Men and Osteoporosis
Osteoporosis is commonly thought of as a women’s disease, even among medical professionals, even through many men get it. It is estimated that 1.5 million men over age 65 years in the United States have osteoporosis. Millions more have osteopenia or are thought to be at risk for developing osteoporosis.
One obstacle is diagnosis. Women are much more likely to be given bone density tests than men. Doctors often don’t find male osteoporosis until the patient comes in for pain, often back pain. If small fractures or osteopenia are detected, that’s a clue for osteoporosis.
The standard definition of osteoporosis relies on a deviation from a statistical mean in bone density. This poses a little bit of a problem for osteoporosis in men as the bone densitometry numbers are not as well defined in men as they are in women. Bone mineral density measurements are useful for predicting fractures in men, although men have a lower absolute risk for fracture than women at any bone density T-score. The World Health Organization (WHO) recommends using the same classification of BMD. (2.5 standard deviations below the mean being osteoporosis, and between 1.0 and 2.5 standard deviations below the mean being osteopenia.)
Should men get bone density mineral tests routinely? The National Osteoporosis Foundation (NOF) and International Society for Clinical Densitometry (ISCD), recommend BMD testing for all men older than 70 years, and in men 50 to 70 years when risk factors are present. Opinions differ, but it can be said that the consensus of the medical community is that men should be tested if they have some obvious symptoms or indications that might suggest osteoporosis. These might include a loss of height (over an inch), a bunch of fractures due to low trauma, and osteopenia showing up on an X-ray. Long-term glucocorticoid (GC) therapy is known to induce osteoporosis. People with hyperparathyroidism are often checked as the two disorders are correlated.
The initial evaluation includes blood and urine tests to rule out kidney or liver disease, a complete blood count, serum testosterone, calcium, alkaline phosphatase, and 25-hydroxyvitamin D (calcidiol).
One reason men (and their doctors) need to be careful is that the mortality rate for men who get bone fractures (hips, vertebrae) are higher than the rate for women.
Treating Men With Osteoporosis
The treatment for men is largely the same as for women: bisphosphonates are considered the standard first-line therapy. Men are sometimes given testosterone replacement therapy, although the results for stopping osteoporosis with this method have been disappointing. The prostate drugs pamidronate and zoledronic acid are given as part of androgen deprivation therapy and they have a side effect of preventing bone loss. They have not been formally studied for use in osteoporosis, though.
Related: Juvenile osteoporosis