickest way is to take our "One-Minute Quiz That Can Save Men's Bones" on p. 142. It includes the risk factors that experts consider when they decide whether to recommend a test for a male patient.

What men don't realize is, by the time they reach 65, they are all at risk. Unlike women, who lose bone mass rapidly in the first years of menopause, men have a slow but steady decline in bone density, beginning at about 50. By age 65, Dr. Bilezikian believes that all men need a bone-density test-especially now that men are living into their 80s and 90s.

Some men, such as Ed Farrell, lose bone much earlier in life. Why does this happen?

One of the biggest risk factors for men is use of corticosteroid medications such as prednisone and cortisone to treat illnesses such as asthma and rheumatoid arthritis. Steroids such as these are bone robbers.

Or have you broken a bone as an adult-especially after a minor trauma such as slipping and falling on an icy sidewalk? This might be a sign that your bones have become too fragile to withstand ordinary knocks. "About 75% of our male patients have had a fracture of the arm, back, or hip," says Dr. Bilezikian.
What's Sex Got to Do with It?

Another possible trouble sign: Your sexual desire has begun to wane. A declining libido may be caused by a low testosterone level, an important risk factor for osteoporosis. (Note: Some men with low testosterone have no symptoms at all.) "As many as half of the male patients with osteoporosis that I see have low hormone levels," notes Dr. Kleerekoper.

Drinking alcohol excessively and smoking are major risk factors, says Dr. Bilezikian. Don't ignore nagging back pain, loss of height, or stooped posture either-all of them can be caused by spinal fractures, a sign of osteoporosis.

Unfortunately, for about 35 to 40% of men with osteoporosis, including Ed Farrell, there's no known cause. "Our knowledge is still in its infancy when it comes to understanding the risk factors for osteoporosis in men," says Dr. Bilezikian. "But the risk factors we know about should not be ignored."
Distant Early Warning

If our quiz reveals that you're at risk for osteoporosis, it's time to discuss the status of your bones with your doctor, who may prescribe a bone-density test. This safe, painless, and quick test is the only way to detect bone loss before it reaches the severe stage. Don't depend on a standard x-ray to do that-they only pick up a drastic bone loss of 30% or more.

For the gold-standard bone-density test, try to get a DEXA (dual energy x-ray absorptiometry) of the spine and hip, the sites of the most serious fractures. If this test isn't offered near you, other tests are available. Ask your doctor to help you find a bone-density testing facility.
Rebuilding Lost Bone

What's the next step, if test results indicate that your density is low? No bones about it, you need to adopt a bone-healthy lifestyle, including exercise, calcium, and vitamin D, if you haven't already done so. (See "The 'Bones of Steel' Lifestyle," below.) But although these tactics can help halt further bone loss, they can't rebuild bone that's already gone.

For that, there are medications to prevent fractures and even build back some bone-though so far, men have fewer options than women. But that's slowly beginning to change. A recent study showed that alendronate (Fosamax), a medication prescribed for osteoporosis in postmenopausal women, is also effective in men.

In a 2-year trial, 146 men with osteoporosis received 10 milligrams (mg) of alendronate per day. Another 95 osteoporotic men received a placebo pill (no active ingredients). Both groups received calcium and vitamin D supplements. At the end of the study, men in the alendronate group had a 7.1% increase in bone density at the spine, compared with only 1.8% for the placebo group. Each 1% improvement in bone density is thought to represent a 5% decrease in fracture risk.

"This is the first time we can point to a trial that was designed specifically to look at a therapy for osteoporosis in men, and the therapy was effective," says lead researcher Eric Orwoll, MD, of Oregon Health Sciences University in Portland.
More Choices for Men

Testosterone replacement is an option for men whose osteoporosis appears to be caused by low testosterone levels. Some doctors also prescribe the nasal spray calcitonin (Miacalcin), a naturally occurring hormone involved in bone metabolism.

One promising medication that may be available in a few years is parathyroid hormone. Ed Farrell participated in an experimental trial of parathyroid hormone and recovered enough bone density to back him out of the fracture zone. With the trial over, he takes alendronate, calcium, and vitamin D. He's lifting weights too, to give his bones extra growth-stimulating resistance.

In the future, we'll know even more about stopping osteoporosis in men. "This is a disease where men lag behind women in terms of studies. But that's turning around," Dr. Kleerekoper says. "Men will catch up to women some day-hopefully soon."
One-Minute Quiz That Can Save Men's Bones

If you're a man, take this quiz. Your answers will tell you whether you need a bone-density test, advises John Bilezikian, MD, director of the Metabolic Bone Diseases Program at Columbia-Presbyterian Medical Center in New York City.

If you answer Yes to one RED ZONE question, ask your doctor about
a bone-density test.
[ ]Are you 65 or older?
[ ]Do you have unexplained back pain, loss of height, or a
stooped posture?
[ ]Have you had prolonged use of any of the following
medications:
Steroids such as prednisone or cortisone
Anticonvulsants such as Dilantin or Tegretol
Thyroid hormone such as levothyroxine
Chemotherapy such as high-dose methotrexate
[ ]Have you experienced diminished sexual desire and been
diagnosed with a low level of the male sex hormone
testosterone?
[ ]Do you smoke?
[ ]Do you have more than two alcoholic drinks per day?
[ ]Have you had a fracture as an adult that wasn't caused
by a major trauma such as a car accident?

If you answer Yes to two BLUE ZONE questions, ask your doctor
about a bone-density test.
[ ]Are you inactive?
[ ]Are you getting too little calcium? (Before age 50, 1,000
milligrams (mg)/day; 50 and older, 1,500 mg/day)
[ ]Are you underweight?
[ ]Do you have a family history of osteoporosis-especially
a mother who had osteoporosis before age 80?
[ ]Have you been diagnosed with
Hyperthyroidism?
Hyperparathyroidism?
Hypercalciuria?
[ ]Do you have chronic liver disease
or celiac disease?
[ ]Do you have chronic lung disease?

Help on the Web

Jerry Donnelly, a retired Army dentist who was diagnosed with osteoporosis when he was in his early 50s, has developed the Men's Osteoporosis Support Group Web site at pages.prodigy.net/jerryd3001/. This terrific site offers a quarterly newsletter, plus links to an electronic National Osteoporosis Foundation support group for men.
The "Bones of Steel" Lifestyle

Men can help prevent osteoporosis from getting a grip with strong-bone habits such as these:

* Get enough calcium and vitamin D. These nutrients are the big shots-proven to help prevent fractures. For calcium, get 1,000 milligrams (mg)/day (before age 50) and 1,500 mg/day (50 and older). For vitamin D, get 400 IU if you're under 50 and up to 800 IU if you're 50 or older.
* Get moving. Weight bearing exercise, which includes walking, jogging, and even stair climbing, helps maintain your bone density. Exercise at least five times a week, and include the following in your program: 1 hour of weight bearing exercise such as walking; or 30 minutes of resistance exercises, such as weight lifting; or some combination of the two.
* If you smoke, quit. Cigarette smoking may reduce your ability to absorb calcium. Smoking is also thought to damage bone cells and prevent new bone growth.
* Easy does it. Limit your alcoholic intake to no more than two drinks per day. Alcohol is bad for the bones in several ways. It blocks the bone's ability to build itself. Too much alcohol can also cause testosterone levels to drop-and a drop in this male hormone for any reason leads to bone loss. Heavy drinking also causes you to lose calcium through the urine.
* Eat your veggies. A study of older people found that those who ate the most fruits and vegetables every day had denser bones. Every extra serving of a vegetable per day increased hipbone density in men by 1%. And every 1% increase reduces your risk of fracture by 5%.
* Get your "K" rations. Broccoli, kale, spinach, parsley, and other green and leafy vegetables supply vitamin K, a lesser-known vitamin that your body may need for healing fractured bone and maintaining normal bone.

PHOTO (COLOR): If men act in time, they can beat this crippling disease

PHOTO (COLOR): Left untreated osteoporosis can cancel your golf game for good

PHOTO (COLOR): Pudding, with bone-building calcium, can be a guy's best friend

PHOTO (COLOR): Your sex life may be a clue to bone health

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By Julie A. Evans

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