Men's Health Week: Part 1, Osteoporosis

In the first part of our Men's Health Week series, we talk about osteoporosis--thinning of the bones. It is usually thought of as a woman's disease, but osteoporosis also affects men. An estimated 2 million American men have osteoporosis and millions more are at risk of suffering associated debilitating bone fractures. Doctor David Gremillion, an associate professor at the University of North Carolina School of Medicine, explains.

Osteoporosis in men is underdiagnosed, undertreated, and a serious health threat. How common is it?

I'd say that at least 40% of men over the age 60 have some level of bone loss. That's not an insignificant number. Many of those men go undetected and suffer life-threatening fractures. They start with stronger bones than women's and their bone loss starts later in life. I'd say it's an unrecognized, "silent" epidemic. Men suffer one-third of all hip fractures.

Why is osteoporosis thought of as just a woman's disease?

I believe it's been studied in women more because of issues related to women like breast-feeding and loss of calcium. Also, there's a great deal of public awareness about bone loss and hip fractures in women. Women do have a greater prevalence but that masks a large number of men who do not get diagnosed because of all the attention women get. Lots of men just don't think it's something they can get.

What's the definition of osteoporosis?

A simple way to explain it is as a demineralization of the bones. It is a loss of bone strength due to a loss of minerals such as calcium.

It's called a "silent disease" because the first sign of bone loss is often a fracture. What are some signs or symptoms men should be on the lookout for?

First, chronic bone pains. Pain that just won't go away and is unexplained. Also, unexpected fractures that occur with minimal trauma. This is very common. Some men have fractured their ribs while coughing. And unresolved back pain is sometimes a good indicator of bone density loss. And check your family history for early hip fractures.

Do men and women lose bone mass at the same rate?

Women have an accelerated bone mass loss, especially after menopause. That's when many women start taking estrogen. But men in general will not use estrogen. Men tend to lose bone mass at a more even pace and throughout their lives.

Should men be asking their doctors for bone density screenings?

Men over the age 60 should be asking their doctors if they are at risk for developing osteoporosis. Men who are in certain risk categories, who have a family history, or who are on certain medicines like steroids for asthma that can promote the demineralization of the bones should be asking.

Preventive steps are:

• Stop smoking.
  
• Drink moderately.
  
• Take a calcium supplement.
  
• Do weight-bearing exercise.

Smoking is a major risk factor and we should also limit alcool intake. Men as they get older should take a calcium supplement, between 1,000 and 1,500 milligrams per day. Do exercises: especially weight-bearing exercises that put some stress on the bones.

Who's most at risk?

White males seem to be at higher risk. Men over the age 60 or men in nursing facilities who get little exercise are at the most risk, along with men who drink a lot and smoke.

What therapies are currently available for men?

Once the disease develops, there are a few treatments available to men other than taking more calcium.

Are hip fractures more serious in men?

Yes, they can be. Men tend to be little taller than women are so they have farther to fall. Once immobile, men tend to suffer complications that dramatically increase the speed of deterioration.
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