Fragile Men

Osteoporosis, a stereotypical ‘woman’s ailment,’ affects males too.

By Linda Melone

July August 2008

Osteoporosis has always been a threat to women—it afflicts 8 million females in the US. But this bone-thinning disorder is rapidly becoming recognized as a serious public health issue among men as well. In fact, more than 2 million men may be at risk for osteoporosis and bone fractures, according to the National Institutes of Health. And 6% of them over age 50 will experience a hip fracture resulting from the disease.

“Osteoporosis may not affect men as often as women, but the risk for men increases with age. And risk factors are similar to those of women,” says Pamela Taxel, MD, associate professor of medicine in the Division of Endocrinology and Metabolism at the University of Connecticut Health Center in East Hartford, Connecticut. Dubbed a silent disease, osteoporosis often exhibits no symptoms until a bone fracture occurs, making early detection crucial.

Hormones and Bone Loss

New bone constantly replaces old. More bone is produced than removed during childhood, enabling the skeleton to grow. Bone mass peaks for most people during their 30s and then the process reverses itself; the amount of bone begins to decline slowly as the removal of old exceeds the formation of new.

Female hormone production drops rapidly at menopause, a condition associated with increased bone loss. Hormonal changes in men occur much more slowly. For example, after the age of 40, testosterone levels decline about 1% a year but typically remain unnoticeable until after age 60. “Decreased testosterone may accelerate bone loss,” says Judith Stanton, MD, medical director of the California Healing Institute in Albany, California.

Women lose bone more rapidly than men up until after age 65, when rates equal out. The absorption of calcium, a crucial bone nutrient, also decreases in both sexes. Excessive bone loss increases the fragility of bones resulting in fractures, most typically of the hip, spine and wrist, and may be permanently disabling. “Women [with osteoporosis] begin to get spine fractures in their late 50s, while it’s about 10 years later for men,” Taxel says. Osteoporosis also appears later in men because it takes longer to develop in their larger skeletons.

Risk and Reduction

In addition to being brought on by advancing age and lower testosterone levels, osteoporosis can develop as the result of small stature, smoking, excessive alcohol intake, gastric cancer, HIV infection, celiac disease, various medications (including aluminum-containing antacids) and growth hormone deficiency. In an effort to find a quick risk evaluation tool, Angela Shepherd, MD and her associates at the University of Texas Medical Branch in Galveston created the Male Osteoporosis Risk Estima­tion Score (MORES) based on data from the National Health and Nutrition Examination Survey (NHANES) III. MORES looks at three factors—age, weight and the presence of chronic obstructive pulmonary disease (COPD). COPD is included because it is frequently treated with steroids and is often a marker for other signs of ill health, including smoking and malnutrition.

Men with a MORES total of six points or higher (maximum score: 13) would benefit from dual energy X-ray absorptiometry (DXA) testing for bone density. MORES also identifies men with osteopenia, below-normal bone density that has not yet progressed to osteoporosis and may be treatable with lifestyle changes. “Men weighing less than 154 pounds at any age get six points and should be screened for osteoporosis,” Shepherd says. “Lower risk tops off at about 180 pounds.”
Shepherd emphasizes that MORES determines risk only in men without any other health issues.

Others may be at a higher risk, such as men with erectile dysfunction due to low testosterone levels as well as men who have ever had prostate cancer. “Lupren, a drug used to treat prostate cancer, increases risk,” Shepherd says. “In addition, any man who has taken steroids for six months or longer at any time of their lives is at a higher risk.” Although no formal age guidelines currently exist as to when men should be tested for osteoporosis, Shepherd recommends those 60 and older be screened and get a DXA if they score six points or higher.

There’s nothing a man can do about his stature, of course, but he can protect his bones with some basic lifestyle adjustments: not smoking, limiting alcohol consumption to no more than two drinks a day and increasing exercise, especially weight-bearing activities such as walking. A man should also seek treatment for any underlying medical conditions that affect bone health.

Calcium is the best-known nutrient associated with healthy bones, but it needs help to provide maximum protection. Other skeleton-strengthening minerals include magnesium, which regulates calcium transport within the body; zinc, required for creation of a bone protein called collagen; and boron, a trace element that helps the body use calcium, magnesium and other minerals.

Boron also activates vitamin D, another key bone nutrient. To ensure adequate D intake, bask in at least 10 minutes of sunlight a day or take dietary vitamin D supplements—an especially good choice in colder, cloudier climes. In addition, B vitamin deficiencies, particularly in B6 and B12, have been associated with an increased chance of developing osteoporosis.

The best way a man can avoid osteoporosis is to be aware that he’s at risk. “Since we’ve developed medications to prevent osteoporosis in women, we’ve seen a downward trend in women breaking hips, but the incidence is still going up for men,” says Shepherd. “And it’s just getting on the radar screen.”
—Linda Melone

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