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Osteoporosis: The Bone Danger That Can Kill Men, Too

Date: December 15, 2016      Publication: Bottom Line Personal      Source:  Harris H. ­McIlwain, MD, McIlwain Medical Group      Print:

If you’re a man, here’s something important you probably don’t know—about 25% of men will have an osteoporosis-related bone fracture in their lifetimes, and a man’s risk of dying in the year following a hip fracture is twice as high as a woman’s.

Women try to protect themselves against osteoporosis because rapid bone loss is a hallmark of menopause. Men eventually will lose as much bone strength as women, but it happens more slowly and later in life—and the consequences of ignoring it can be terrible. Here’s what men need to know to protect their bones…

MALE BONE LOSS

Bone is always breaking down and building up. This process, known as remodeling, depends on things such as exercise, vitamin D and calcium intake, hormone levels and other factors. Osteoporosis (or osteopenia, an earlier stage of bone loss) occurs when more bone is lost than gained.

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Women can lose 20% or more of their total bone mass within just five years of menopause. Men are somewhat protected but only at first. They have more bone mass to begin with…are more likely to have been physically active, which builds bone…and don’t have the same midlife estrogen changes that deplete bone. But men may lose bone when testosterone levels are low. Men tend to have their first bone fractures about 10 years later than women.

By the time men have reached their 70s, their osteoporosis risk is the same as women’s. In severe cases, the bones can become almost paper thin. This can lead to fragility fractures—bone breaks that are caused by seemingly minor mishaps such as stepping off a curb in an unusual way or merely bumping into a doorframe.

RISK FACTOR

With a few exceptions (see below), men don’t need to be tested for osteoporosis until about age 65. Before that age, they should assume that they’ll eventually lose bone and start taking steps to prevent it.

The DEXA (dual-energy X-ray absorptiometry) test, which measures bone density at the hip and spine (and sometimes in the wrist), usually costs between $100 and $200 and often is covered by insurance. It assigns a T-score, a measure of your bone density. A negative reading (for example, a score of –1) indicates some bone loss. A score of –2.5 means that you have possible early osteoporosis. Anything lower indicates serious bone loss.

Most at risk: Older men who are underweight are up to 20 times more likely to get osteoporosis than heavier men. Smoking greatly increases bone loss. So does low testosterone, lung disease and a poor diet. Some drugs used to treat prostate cancer and other diseases (including some lung diseases) cause bone loss as a side effect.

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Men with any of these risk factors should get tested earlier—say, at about age 50. So should men who have suffered fragility fractures. The fractures usually occur in the hips or spine, although wrist and shoulder fractures also are common. (Broken fingers and toes aren’t considered fragility fractures.)

WHAT WILL SAVE YOUR BONES?

Men with early osteoporosis (or a high risk of getting it) can improve their diet, take calcium and vitamin D supplements, and get more exercise. Such men probably won’t need medication right away—or ever. Steps to take…

Plenty of exercise. Forty minutes a day is ideal. It’s the best way for middle-aged men to build bone mass and for older men who already have osteoporosis to slow the rate of bone loss. Research has shown that people who exercise will have fewer hip or spine fractures than those who are sedentary.

Weight-bearing exercises—walking, lifting weights, playing tennis, etc.—are the most effective at slowing bone loss. My advice: Take frequent walks. Many people enjoy walking more than other forms of exercise, and it’s foolproof. It doesn’t matter whether you walk slow or fast—simply standing up and working against gravity stimulates bone growth in the hips and spine.

More calcium. You can’t build strong bones without calcium. Unfortunately, most Americans don’t get enough. The problem is compounded in older adults, who absorb dietary calcium less efficiently. Men and women need a daily calcium intake of 1,000 milligrams (mg) up to age 50 and 1,200 mg thereafter.

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Important: The guidelines include the calcium that you get from foods and supplements. There’s no reason to take a high-dose calcium supplement if you also get plenty of calcium from dairy, fortified juices or high-calcium foods such as sardines with bones. For most people, a 500-mg calcium supplement is enough—take more if you tend to avoid calcium-rich foods. Your body absorbs calcium more efficiently when it is taken in smaller amounts (500 mg or less) several times a day. Taking 50 mg to 100 mg of magnesium a day also helps with absorption.

Add vitamin D. You can’t absorb calcium without enough vitamin D in your system, and older adults’ bodies are not very efficient at using sun exposure to create the needed form of vitamin D. My advice: I recommend taking 1,000 units of vitamin D-2 daily. Check with your doctor to see how often you should get your blood levels tested to make sure that you’re getting enough.

Go easy on the colas. Research has shown that people who consume a lot of cola (but not other carbonated beverages) tend to have lower hip-bone densities. It could be that the phosphoric acid in colas reduces calcium absorption or that people who drink a lot of soft drinks tend not to consume calcium-rich foods in general and need to be aware of this. I agree with the National Osteoporosis Foundation recommendation to have no more than five cola soft drinks a week.

If you smoke, do everything you can to quit. Smoking interferes with the hormones that you need for bone strength…decreases blood supply to bones…and slows the production of bone-forming cells. By the age of 80, smokers are about 71% more likely to have bone fractures than nonsmokers.

MEDICATIONS

Men with more advanced disease may need medication. Some of the same drugs used to treat osteoporosis in women also work in men. Bisphosphonates such as Fosamax and Actonel slow the rate of bone loss. The most common side effects include heartburn or an upset stomach. Using bisphosphonates for more than five years has been linked to two rare but serious side effects—thighbone fracture and osteonecrosis (bone death) of the jaw. Prolia, a different type of drug, helps prevent fracture and requires an injection every six months. Discuss this drug with your physician because it too has osteonecrosis of the jaw and thighbone fractures as possible side effects of long-term use. For men with low testosterone, hormone replacement will help increase bone mass and reduce the risk for fractures. Testosterone replacement should be done only under the guidance of a physician because too much testosterone has been linked to stroke and heart attack.

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Source: Harris H. ­McIlwain, MD, founder of McIlwain Medical Group in Tampa and former chair of the Florida Osteoporosis Board. He is board-certified in rheumatology, internal medicine and ­geriatric medicine. He is the pain expert for Dr. Oz’s ShareCare.com website and is a coauthor of Reversing Osteopenia.

  • sky35

    MAGNESIUM is necessary for optimal absorption of calcium. It is best to study the balance of Calcium,Magnesium, Vit. K2, and Vit. D for stopping or reversing bone loss.