Osteoporosis, the bone-thinning condition once considered a disease affecting just women, is now coming to light as an underdiagnosed condition in men. As the number of men in the 70+ age group increases with the rising life expectancy, male osteoporosis has been recognised as an important public health issue.
A silent disease like osteoporosis shows no signs or symptoms until a fracture occurs. And fractures resulting from osteoporosis most commonly occur in the hip, spine and wrist, and can be permanently disabling.
Why is osteoporosis largely overlooked in men?
It is believed to develop less often in men than in women because men have larger skeletons. For most people, bone mass is at peak when they reach 30. By this age, men typically have accumulated more bone mass than women. Moreover, men do not experience rapid bone thinning like women do post menopause (they do not have periodic hormonal shifts).
What remains unnoticed here is the fact that bone density is affected by several factors including genetics, diet, sex hormone alterations, lifestyle choices, physical activity, chronic diseases and even the use of certain medications and steroids. So although men have an advantage over women in terms of peak bone density, they can still acquire the disease.
As per the National Osteoporosis Foundation, 2 million American men have osteoporosis and 12 million at a risk for it. The American College of Physicians recommends beginning periodic osteoporosis risk management in men before 65 years of age and performing dual energy X-ray absorptiometry for those who are candidates for drug therapy and at increased risk of osteoporosis.
Diagnosis and Treatment
Bone mineral density measurement with a T-score of -2.5 or less indicates osteoporosis. A basic evaluation includes measurement of serum calcium, phosphorus, creatinine, alkaline phosphatase, liver function tests, complete blood count, 25-hydroxyvitamin D, parathyroid hormone, serum testosterone and LH, and serum protein electrophoresis in those 50 or older. Additional testing may include thyroid function tests, 24-hour urine cortisol and bone turnover markers.
Only a handful of osteoporosis treatments have been approved for use by men – few treatments have been subjected to the lengthy trials required specifically for males. At present the best studied treatment for men is from the bisphosphonate drug group, alendronate.
There is evidence also for other medications such as risedronate and etidronate and the bone building drug parathyroid hormone.
In men with low levels of testosterone, bone density can be increased by giving doses of this male hormone.
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