Tough Guys, Brittle Bones

Osteoporosis is a silent yet dangerous disease, especially for men

By Dawn Klingensmith
CTW Features

Although widely regarded as a "women's disease," osteoporosis afflicts the opposite sex, as well. In fact, over the next 15 years, osteoporosis rates among men are expected to increase 50 percent, according to the American College of Physicians (ACP). As such, the ACP has established new screening guidelines for men.

Osteoporosis is a reduction in bone mass that increases susceptibility to fractures. Following a hip fracture, the one-year death rate in men is twice that of women. Also, "Men are at higher risk of suffering subsequent fractures that permanently prevent them from returning to normal activities," says Dr. Felicia Cosman, clinical director of the National Osteoporosis Foundation (NOF).

Yet the disease is significantly under-diagnosed and under-treated in men, says Dr. Amir Qaseem, senior medical associate in ACP's Clinical Programs and Quality of Care department.

"Few men are screened for osteoporosis because it is often viewed as a women's health issue," he says. "However, because of the aging population, a dramatic increase in osteoporosis among men is expected in the near future. Physicians should periodically assess the risk factors for osteoporosis in men, especially those over the age of 65."

The new ACP guidelines call for periodic assessment of older men, and those who are at increased risk should undergo scans that more accurately gauge their susceptibility to the disease.

Risk factors include older age, low body weight or significant weight loss, physical inactivity, previous fractures not caused by substantial trauma, insufficient calcium in the diet, smoking, excessive alcohol use, a previous diagnosis of rheumatoid arthritis or Celiac disease (also known as gluten intolerance), and ongoing use of certain drugs used to treat prostate cancer.

"If you've had a fracture after age 45, except in the fingers, toes and face, your doctor should make a presumptive diagnosis of osteoporosis," Cosman says.

Men who are candidates for preventative medicine due to osteoporosis risk factors should have a bone density test every one to two years, according to the NOF, which currently recommends periodic screening at 70 years of age as opposed to 65.

Women begin to lose bone density during menopause and should be screened much earlier.

For men and women alike, calcium and Vitamin D supplements can help prevent bone density loss.

"The focus is largely on calcium," Cosman says, "but Vitamin D helps the body absorb calcium. There's a huge epidemic of Vitamin D deficiency because we're all wearing sunscreen, which inhibits the skin's ability to make Vitamin D. And since very little food has Vitamin D, the only way to really make up the difference is to take a Vitamin D supplement."

Dr. William Dowling, chairman of the Department of Orthopedics at Morristown Memorial Hospital, Morristown, N.J., says it might take a while for doctors to recognize and respond to rising osteoporosis rates among men. Therefore, "It's important for patients to be their own advocate and talk with their physician to ensure this health concern is being addressed."

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