Male Osteoporosis

Neil Gonter, MD Health Pro
  • Q: I am a male in my low 70's and a male friend of mine recently broke his hip with a simple fall in his house. He was told that it happened because his bones were very thin. How is this possible? I thought this only happens to women.

     

    Unfortunately, this is a common misconception. In reality, 30% of all hip fractures occur in men. If one applies the World Health Organization's (WHO) definition to men, approximately 8-13 million men have osteopenia (thin bone) and 1-2 million men in the United States have osteoporosis (very thin bone).

     

    Significant bone loss and all types of fractures including hip, spine and wrist usually occur about 10 years later in men than in women. This is due to multiple factors including their higher peak bone density and the excessive loss of bone in women that occurs after menopause. Starting at about age 75, the incidence of hip fracture begins to increase rapidly. With our continued increase in life expectancy, the number of men with hip fractures is also expected to increase dramatically. Hip fractures are devastating for all individuals, but more so for males. They have a higher rate of morbidity and mortality than in females. For example, men are twice as likely as women to die in a hospital after a hip fracture and have a 31 percent death rate at one year versus of 17 percent in women.

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    Risk Factors for Male Osteoporosis:

     

    Many of the same risk factors for women are a concern for men. These include:

     

    1. Endocrine disorders: Cushing's syndrome, excessive thyroid hormone, hyperparathyroidism, hyperadrenocorticism and diabetes mellitus
    2. Nutritional disorders: vitamin C, calcium or vitamin D deficiency
    3. Genetic disorders: Osteogenesis Imperfecta, Marfan's syndrome, Ehlers-Danlos syndrome and Cystic fibrosis
    4. Hypogonadal states: androgen insensitivity, anorexia/bulimia, female athlete triad, hyperprolactinemia, panhypopituitarism, and premature menopause
    5. Inflammatory diseases: inflammatory bowel disease, ankylosing spondylitis and rheumatoid arthritis
    6. Miscellaneous conditions: alcoholism, congestive heart failure, emphysema, end-stage renal disease, HIV/AIDS, immobility, multiple sclerosis and sarcoidosis.

     

    Osteoporosis Prevention in Men:

     

    Prevention is the same in men as in women. This includes maintaining adequate calcium and vitamin D intake (with diet and supplements), weight bearing exercises, avoidance of excess alcohol and stopping smoking.

     

    Screening:

     

    There is a lack of a clear guideline of when to check for this disease in males. The International Society of Clinical Densitometry (ISCD) recommends screening with a bone density test (DXA) in all men above the age of 70. Unfortunately, Medicare and most other insurances only pay for screening in women. Men, who would like to be appropriately screened, may be responsible for the fee for this study themselves (~$100). Call your legislators!

     

    Treatment:

     

    Once again, the treatments are relatively the same as in females. There is FDA approval for male use of numerous bisphosphonates including Actonel and Fosamax, and the PTH agonist, Forteo. Estrogen and Evista are not used in men.

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    Low testosterone is an important cause of osteoporosis in this population. If this has been found to be the possible cause of disease, treatment with testosterone replacement can be considered.

     

    As always, one has to evaluate all the possible risks and benefits of any therapies with their own physician or practitioner.

     

    Learn more about male osteoporosis

     

    Also read Health Journalist Craig Stoltz's analysis of a study about screening and treatment for male osteoporosis.

     

Published On: November 09, 2007