More than 2 million American men have osteoporosis, and an additional 12 million are at risk, according to the National Osteoporosis Foundation. Male osteoporosis seems to be a disease ahead of its time: under-diagnosed, under-treated, and under-researched. Data from NIH’s ongoing National Health and Nutrition Examination Survey indicate that the number of men affected will roughly double to nearly 5 million men by 2020. A study in the Archives of Internal Medicine confirms the lack of awareness regarding male osteoporosis, with fewer than three percent of men, compared with 42 percent of women, receiving treatment.
Despite the large number of men affected, male osteoporosis is often a back-burner issue, as physicians and patients concentrate on hypertension, diabetes, and prostate problems. Thus, osteoporosis may remain clinically unnoticed until fractures occur, which may be too late for some patients, as the mortality rate for men with hip fractures (31 percent) is double that of women (17 percent). (These numbers are age-dependent: far lower for a 30-year-old who falls skiing, and a bit higher for a 95-year-old man who falls in the bathroom.)
Men have more dense bone, which is why fewer men than women are affected by osteoporosis, and why they usually present ten years later. Risk factors for osteoporosis in men include heredity, smoking, excessive alcohol use, low calcium intake, inadequate physical exercise, prolonged exposure to certain medications (such as steroids to treat asthma or arthritis), and disorders that decrease testosterone levels. Like women, men should be thinking about osteoporosis if they notice a loss of height, change in posture, or the sudden onset of severe back pain. Fractures that occur in the absence of a fall or trauma should also raise suspicions.
The good news is that bone loss and fracture risk can both be reduced by taking up healthy habits—an improved diet and weight-bearing exercise. Most American men have an inadequate daily calcium intake, so be sure to have a daily elemental calcium intake of about 1200 milligrams. Vitamin D is also important for strong bones, and men should have between 10 and 20 micrograms (400 and 800 international units) each day. Treatment with bisphosphonates, which has been shown to increase bone density, should be discussed with a physician. Male osteoporosis is on the rise, but there are steps you can take to keep you and your bones healthy. If you think you’re at risk, make sure you talk about it with your doctor. It’s the "manly" thing to do.
Robert W. Lash, M.D. is anassociate professor of internal medicine at the University of MichiganMedical School. His clinical interests include thyroid disease,diabetes, endocrine disorders in pregnancy, osteoporosis and metabolicbone disease, and medical education. A member of the LLuminari team ofexperts, a board certified internist and endocrinologist, Dr. Lash hasan active clinical practice and is a hospitalist at the University ofMichigan.
Every month Dr. Lash answers questions from Discover readers, so if you're confused about health information, email him at DrLash@LLuminari.com.