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Stories for Reprint
Men, Be Afraid: Osteoporosis is No Longer a Woman's Disease
By Katerina Pesheva, MARRTC Staff
Two million men in the United States have osteoporosis, a bone disease marked by thinning of bones that can lead to easy fractures. Three million men are at risk for developing the disease, which is predatorily silent with the first sign often being a broken hip or fracture in the backbone. Yet, amazingly, osteoporosis is still thought of as a woman's disease by both men and their physicians.
"Osteoporosis is often overlooked in women, but it's definitely overlooked among men because all public-health initiatives have been focused on women," says Laura Robbins, Ph.D., associate scientist at the Research Division of New York City's Hospital for Special Surgery, which specializes in treatment and research of orthopedic conditions.
It is true that osteoporosis develops more often in women than in men. Some 80 percent of those with osteoporosis are female. One explanation for the higher incidence among women is post-menopausal loss of estrogen, a hormone that helps maintain healthy bone mass.
Yet, the millions of men who have osteoporosis may have worse outcomes just because the disease is diagnosed much later when the consequences are much harder to reverse.
Compounding physician oversight may be the fact that men have a false sense of security when it comes to assessing their osteoporosis risk.
"Men in general tend not to pay attention to an issue until a major medical event," Robbins says.
With the exception of estrogen loss, men and women share quite a few risk factors, such as family history, use of steroid drugs as well as lifestyle.
"A lot of the risk factors for men and women are surprisingly similar," Robbins says. "So we began to think: 'Why wouldn't that be same in men?'"
Risk factors for osteoporosis in both men and women include:
Age
Family history of osteoporosis
Hard patches on the skin, usually white in color
Use of corticosteroid drugs such as prednisone, used to treat certain autoimmune conditions
Recreational use and abuse of steroids
Diet low on calcium and vitamin D
Sedentary lifestyle, smoking and drinking
In addition, hypogonadism, a condition marked by low testosterone levels in men, can cause bone loss. Another risk factor in men is androgen ablation therapy for prostate cancer, which causes testosterone to drop.
Each year, roughly 1.5 million people suffer a bone fracture related to osteoporosis.
Fractures are the most dangerous effect of untreated osteoporosis, and untreated osteoporosis can be deadly. One in five senior citizens who have a hip fracture die within a year, according to a recent report of the Surgeon General's Office. Hip fractures account for 300,000 hospitalizations a year, the report says.
The direct cost of care for osteoporosis-related fractures saps the nation's economy of $18 billion a year.
"As with many diseases, preventions will make such great economic impact on the country's health care," Robbins says.
So what should be done to improve prevention, especially among men?
"First, we need to put men and women in the same sentence. That's what we need to do," Robbins says.
In addition, doctors need to begin screening men for osteoporosis more vigilantly. Evaluating men for osteoporosis should become standard practice during annual physical exams as much as is screening for cardiovascular disease or prostate cancer, Robbins suggests.
Public health initiatives should focus increasingly on teenagers and young people since peak bone mass is reached by age 25 and dietary and lifestyle habits are formed early in life.
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