Men and Osteoporosis?



Q: Do men also need to worry about osteoporosis?


A: Despite popular belief, women do not have a monopoly on osteoporosis. According to the National Osteoporosis Foundation, 2 million American men have osteoporosis and an additional 3.5 million are at risk for this bone-weakening condition, facing an increased vulnerability to hip, spine and wrist fractures.

      The bone deterioration process in men starts around age 60, progresses slowly and is linked to factors such as genetics, bone metabolism changes and a diminishing ability to absorb calcium, says Dr. Eric Orwoll, professor of medicine at the Oregon Health Sciences University in Portland and a leading osteoporosis researcher. The result is while only 20 percent of osteoporosis patients are men, they sustain as much as 33 percent of all hip fractures. "And men are much more likely than women to die or experience chronic disability after a hip fracture," says Dr. Orwoll.
      Which explains why osteoporosis researchers are eagerly awaiting the findings of a soon-to-be-launched nationwide study of 6,000 elderly men. Meanwhile, experts recommend men follow the National Osteoporosis Foundation's bone-building regimen: Consume sufficient calcium from foods or supplements (1,000 milligrams per day for men under age 65; 1,500 milligrams for older men); stop smoking; avoid excessive alcohol intake; get enough vitamin D (400 IU to 800 IU/day or 10 minutes of sunshine); and exercise with weight-bearing activities, like walking and lifting weights. Men 60 and older also need to check their testosterone level and, if necessary, start hormone replacement therapy.
      "Low levels of testosterone are important to know about," says Dr. Nancy E. Lane, associate professor of medicine at the University of California, San Francisco, and author of "The Osteoporosis Book" (Oxford University Press, 1999). "But its relationship to bone mass is complex — testosterone is broken down into estrogen, most likely acting on men's bones the way estrogen does in women."
      Dr. Lane also recommends bone mineral density tests for older men who lose height, suffer fractures or take certain medications, such as steroids (for asthma or arthritis), anticonvulsants and thyroid hormone replacement drugs. Treatment for diagnosed bone loss, she says, is usually with medications such as calcitonin, the bisphosphonates (for example, alendronate — brand name Fosamax) and sodium fluoride. "I also expect parathyroid hormone will be FDA-approved soon," says Dr. Lane, who has studied it in patients with steroid-induced osteoporosis and says it works well.

J. Arenofsky



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