Although women suffer 70 to 80 percent of fractures due to osteoporosis, older men are also at risk and, in fact, are more likely than women to die or be sent to a nursing home as a result of complications. Of men living to age 90, about 17 percent have had at least one hip fracture. Osteoporosis is a silent disease, often unknown until a fracture happens as a result of a fall or a simple action such as reaching down to pick up a paper clip. Because most think of osteoporosis as a female disease, men are unlikely to see the early signs such as a loss of height, change in posture, unexplained back pain or having a fracture happen while doing everyday activities.
Bones in the human body are always renewing themselves. Old bone is broken up and new cells are laid down in the small holes left behind. During the early years of life bones grow until they reach their peak length in the mid-to late-teens. However, they continue to grow in thickness and strength until around the age of 30. Men tend to gain more bone mass during their younger years, which acts as a reserve as bone mass decreases with age. This may result because puberty occurs later in boys and lasts longer than it does in girls.
During menopause, a woman experiences a rapid decrease in the production of estrogen, and this can have an effect on bone formation. During this period, commonly between ages 45 and 55, women are six times more likely than men to develop osteoporosis. However after age 70, age-related bone loss becomes a threat to both men and women. At this age, women are only twice as likely as men to develop osteoporosis.
There are different types of fractures that can happen, but the most concerning is a hip fracture. About 31 percent of men and 17 percent of women die within a year of having the fracture. Many of those who survive enter a long-term care facility, and men are more likely to need help after a hip fracture.
Men as well as women with a family history of osteoporosis are at increased risk of having low bone mineral density and a risk of osteoporosis. While women go through a rapid drop in estrogen production, some men can go through a slow decrease of testosterone production as they age. This decrease has an effect on bone density.
Even persons with a low risk, such as women who have not reached menopause and African Americans, may be more likely to develop osteoporosis as a result of too much alcohol or long-term use of certain medications. The medications most commonly linked with osteoporosis are corticosteriod drugs such as cortisone or prednisone used to treat asthma, arthritis or other disorders. Other drugs that can affect bone mass include anti-seizure medications such as phenytoin (Dilantin) and phenobarbital, cancer drugs, heparin, warfarin and antacids that contain aluminum.
The Food and Drug Administration (FDA) has approved three drugs for the treatment of osteoporosis in men: alendronate sodium (Fosamax), risedronate (Actonel) and parathyroid hormone (Forteo). However, when low testosterone levels are suspected, hormone replacement may be part of the treatment plan, just as estrogen therapy is used for women.
For both men and women at risk, lifestyle changes are important. These include regular exercise, smoking cessation, increased amounts of calcium and vitamin D and decrease the use of alcohol and caffeine.
In later life, and mainly after age 70, it is important to keep bones strong and avoid falls. Wear shoes that provide solid support; keep the stairways and halls of your home well lit; beware of throw rugs; and be careful when going outside onto icy or slippery sidewalks and steps.
Kerri Musselman, PharmD—Rev. 5/12/10 TNK
