Oct. 07--GRAND FORKS, N.D. -- Osteoporosis, a disease that causes bones to
weaken and sometimes break, is often thought of as a "women's disease," but it
poses a significant threat to more than 2 million men in the United States,
according to the National Institutes of Health.
After age 50, 6 percent of all men will experience a hip fracture and 5 percent
will have a spinal fracture as a result of osteoporosis, NIH has reported.
Osteoporosis in men "is an area, you could say, that's forgotten almost," said
Bob Schmaltz, radiology assistant with Altru Health System in Grand Forks.
About 12 million American men are at risk of osteoporosis, he said.
Schmaltz performs Dexa scans, dual-energy X-ray absorptiometry, a technology
that measures bone mineral density, or BMD.
The scans focus on the spine and hip, which is where most osteoporosis-related
fractures occur, he said.
Osteoporosis is considered to be a "silent disease," Schmaltz said. "You don't
know you have osteoporosis until you're well into the disease."
In men, the diagnosis is often not made until a fracture occurs or a man
complains of back pain and sees his doctor.
"Men at age 70 should be scanned," Schmaltz said. "I don't see that happening in
our practice. We're not seeing a glut of males" coming in for a scan.
On average, he scans 10 patients a day, he said. "I have not seen a male in
about two months."
In recent years, recognition of male osteoporosis as an important public health
issue has grown, particularly in light of estimates that the number of men older
than 70 will continue to increase as life expectancy continues to rise.
Several reasons explain why men have a lower risk of osteoporosis.
Because women live longer, they are more likely to get the disease, Schmaltz
said. "There are four times as many women who have osteoporosis than men."
Lifestyle may also be a factor in protecting men from osteoporosis.
"Generally -- and I'm speaking generally now -- men are more physically active
during their lives," he said. "They're engaging in heavier work."
Physical activity and weight-bearing exercise have been shown to play an
important part in building and maintaining bone density.
But some lifestyle behaviors, such as extensive alcohol use and smoking,
contribute to their risk.
"Smokers have a higher rate of fractures," Schmaltz said. "They have a 55
percent higher risk for hip fractures compared to nonsmokers."
People who use nicotine and caffeine excessively and "couch potatoes" tend to
have lower bone mass than those who don't, he said.
The most common cause of male osteoporosis is testosterone deficiency, an area
that needs more scientific attention, Schmaltz said, based on studies he's read.
More men who have this condition should be evaluated by bone density scans, he
Several medications -- such as steroids and drugs for prostate cancer and
seizures -- can affect bone mass, he said.
"A lot of times, someone who's taking medications for prostate cancer or
metastatic disease elects not to have surgery," he said. "We get a baseline
(Dexa scan) to start with."
If later scans reveal that medications are causing major bone loss, a change in
treatment may be considered, he said. Doctors "don't want to create another
Conditions such as rheumatoid arthritis, digestive and blood disorders, and
cystic fibrosis play a role in developing osteoporosis, Schmaltz said. They can
impair the body's ability to absorb needed nutrients.
Bone loss is a common side effect of drugs used to treat asthma and rheumatoid
arthritis, according to the NIH.
Men have larger skeletons, their bone loss starts later and progresses more
slowly, and they have no period of rapid hormonal change and bone loss, as women
do after menopause, according to the NIH.
Bone is constantly changing -- that is, old bone is removed and replaced by new
bone. During childhood, more bone is produced than removed, so the skeleton
grows in both size and strength.
"Bones, if they're healthy, are very, very strong," Schmaltz said.
For most people, bone mass peaks during their 20s. By this age, men typically
have accumulated more bone mass than women. After this point, the amount of bone
in the skeleton typically begins to decline slowly as removal of old bone
exceeds formation of new bone.
"Bone continually monitors what stress we put on it," he said. "With bone mass,
it's a 'use-it-or-lose-it' proposition, much like muscle."
But by age 65 or 70, men and women are losing bone mass at the same rate, and
the absorption of calcium -- an essential nutrient for bone health throughout
life -- decreases in both sexes, the NIH said. Excessive bone loss causes bone
to become fragile and more likely to fracture.
Most commonly, fractures occur in the hip, spine and wrist, and can be
permanently disabling. Hip fractures are especially dangerous. Perhaps because
such fractures tend to occur at older ages in men than in women, men who suffer
hip fractures are more likely than women to die from complications, according to
Early detection of a loss in bone density can alert your doctor to the need for
medication or supplements, a balanced diet with a lot of calcium- and vitamin
D-rich foods, a program of physical exercise and smoking cessation.
Exercise -- such as brisk walking at least 30 minutes a day -- is a proven
method to strengthen bones, Schmaltz said. And any weight-bearing exercises are
"In the 25 to 64 age range, only about 35 percent of men are meeting the minimum
exercise prescription of what they should be doing," he said.
Calcium is critical to helping the body build and maintain bone density.
"To make new bone the body needs, it takes plenty of calcium," Schmaltz said.
"In the age range of 19 to 50, it's recommended that a person get 1,000
milligrams a day. If you're older than 50, the recommendation is 1,200
milligrams a day."
To help the body properly use calcium, vitamin D is recommended, he said. "The
recommendation used to be 400 to 800 (international) units a day; now it's 800
units a day. Some take 1,200."
Some health professionals are including the Dexa scan to their male patients'
annual physical exam, Schmaltz said. "They'll tell the patient, 'We'll check
your BMD along with your hemogloblin and cholesterol.'
"It's better to be proactive than waiting for something to happen."
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