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, N.D.
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.
• RISK FACTORS: 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 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.
People who use nicotine and caffeine excessively and “couch potatoes” tend to have lower bone mass than those who don’t, he said.
• CAUSES: 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 said.
Several medications — such as steroids and drugs for prostate cancer and seizures — can affect bone mass, he said.
If later scans reveal that medications are causing major bone loss, a change in treatment may be considered, he said.
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.
• MALE DIFFERENCES: 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.
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.
• PREVENTION: 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 helpful.
Calcium is critical to helping the body build and maintain bone density.
Some health professionals are including the Dexa scan in their male patients’ annual physical exam, Schmaltz said. “They’ll tell the patient, ‘We’ll check your BMD along with your hemogloblin and cholesterol.'”
