ElderCare Q&A

Osteoporosis In Men

Osteoporosis causes the skeleton to weaken and the bones to break. It's referred to as a "silent disease" because it has no symptoms---until a fracture occurs. Women get osteoporsis more often than men because men have larger skeletons, their bone loss starts later in life, and it progresses more slowly. Men also have no period of rapid hormonal change and bone loss. But osteoporosis in men is an important public health issue, especially as the number of men over the age of 70 continues to rise.

Your bones are constantly changing: old bone wears away, and new bone replaces them. As people age, the amount of bone in their skeleton will start to drop. Men in their fifties do not lose bone mass as rapidly as women do following menopause. By age 65 men and women are losing bone mass at the same rate. After too much bone loss, your bones become more likely to fracture.

Bone fractures often happen in the hip, spine and wrists. Men tend to have hip fractures later in life than women, so men who fracture a hip at an older age, more often die from complications.

There are two major kinds of osteoporosis: primary and secondary. For primary osteoporsis, 'age-related bone loss is one cause - but the cause may also be unknown. Most men with osteoporosis have one or more "secondary" causes. Their bone loss may be due to certain diseases, or medications, or lifestyle. Common secondary causes of bone loss include alcohol use, smoking, gastrointestinal disease, and low levels of testosterone.

Some medications like glucocorticoid (a form of steroids), used to treat asthma and rheumatoid arthritis, can result in bone loss as a side effect. People taking these medications should talk to their doctor about having a "bone mineral density" (BMD) test. Men should also be tested to monitor testosterone levels, as glucocorticoids often reduce testosterone in the blood. Talk to your doctor about calcium and vitamin D intake and osteoporosis medication.

Abnormally low levels of sex hormones can also cause osteoporsis. As women lose estrogen, it can cause osteoporosis. Similarly in men, reduced levels of sex hormones may also cause osteoporosis. Prostate cancer treatment can lower testosterone levels. For men, hormone replacement therapy may be helpful in preventing or slowing bone loss. Low levels of estrogen can also be a cause of osteoporosis in men.

Alcohol abuse may decrease bone density and lead to an increase in fractures. Since excess use of alcohol causes many other health and social problems, quitting is the best treatment, along with a balanced diet with calcium and vitamin D rich foods, physical exercise, and smoking cessation.

Smoking also causes bone loss. Rates of hip and vertebral fracture are higher among men who smoke. With alcohol and smoking, it is not known whether quitting leads to reduced rates of bone loss or to a gain in bone mass.

Long confinement in bed (after surgery or illness) and immobilization of some part of the body can result in bone loss. Exercise like walking should be resumed as quickly as possible after bed rest.

Osteoporosis can be treated if it is detected before significant bone loss has occurred. In men, a diagnosis of osteoporosis is often not made until a fracture occurs or a man complains of back pain. This makes it especially important for men to inform their doctors about risk factors for developing osteoporosis, loss of height or change in posture, a fracture, or sudden back pain. If you have been diagnosed with osteoporosis, your doctor may prescribe a medication approved for this disease, and develop a treatment plan that includes nutrition, exercise, and lifestyle guidelines. Doctors suggest that all people should protect their bone health by not smoking, reducing alcohol intake, increasing your physical activity, and taking a daily calcium and vitamin D intake appropriate to your age.

For more information on osteoporosis, go to www.bones.nih.gov or call 800-624-2663.