Osteoporosis On The Rise in Men
The International Osteoporosis Foundation tells us one in five men will suffer some type of fracture over the age of 50. One-third of all hip fractures occur in men, with mortality of 37% in the year following fracture, says a new report highlighting the lesser-known issue of osteoporosis in men as opposed to women, according to the International Osteoporosis Foundation (IOF). In the US, while hip fractures in men will increase by 51.8% from 2010 to 2030, they will decrease by 3.5% in women. This means the message about osteoporosis awareness is not getting through to men.
Women are told to take plenty of calcium, vitamin D and to exercise, but is that message getting to men as well? Once a women reaches menopause their doctors recommend a DXA scan to check their bone mineral density, but how many doctors are giving this information to men? The Centers for Medicare and Medicaid Services includes a DXA scan in their welcome to Medicare program, but the men in this group aren’t getting the same message or may not be paying attention to it since they feel this doesn’t apply to them.
Since men continue to live longer, we need more education on osteoporosis in this population. Men also have more comorbid diseases than women so this puts them at greater risk of death from a hip fracture. For this reason, men are twice as likely to die from a hip fracture as women. According to this recent report from the IOF, men are 27 percent more likely to break a bone than contract prostate cancer. Since men are living longer, policy-makers need to include men in their clinical guidelines so that they receive this information and can take steps to diagnose and or prevent bone loss.
Bone loss and osteoporosis can be caused by secondary disorders and lifestyle choices, so we need to educate men as we do women to prevent all types of fractures.
Secondary Causes of Bone Loss in Men
- Glucocorticoid use
- Excessive alcohol use
Hypogonadism is a testosterone deficiency and is present when a serum testosterone level is less than 300 ng/dl. This loss of testosterone is present in two thirds of all American men putting them at risk for osteoporosis.
Androgen deprivation therapy is a common treatment for prostate cancer and it also causes bone loss.
Glucocorticoids are used to treat many medical disorders. Among them are rheumatologically disease, chronic obstructive pulmonary disease and inflammatory bowel disease.
Smoking also causes bone loss and eventually osteoporosis. Smoking is causing a 29% increase in fragility fractures and an 84% increase in hip fractures among our men.
Excessive alcohol intake of two or fewer drinks can lead to bone loss and osteoporosis.
Should you be tested?
If you have sustained a fragility fracture—which is a fall from a standing height or lower—that results in a fracture, you should be tested for bone loss. The following is a list of risk factors in men for osteoporosis which would indicate the need to have your bone mineral density tested with a DXA scan.
- Eating disorder and low BMI
- Vitamin D deficiency
- Chronic obstructive pulmonary disorder
- Glucocorticoids in excess
- Osteogenesis imperfecta
- Chronic kidney disease
- Delayed puberty
- Inflammatory arthritis
- Multiple myeloma
- Primary hyperparathyroidism
We need to encourage our health care providers and the medical policy-makers to include men in our education and awareness of bone loss across the U.S. and the world.
Melaina Juntti. (2014). Why Men Are Actually At Greater Risk for Osteoporosis. Retrieved 11-07-14 from: http://www.mensjournal.com/health-fitness/health/why-men-are-actually-at-greater-risk-for-osteoporosis-20141020
International Osteoporosis Foundation. (2014). Osteoporosis in Men Why Change Needs to Happen. Retrieved 11-05-14 from: http://share.iofbonehealth.org/WOD/2014/thematic-report/WOD14-Report.pdf
Justin Worland-Time Magazine. (11-5-14) Why Men Often Go Untreated For Osteoporosis. Retrieved: 11-6-14 from: http://time.com/3558795/osteoporosis-men/