Osteoporosis cases could soar 300% among men
June is Men’s Health Month, an annual commemoration intended “to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys,” according to MensHealthMonth.org.
Throughout the month, Healio Family Medicine has been highlighting specific health conditions and their impact on men. We’ve looked at some of the most common diseases in men such as heart disease and diabetes and a condition frequently overlooked in men, postpartum depression. The final installment of this four-part series discusses another condition with increasing prevalence in men that has not garnered as much attention: osteoporosis.
“There are some reports that estimate that during the next 10 years, there will be a 300% increase of osteoporosis in men,” Kenneth W. Graf, MD, director of the Orthopaedic Trauma Program at Cooper University Health Care in Camden, N.J., said in an interview.
"Because osteoporosis is more common in women, many primary care providers and specialty care providers tend to offer screening and education more often to women than men in their practices,” Karla L. Miller, MD, an internist with University of Utah Health, told Healio Family Medicine.
“However, it is important to remember that one-third of osteoporotic fractures occur in men, and the mortality rate associated with hip and other osteoporotic fractures is higher in men than women,” she added.
To help bring this condition more to the forefront of patient-PCP discussions, Healio Family Medicine asked several leading clinicians for suggestions to help primary care physicians understand the risk factors, prevention, and other topics surrounding osteoporosis that are applicable to men. Other experts including Douglas K. Owens, MD, MS, vice chair of the U.S. Preventive Service Task Force, and Jaclyn Demeter, PA-C, MPAS and Joseph D. Smucker, MD, both of the Indiana Spine Group. – by Janel Miller
Healio: How can PCPs broach the subject of osteoporosis with male patients?
Graf: It’s important to realize that men may see osteoporosis as a feeling of weakness. You can try to help them get around that mindset by explaining the biology of the disease to them, why it happens and the importance of having it treated. Men also need to know that if they get a hip fracture, they’re at three times greater risk for mortality than women at 1 year.
Miller: When discussing the subject of preventive health care with my patients, I discuss their own personal goals for their health. What things do they enjoy doing now? What would they like to be doing or able to do in 5 years? 10 years? Then I discuss preventive measures, recommended screenings, and likelihood of a hip or other osteoporotic fracture resulting in disability, diminished function, and loss of independence. It is important to find out what motivates your patients.
Healio: What are some of the ways men can do to prevent osteoporosis?
Miller: Men can take a proactive role in their bone health by understanding that healthy bones are vital to living an active and independent lifestyle. Weight-bearing exercise such as walking, hiking, stairs, and weight-lifting can help improve bone strength, and core muscle strengthening such as tai chi, yoga, pilates, and paddling can improve balance and make falls less likely. Calcium and vitamin D are important nutrients for healthy bones, and daily intake recommendations for men are 1,000 mg of calcium and 600 IU to 800 IU of vitamin D3 from dietary and supplemental sources combined.
Graf: Men should try not to have more than three drinks a day. They, like women, should also try to quit smoking or never start, follow a healthy diet, and adhere to medications that treat underlying medical conditions to reduce their chances of developing osteoporosis.
Healio: What are the current U.S. Preventive Services Task Force recommendations regarding screening for osteoporosis in men?
Owens: We don’t have sufficient evidence to know whether screening for men helps or not, so currently screening for men for osteoporosis has an ‘I’ grade recommendation for insufficient evidence. This means there are not enough clinical trials to support a recommendation in men without symptoms either for or against screening. We also found that evidence is inadequate to determine whether medications can reduce the risk for fractures in men.
Healio: What are some of the risk factors for osteoporosis in men?
Owens: The risk factors include low body mass, excessive alcohol consumption, currently smoking, long term corticosteroid use, and a history of falls within the past year. Men are at lower risk than women, and it is at about age 80 years that men get to the same level of risk that a woman is at age 65. So, while that might seem like good news, osteoporosis is still an important problem, and 1 in 5 men will be at risk for osteoporotic fractures in their lives.
Graf: Men who are aged 70 years and older have a significantly higher risk for osteoporosis than younger men, as do men who are white and of North America and/or Northern European decent.
Miller: Men who use high risk medications (eg, glucocorticoids, androgen deprivation therapies for prostate cancer, anti-seizure medications), or have a vitamin D deficiency, and a number of chronic medical illnesses (eg, diabetes, hyperthyroidism, hyperparathyroidism, chronic liver and or kidney disease, rheumatoid arthritis, and gastrointestinal illnesses that result in nutrient malabsorption) are at risk for osteoporosis.
Healio: How is the dynamic of osteoporosis in men different than that in women?
Demeter, Smucker: Both men and women achieve their peak bone density in their late 30s, typically, and then there after there is a gradual decline. However, since men do not go through menopause, there is less risk for bone density loss in their 40s and 50s. But as men reach their 70s and 80s, they eventually catch up with women.
Graf: Men who have lower levels of testosterone seem to be at greater risk for osteoporosis. The number of men affected by this condition appears to be rising.
Healio: What tools can a PCP use to help diagnose osteoporosis?
Demeter, Smucker: Treatment options sometimes depend on the level of diminished bone density — so whether that’s osteopenia, which is defined based on results of a DEXA scan, which gives a report based on a T score. These scores are considered normal if it’s anywhere from +1 to –1. Osteopenia falls into –1.1 to –2.4 and then osteoporosis is defined as greater than –2.5. These conditions happen when the body doesn't make new bone as quickly as it reabsorbs old bone.
Graf: PCPs can also use the FRAX score, which uses age, sex, weight, height, personal and parental history of fractured hip, femoral neck bone mineral density, as well as smoking, glucocorticoid, rheumatoid arthritis, secondary osteoporosis and drinking status to predict an individual’s risk for fracture during a 10-year period. There are apps that can help PCPs help their patient determine this score.
Healio: What are some of the treatment options for reducing the risk for, and treating, osteoporosis?
Owens: The USPSTF didn’t find sufficient evidence to know whether medications work to reduce the risk for osteoporotic fractures in men without symptoms.
Demeter, Smucker: Osteopenia is often treated with calcium and vitamin D. When you get into the osteoporosis realm, oral treatments including bisphosphonates are oftentimes recommended, and more recently there have been injectable forms of treatments.
Miller: The treatment of osteoporosis consists of lifestyle modification (eg, smoking cessation, avoidance of excess alcohol intake, weight-bearing exercise, fall prevention counseling), ensuring adequate dietary and/or supplemental calcium and vitamin D intake, and starting prescription treatments such as antiresorptives (eg, alendronate, risedronate, zoledronic acid) or anabolics (eg, teriparatide) in those men who have osteoporosis by bone density testing, by osteoporotic fracture at the hip or spine, or those men who have low bone density and a high risk for major osteoporotic fracture that is 20% or greater or hip fracture of 3% or more over the next 10 years.
Disclosure: Neither Demeter, Miller, Owens nor Smucker reports any relevant financial disclosures. Healio Family Medicine was unable to determine Graf’s relevant financial disclosures prior to publication.