Osteoporosis is not just a woman’s disease. Johns Hopkins provides a review of risk factors, screening tests, and drugs that are FDA-approved for use in men with osteoporosis.
For many of us, the face of osteoporosis belongs exclusively to older women. As we’re finally coming to understand, men can get osteoporosis, too. Osteoporosis is estimated to affect approximately two million men in the United States, and that number is expected to grow as more men survive into their 80s and 90s. Overall, one in four men is likely to have an osteoporosis-related fracture in his lifetime (compared with one in two women). While osteoporosis typically begins later in life in men than it does in women, it can be equally dangerous. Of those men who have hip fractures, for instance, one-third will die within a year.
Risk factors for osteoporosis in men
There are two risk factors—male hypogonadism and prostate cancer— that affect only men. Male hypogonadism refers to low testosterone levels, which may occur naturally with aging or as a result of a disease. When it comes to other risk factors, however, osteoporosis knows no gender difference. Several diseases -- notably, rheumatoid arthritis and asthma -- raise the risk of developing osteoporosis because of the drugs used to treat them, especially glucocorticoids. Anticonvulsants and immunosuppressive drugs can also raise the risk of developing osteoporosis.
In addition, people with hypercalciuria, or gastrointestinal disorders that interfere with absorption of nutrients important for bone health are at risk of developing osteoporosis. Several glandular disorders such as hypothyroidism, hyperthyroidism, or Cushing’s syndrome put people at risk for osteoporosis as well.
Finally, behavioral or lifestyle factors -- drinking too much alcohol, smoking cigarettes, not getting enough weight-bearing exercise, and low calcium and vitamin D intake -- put men at risk for osteoporosis, just as they do for women.
Osteoporosis screening advice
Many women begin to think about getting a bone density test around the time of menopause, when estrogen levels drop. But men have no similar timeline, other than general aging or fractures that occur in the absence of obvious trauma.
Certainly, if you experience a suspicious fracture, your bone mineral density (BMD) should be checked. Currently, there are no age-specific guidelines for men, but it might be worth discussing your risk with your doctor if you’re 65 or older. By age 65, men and women lose bone at the same rate.
Be aware, however, that BMD testing in men has its own challenges: There is an ongoing debate over whether the same reference values used in women should be applied to men. One organization, the International Society for Clinical Densitometry, has recommended using a T score of –2.5 or less to diagnose osteoporosis in men who are 65 or older. However, not all osteoporosis experts agree with this recommendation.
Basic osteoporosis treatment for men includes adequate calcium and vitamin D intake, regular weight-bearing exercise, stopping smoking, and cutting back on alcohol. As for drugs that are FDA-approved for osteoporosis, the following are approved for use in men:
- The bisphosphonates Fosamax (alendronate) and Actonel (risedronate)
- Teriparatide, a parathyroid hormone, which is approved for men who are at high risk of fractures. It also may be used in those men who don’t respond to bisphosphonate therapy
- Testosterone therapy for men with low testosterone levels
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