A 45-year-old man, who otherwise was completely healthy, experienced a height loss over about three years, dropping from 6 foot 1 to 5 foot 9 after several vertebral fractures.
The diagnosis-osteoporosis.
Another man, age 70, who never drank much milk in his life, was being treated with steroids for emphysema, after smoking for years, and had low testosterone levels.
He, too, has osteoporosis.
Although osteoporosis evokes an image of frail older women with broken hips, more than 2 million American men also suffer from it and about 3 million more are at risk of developing the disease.
According to the National Institutes of Health, approximately 80,000 men fracture their hips and a third of them die within a year as a result. While women have menopause as a prominent warning sign that osteoporosis might occur, men’s symptoms often are silent or unrecognized.
Michael T. DiMuzio, director of the Osteoporosis Center at Highland Park Hospital, uses himself as an example.
“I’ve played tennis pretty competitively most of my life, but I’ve also avoided calcium,” says the 49-year-old. “I had my bones measured a few years ago and was surprised to find that I had low bone mass.”
Osteoporosis is a disease resulting in structural deterioration of the bone tissue and low bone mass. When bone becomes porous, fractures of the wrist, spine and hip can occur.
Women are well aware of their osteoporosis risk, especially after menopause when their estrogen levels drop. Men may not realize that they, too, are at risk.
Men’s osteoporosis has different causes and results in fractures different from those that women get, says Dr. Eric Orwoll, professor of medicine at Oregon Health Sciences University, who has focused on osteoporosis in men for about 15 years.
“Women frequently fracture their forearms, and that seldom happens to men,” he says. “Women usually fracture their hips from a fall to the side, but men fracture their hips because they are generally debilitated and in poorer health.”
And when they break their hips, men have a much higher mortality rate — dying at a rate three times higher than women because they are in worse health overall.
Dr. Michael Kleerekoper, a researcher and professor of medicine at Wayne State University School of Medicine in Detroit, identified three categories of men with osteoporosis.
Ideopathic osteoporosis, which arises spontaneously from an unknown cause, affects about one-third of men with osteoporosis and may be to blame in young to middle-aged men who unexpectedly suffer a spine fracture.
“We are learning more about this disease, and it may be related to a deficiency of a particular growth factor,” he says. “The level of this growth factor is low in many younger men. The observation has been made, but the link between the growth factor and the disease has not yet been made.”
Orwoll says an alternative theory is that there is a genetic basis to ideopathic osteoporosis, but the mechanism for it isn’t clear.
The second and most common type of osteoporosis diagnosed in men is old age osteoporosis, which occurs about 5 to 10 years later in men than in women. This is an important issue, particularly because the number of men who live to be over 70 is expected to double in the next 50 years.
Because men have larger skeletons than women, their bone loss begins later and progresses more slowly. In addition, men don’t experience the rapid hormonal loss that women have at menopause. However, men and women lose bone mass at the same rate, causing bone weakening and the potential for fracture.
A third type of osteoporosis involves other factors. In some men, osteoporosis may be related to a low level of the male hormone testosterone, Kleerekoper says.
“The first symptom these men notice is impotence, now called erectile dysfunction,” he says. “But the symptom that’s more important is loss of libido — loss of interest in sex.”
Orwoll notes that the vast majority of men with erectile dysfunction don’t have osteoporosis.
Other lifestyle factors also put men at risk for osteoporosis, according to the National Institutes of Health. These include smoking, excessive alcohol intake, low calcium intake, inadequate vitamin D and lack of weight-bearing exercise.
Men who undergo prostate surgery or those who take steroids for health problems such as rheumatoid arthritis, asthma or Crohn’s disease also have a greater chance of developing osteoporosis.
The “good news” about osteoporosis, DiMuzio says, is that it is preventable and treatable.
Prevention begins by getting adequate calcium intake. Adult men should add 1,000 to 1,200 mg of calcium to their diet daily (compared to 1,200 to 1,500 mg for premenopausal women).
Milk is a great source of calcium but not the only one. Calcium also is found in dairy products including cheese, yogurt and ice cream. Other sources of calcium are fortified juices and cereals; dark green, leafy vegetables such as broccoli and spinach; and sardines and salmon with the bones.
Adequate calcium intake is something you should begin sooner, not later.
“Men and women reach their peak bone mass at age 30,” DiMuzio says, “and if they don’t, they start this horse race of losing bone at one percent a year for the rest of their lives. If you’re already at five percent below peak bone mass and then start losing it, you will be at the low side of your skeletal strength your whole life.”
During childhood and the teen years, new bone is added faster than old bone is removed, making bones larger, denser and heavier. Bone formation outpaces resorption (the removal of old bone) until the body’s maximum bone density and strength are reached in the mid-20s. Beyond age 30, bone resorption begins to exceed the formation of bone. That’s why it’s important to build bone mass up to age 30 through proper nutrition, calcium and exercise.
Equally important is vitamin D, which is necessary for the intestinal absorption of calcium. “I think vitamin D is a big player,” Kleerekoper says. “There is increasing evidence of a vitamin D deficiency in our elderly population.”
Vitamin D not only is important to the bones, but to the muscles, he says. If you don’t have good muscle strength, then you tend to fall, and if you fall you can fracture your hip.
Vitamin D is a hormone the body makes when ultraviolet light reacts with our skin. The body makes the vitamin fairly efficiently until people reach their late 60s and early 70s. Then it kind of peters out, DiMuzio says.
Older men and women need 600-800 units of vitamin D in their daily diet.
They can get it by drinking milk or by taking vitamin D supplements. In addition, just 15 minutes of sunlight can provide vitamin D to the body.
The other important factor in preventing osteoporosis is exercise, Orwoll says.
“Exercise is good for strength and coordination so you don’t fall, and it also helps maintain bone mass.”
For strength and coordination, any lower limb exercise is good, such as swimming, biking and walking. To maintain bone mass, however, it’s important to engage in weight-bearing exercise. Some of the best forms of weight-bearing exercise are tennis, climbing, gymnastics, weight lifting and using resistance machines.
Men also can preserve bone health by avoiding smoking and by not drinking excessively (more than two drinks daily).
“Taken in large quantities, alcohol causes the kidneys to eliminate more calcium than they should. Kidneys clean the blood, filtering out some calcium every day and putting some back,” DiMuzio says. “With too much alcohol, the kidneys aren’t putting as much calcium into the blood, so we eliminate more in our urine, taking it out of our bones. This leads to a problematic cascade of bone loss.”
Orwoll says men who have had a fracture or who have any of the risk factors for bone loss should consider getting a bone density measurement.
Until recently, medical research on osteoporosis in men has been inadequate. For that reason, men should see a physician who can conduct a physical exam and identify any risk factors they may have. This is especially important for men who have noticed a change in posture, loss in height or sudden back pain.
———-
More information on osteoporosis can be found at these Internet sites: the National Osteoporosis Foundation, www.nof.org; The Osteoporosis Center, www.endocrineweb.com/osteoporosis; Osteoporosis and Related Bone Diseases–National Resource Center, www.osteo.org.
