Osteoporosis and Men

Last Editorial Review: 1/30/2005

By Marvin Ross
WebMD Feature

It is a condition normally associated with postmenopausal women but osteoporosis, or brittle bones, is also seen in men. According to Dr. P. Peris of the University of Barcelona, "Osteoporosis in men has received much less attention; however, it is increasingly recognized as a problem in clinical medicine."

In a 1995 study published in the British Journal of Rheumatology, Peris pointed out that 30 percent of all hip fractures occur in men and that vertebral fractures are much more common in men than previously thought. The female-to-male ratio is only 2-to-1. According to Dr. Allan Gold, an endocrinologist and senior physician at the Montreal General Hospital, a recent Canadian survey found that 20 percent of men have serious bone loss in their vertebrae, and by age 70 the figure is as high as 30 percent. Gold said that "men in their 80s have a fracture rate that is equal to women's."

Strong bones require the action of two cells in the body. Osteoblasts use dietary calcium and minerals to manufacture new bone, while osteoclasts clear away old bone. When the clearing-away process outpaces the formation of new bone, osteoporosis and its increased likelihood of fractures results.

The main cause of osteoporosis is aging. The sex hormones, estrogen and testosterone, hold the balance between bone renewal and deterioration. Women who are entering menopause are briefed on the tools to fight osteoporosis: exercise, a calcium-rich diet, and estrogen-replacement therapy and other medications. Men in their 60s rarely receive any such medical alert even though their testosterone levels decline, and some men suffer from male menopause, or andropause. For those men and others, osteoporosis is a real risk.

In addition to the decline in sex hormones, certain other medical conditions and lifestyles predispose both men and women to the dangers of osteoporosis at an earlier age than normal. Osteoporosis is classified as primary or secondary. Primary osteoporosis develops without any known risk factors, whereas secondary osteoporosis is the result of another medical condition. Men frequently have an underlying secondary cause of osteoporosis; men with such problems should be aware of the possibility of osteoporosis and take necessary preventative measures.

Peris conducted one of the few studies done on the cause of osteoporosis in men and found that secondary osteoporosis was far more prevalent than primary (78 percent, as compared to 22 percent). Hypogonadism was the most frequent condition associated with secondary osteoporosis; it causes a decline in testosterone.

Corticosteroid prescription medications like prednisone were a close second cause, followed by alcoholism. Other risk factors are chronic bowel disease, which may result in malabsorption of nutrients; hyperthyroidism; and smoking. Gold said that it isn't understood how smoking contributes to the onset of the disease, but that people who smoke tend to lose more calcium than nonsmokers.

Peris mentions our lack of exercise as another problem that predisposes us to osteoporosis. Exercise at any age helps to build bones; the best exercise, according to Gold, is walking up and down stairs. "You are lifting your whole body weight, plus you are strengthening the muscles of the thighs and the underlying bone -- the femur."

Like women, men should ensure that they are getting enough calcium and vitamin D in their diets. Vitamin D is required to help absorb calcium. Men should also have a bone-density test done if they are on corticosteroids. This is a very simple, noninvasive test that measures the thickness of some of the major bones in the body. It only takes a few minutes to perform.

For anyone with osteoporosis, new drugs are now available that have proven to be very effective. Dr. Gold said that a number of unpublished studies have shown that Fosamax (alendronate sodium) is just as effective in men as it is in women.

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