More Men at Osteoporosis Risk Than Commonly Believed

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"Osteoporosis is commonly perceived as an illness of women--both doctors and the lay public are much less aware that it's a very common problem in men," says Eric Orwoll, MD, a professor of medicine at Oregon Health Sciences University.

How common? One in every eight men older than 50 will suffer a hip fracture as a result of the disease.

Part of the problem is a lack of screening and subsequent treatment; men aren't tested for osteoporosis as often as women. "If you talk to the bone mineral density labs," Dr. Orwoll comments, "the number of men measured is quite few." Granted, you'd expect more women to be screened, since they are more likely to have the disease. But, he points out, "the disproportion between women's and men's testing is still very inappropriate."

What puts men at risk for osteoporosis is different from what makes women vulnerable. In women, it's largely the steep drop in bone-sustaining hormones after menopause. Men's osteoporosis is often the outcome of another illness, especially one that requires treatment with drugs like corticosteroids or anticonvulsants. Both are notorious for thinning bone. Anyone taking a corticosteroid to decrease the pain and inflammation of rheumatoid arthritis, for instance, is considered at high risk for osteoporosis. Also at high risk are tobacco users and heavy drinkers. The two habits, linked with fractures from the disease, are more common in men than in women.

Which men should get tested?
Men who've had a fracture after age 50 or evidence of a spinal fracture on an x-ray should get a DEXA scan for osteoporosis, says Dr. Orwoll. So should anyone with a condition associated with osteoporosis, such as an illness requiring corticosteroid treatment. Some risk categories are actually becoming more common; for example, men receiving androgen ablation therapy for prostate cancer "lose bone quickly" and should therefore get screened, too, Dr. Orwoll advises.

Heel ultrasounds that you sometimes see in pharmacies won't cut it for men. They're meant to be a quick diagnostic tool for osteoporosis, but usually they do not use a male database, making the measurement meaningless. The reason is that your score from a heel ultrasound compares your bone density to that of a reference population. If the population is all women, fewer men will be diagnosed with osteoporosis because next to women's bones, theirs could look dense even after they've become significantly demineralized.

The good news, says Dr. Orwoll: Just about all of the drugs that work to combat osteoporosis in women--Fosamax, Actonel, Forteo--are "just as effective in men."

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