Bone loss common in men as well as women

Studies indicate that as men age, they are likely to experience health risks associated with osteoporosis. However, the problem is often overlooked and undertreated.

By Kathleen F. Phalen, amednews correspondent. Nov. 18, 2002.

Gary M. Kiebzak, PhD, already knew that women with osteoporosis were undertreated. And he suspected the same for men.

"We were quite certain that men were not adequately treated, and we wanted to document this," says Dr. Kiebzak, associate professor of orthopedics at Baylor College of Medicine and chief research scientist at the Center for Orthopedic Research and Education at St. Luke's Episcopal Hospital in Houston.

Men at risk
Unsafe numbers
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So, along with fellow researchers, he evaluated the outcome and treatment status of 363 elderly low-impact hip fracture patients admitted to St. Luke's between 1996 and 2000.

A 60-year-old white man has a 25% chance of a future osteoporotic fracture.

The study's findings, published in the Oct. 28 Archives of Internal Medicine, were worse than expected, says Dr. Kiebzak. "It was pretty dramatic; 4.5% of men and 27% of women left the hospital with some type of osteoporosis treatment."

This finding seems to support the belief that there is an underawareness that osteoporosis is common across the board as individuals age -- not simply relegated to elderly and postmenopausal women with decreasing estrogen levels.

According to the National Osteoporosis Foundation, aging men are also at risk. At 60, the average white male has a 25% chance of sustaining an osteoporotic fracture in his remaining lifetime, says Eric Orwoll, MD, professor of medicine at Oregon Health and Science University in Portland. "It is definitely common in men. Awareness is a primary care issue."

See signals, think bones

Still, for men, osteoporosis is rarely diagnosed in time to implement effective treatment. It just does not get mentioned, says Dr. Kiebzak. "Men account for 30% of hip fractures, but unless a bone mineral density test is done, [osteoporosis] doesn't pop up on the physician's radar," he says. "By the time someone is 80 and has a hip fracture, they could have had low bone density for 30 or more years."

Osteoporosis is an age-related issue, says Dr. Orwoll. "Just like postmenopausal women, when aging happens in a man, it has similar effects on a man and decreases bone," he says. "If a man has been treated for prostate cancer, it can have skeletal effects. There are also lifestyle issues -- smoking, drinking, exercise."

What scientists are now discovering is that many disorders and conditions can contribute to low bone density. Among them are hypogonadism, hyperparathyroidism, high-dose thyroid medications, intestinal absorption disorders, prostate cancer therapy, prednisone, alcoholism, chronic inactivity and smoking.

Men account for 30% of hip fractures.

"Do the appropriate tests -- bone mineral density -- when an older man has a fracture, low testosterone levels, is on prednisone therapy, is alcoholic," says Dr. Orwoll. "It should trigger in your mind, 'I better think about bones.' "

According to the National Osteoporosis Foundation, "Fractures that occur in the absence of trauma should always raise the suspicion of osteoporosis and the possibility of osteoporosis. Bone mineral density of the spine, hip or other sites can provide valuable information concerning bone mineral content, bone strength, and the risk of future fractures. Blood and urine tests may identify many of the secondary causes of osteoporosis; occasionally a bone biopsy is helpful in identifying unusual causes of osteoporosis."

Because low bone density was initially considered a woman's disease, scientific study focused on women. But that's changing.

Scientists at the University of Pittsburgh found that as men aged, the amount of calcium absorbed dropped; the most dramatic decrease occurred in men older than 80.

Researchers at the University of Maryland School of Medicine, Baltimore, are exploring what causes the disease in men, how it can be prevented and the differences between Caucasian and African-American men. Last year, the Food and Drug Administration approved alendronate, produced by Merck & Co. Inc. under the brand name Fosamax, for the treatment of osteoporosis in men.

And last month, the International Society of Clinical Densitometry published guidelines for testing men in the Journal of Clinical Densitometry.

"Much of this is new research, and primary care physicians can't be expected to know all this," says Dr. Kiebzak. "This gives the physician guidelines."

ADDITIONAL INFORMATION:

Men at risk

Recent guidelines indicate that the following men should receive bone mass measurement:

Those 70 or older regardless of other osteoporosis risk factors
Those with prior fragility risk factor
Those with conditions widely recognized as increasing risk for bone loss-related fracture such as hypogonadism, corticosteroid treatment, hyperparathyroidism, alcohol abuse, anticonvulsant use and prior gastrectomy

Source: Journal of Clinical Densitometry

Unsafe numbers

The following statistics offer a snapshot regarding the risk and incidence of osteoporosis among men:

30% of all hip fractures are sustained by men.
At 60, the average white male has a 25% chance of sustaining an osteoporotic fracture in his remaining lifetime.
As men age, the amount of calcium their system absorbs drops -- most significantly after 80.

Weblink

National Osteoporosis Foundation (http://www.nof.org/)

Abstract, "Undertreatment of Osteoporosis in Men with Hip Fracture," Archives of Internal Medicine, Oct. 28 (vol. 162, issue 19) (http://archinte.ama-assn.org/issues/current/rfull/ioi10759.html)