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Osteoporosis Special Report

Osteoporosis: Not Just a Woman’s Disease

This Special Report is intended for readers interested in learning about the prevention, diagnosis, and management of osteoporosis.

Approximately 14 million American men have or are at risk for osteoporosis. As with women, men with osteoporosis have an increased risk of fracture. In fact, one third of all osteoporosis-related fractures occur in men, and one of every five men will experience such a fracture at some point in his life. To put this into perspective, after age 60, a man's risk of hip or spinal fracture is similar to his risk of developing prostate cancer.

As a result of these surprising statistics, the National Osteoporosis Foundation (NOF) now recommends bone mineral density (BMD) testing for all men over age 70 to determine if they have osteoporosis or osteopenia, a precursor to osteoporosis. Men between the ages of 50 and 70 should check with their doctor to determine if they are at high risk for osteoporosis and should undergo BMD testing as well.

Low Hormone Levels, Low BMD
Women rapidly lose BMD at menopause because of reduced estrogen levels. As they age, men, too, experience hormonal changes that cause bone thinning, although at a much slower rate. Low levels of the hormone testosterone (a condition known as male hypogonadism) are known to increase osteoporosis risk in men. But estrogen -- often inaccurately dubbed the female hormone -- may be a key player as well.

For example, a recent Johns Hopkins study involving more than 1,200 men, ages 20 to 90, found that those with lower levels of estradiol (a form of estrogen) were more likely to have or be at risk for osteoporosis than men without an estrogen deficiency. And those with the lowest levels had nearly three times the risk of having low BMD as men with the highest levels. These findings held true regardless of age.

Are There Male-Specific Risk Factors?
With the exception of hypogonadism, the known risk factors for osteoporosis in men are the same as those for women. These include hyperparathyroidism, certain gastrointestinal disorders like celiac disease, long-term use of steroid medications like prednisone, smoking, excessive alcohol consumption, chronic inactivity, low body weight, and family history.

Bottom Line Advice:
To preserve bone health and prevent osteoporosis, men should follow the same basic steps as women: get enough calcium (1,200 mg daily for men over age 50) and vitamin D (800 to 1,000 IU daily for men over age 50); don't smoke cigarettes; limit alcohol intake; and exercise regularly with weight-bearing activities, such as walking, jogging, racquet sports, stair climbing, or weight lifting. Bicycling and swimming may be great for your heart, but they don't do much for your bones.

If you're age 50 or over, ask your doctor to conduct an osteoporosis risk assessment at your next physical to determine if you might benefit from BMD testing. If you're age 70 or over, ask your doctor to refer you for BMD testing.

To treat osteoporosis, your doctor will likely prescribe one of the medications approved by the U.S. Food and Drug Administration (FDA) for use by men. These include many of the medications used to treat osteoporosis in women—the oral bisphosphonates alendronate (Fosamax) and risedronate (Actonel) and the injectable parathyroid hormone teriparatide (Forteo). Bisphosphonates may also be used to treat osteopenia (lower-than normal bone mass that does not meet the diagnostic threshold for osteoporosis).

Your doctor may also try to treat any underlying cause of osteoporosis. For example, if your blood test reveals that your testosterone level is less than 200 ng/dL, your doctor may suggest testosterone replacement therapy. This therapy has been shown to increase bone density, but there are concerns that it may increase the risk of prostate cancer.

Posted in Osteoporosis on February 26, 2010


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