When most of us think of osteoporosis, we may assume that it’s a disease that affects only aging women. While it’s true that nearly half of postmenopausal women have low bone density, or osteoporosis, studies have shown that it afflicts one in four men age 50 and older.
Randall Taylor was diagnosed with osteoporosis in 2014. The 66-year-old from Lexington, North Carolina has had degenerative back disease since 1994. As a result, he’s had back surgery six times and surgery on each of his shoulders.
“During the shoulder surgeries for bone spurs, my doctor told me that the bones in my back and shoulder were full of osteoporosis and that it was very aggressive,” Taylor said. As a result, Taylor has had multiple fractures in his spine.
The disease has really affected his quality of life. He can’t garden. “My doctor told me I can’t ride the lawn mower, use a rake or shovel or even use a broom. I can’t even bend over because my bones are so brittle I might break another bone,” Taylor added.
Osteoporosis is a silent condition because most people can’t feel the changes in the bones as they age, making it a serious and common problem. About 54 million Americans have osteopenia, which puts them at increased risk for osteoporosis .
Many Americans will only become aware they have osteoporosis after getting treated for a broken bone. Fractures caused by osteoporosis are most likely to occur in the hip, spine or wrist, but other bones can break, too, according to the National Osteoporosis Foundation. Fractures of the wrist are considered an early warning sign of osteoporosis.
About 2 million men in the United States already have osteoporosis and an additional 12 million are at risk. In fact, men are more likely to develop osteoporosis than prostate cancer. Equally troubling are studies indicating men who break a hip are twice as likely as women to die in the year following the fracture.
Novant Health Forsyth Medical Center in Winston-Salem, North Carolina, treats about 600 to 700 patients annually for hip fractures, said Dr. Catherine Rolih , an endocrinologist and the medical director of the Novant Health Osteoporosis Clinic at the hospital. “Twenty percent of the hip fractures we treat are in men,” she added. “A hip fracture in a man requires special evaluation to determine if there is a secondary cause for the condition.”
The osteoporosis clinic is the only one of its kind in the Novant Health system and is part of a Joint Commission-certified program in hip fracture management. The clinic’s goal is to identify and treat patients at risk of osteoporosis and to educate doctors about osteoporosis risks.
“There is a preconceived notion in the public that this is an old ladies’ disease, and (that conception) even exists among providers,” Rolih said. “Orthopedists are concerned with fixing the fractures and primary care doctors are focused on taking care of acute issues. Osteoporosis treatment after fracture is at the bottom of everyone’s list. That’s where we can help.”
Recovering from a fracture due to osteoporosis can be painful and debilitating. It prevents people from getting around easily and doing the things they love most. “Osteoporosis is one of the leading causes of long-term disability,” Rolih said. “People can lose mobility and end up unable to live independently.”
Bone density increases in both women and men until age 30 and then starts declining. Vulnerability to bone loss depends on the peak of bone density achieved, which is why women are more at risk than men and can be more affected by exposure to serious illness, she said.
Screening is one way to detect early bone density loss, but studies indicate the number of people who receive these screenings is very low, particularly among men. Researchers at Boston’s Beth Israel Deaconess Medical Center found that following a wrist fracture, 53 percent of women received a bone density test. However, only 18 percent of men had the same tests.
In addition, the study showed that treatment for bone loss was equally inadequate among men following the fracture and testing. Only 21 percent of men started treatment with calcium and vitamin D supplements compared with 55 percent of women. Three percent of men versus 22 percent of women began taking bisphosphonates, a common medication used to increase bone mass.
Bone density screening for women is recommended at age 65, said Rolih. The National Osteoporosis Foundation recommends screening for men at age 70.
There are lifestyle changes men and women can make in order to protect their bones. Many of the risk factors that apply to women also apply to men. Taking steroid medication, not getting daily weight-bearing exercise, smoking and drinking alcohol can contribute to osteoporosis.
“People who have diabetes or chronic liver or kidney disease are at increased risk,” Rolih added. “Smoking is a big risk factor. Consuming three or more drinks a day raises the risk for osteoporosis. Taking prednisone, which is used to treat disorders like chronic lung disease, lupus and ulcerative colitis, for three or more months can increase your osteoporosis risk.”
Other medical conditions can also make people more vulnerable to osteoporosis. These include rheumatoid arthritis and inflammatory bowel disease, which are treated with glucocorticoid medications.
Low testosterone levels in men can also cause low bone density. “We see a fair amount of this in our male patients,” Rolih said. Treatments and therapies for prostate cancer and breast cancer may make people more susceptible to bone loss.
There is no cure for osteoporosis, according to the National Osteoporosis Foundation. However, people can take steps to prevent or slow its progress, including getting adequate amounts of calcium and vitamin D.
Calcium is an essential mineral for strong bones. Since the body doesn’t produce calcium, it has to be taken in through diet and supplements. Good calcium sources are dairy products, green leafy vegetables, nuts and items fortified with calcium such as orange juice.
Vitamin D also plays an important role in protecting bones. In food, vitamin D is in fatty fish like salmon and tuna. Milk and other dairy products often are supplemented with this vitamin. If you’re not getting adequate vitamin D from your diet, consider taking a supplement.
“A lot of people don’t get adequate vitamin D, particularly if they aren’t out in the sunshine very much,” said Rolih. “They often need supplements.”
Fosamax and Boniva can also be used by men for the treatment of bone loss.
Taylor, who has rheumatoid arthritis, is treating his osteoporosis with nightly injections of Forteo , a medication that helps to reverse severe bone loss. His treatment with the shots will last two years.
Your doctor can help you to evaluate your risk factors and advise what action is best for you based on the severity of the bone loss and other factors.
Learn more about the Novant Health Osteoporosis Clinic at nhosteoporosisclinic.org .