Everything You Need to Know About Osteoporosis in Men
Osteoporosis in Men
Osteoporosis in men develops a bit later in life, usually 65 to 70 years old compared to women, who start experiencing major bone loss during and after menopause.
Osteoporosis is a disease in which the bones become brittle and weak due to deterioration of bone tissue. The bones are known as ‘porous’. Common areas of osteoporosis are the hip, spine and femur. Osteoporosis is also known as the “silent disease” because there are no signs or symptoms.
How Do Men Get It? | Causes | Where Do Men Get It? | Male vs. Female Osteo | Risk Factors | Bone Density in Men | Treatment Options
How Do Men Get It?
While osteoporosis is more common in women, men do get it.
In fact, the numbers show that:
- One in four men over age 50 will break a bone due to osteoporosis.
- Men older than 50 are more likely to break a bone due to osteoporosis than they are to get prostate cancer.
- Men with Osteoporosis are more likely than women to die within a year after breaking a hip, which has to do with related problem to the break.(1)
So how do men get it?
Just as with women, age plays a role.
After peak bone mass (around age 40) both men and women begin to lose about 1% of their total bone mineral density each year. Women tend to develop osteoporosis much earlier in life, usually in their fifties, because of menopause. The drop in estrogen production at this time increases bone loss to as much as 5% or even 10% each year in some women!
So while men are not experiencing this rapid rate of bone loss in their fifties, by age 65 or 70, men and women lose bone mass at the same rate. (2) At this time, absorption rate of nutrients and foods decreases in both sexes. This can cause excess bone loss and can lead to increased fracture risk.
Causes of Osteoporosis in Men
But in general, osteoporosis in men is an indication that something else is going on.
And for many men, that “something” is hormonal.
#1 Drop in Hormone Levels: As you know, we start to gradually break down more bone more rapidly as we age. This is due to the falloff in hormones: estrogen in women and testosterone in men. The most common cause of osteoporosis in men happens to be testosterone deficiency.(3) In men, some testosterone (a very small amount) is converted to estrogen. And estrogen is critical to bones. Why? It plays an important role in the growth of bone and its maturation. It also regulates healthy bone turnover.(4) So while there isn’t a lot of estrogen circulating in men, it is crucial for bone health.
Older adults absorb calcium less efficiently than children. Especially from the intestine and kidneys. This means that if you are not giving your bones what they need in terms of vitamins and minerals, your bones will start to lose bone density.
#2 Deficient in Bone Building Nutrients: Calcium is critical to bone health – you already knew that. But did you know that in addition to calcium there are 11 other minerals and two other vitamins that are essential to healthy and strong bones? So as you age and your absorption decreases, it’s more important than ever to give your bones what they need in their proper proportions. Discover the top proven bone building nutrients and how to get them, here.
When it comes to bone health, nutrition is key, but so is exercise. A lack of exercise and specifically weight-bearing exercise, plays a vital role in deteriorating bone health.
#3 Move it or Lose it: Weight-bearing exercises literally means to, ‘bear your own weight’ and is one of the best things you can do to increase your bone strength. When you don’t regularly stress your muscles, joints and bones, they begin to weaken over time. But when it comes to osteoporosis in men, some sports are better than others. A five-year study conducted by the Centre for Bone and Arthritis Research has clearly demonstrated that when it comes to protecting men’s bones, the superior sports are:
See how all these sports are ‘load-bearing’ or ‘weight-bearing?’. The study showed that these sports reduced a man’s risk of developing osteoporosis later in life.(5) This study suggested that spending just four hours per week playing a load-bearing sport helped the men increase their hip bone density by as much as 1.3% over the period of the study. This was especially critical when viewed against the discouraging data of sedentary men who lost as much as 2.1% of their hip bone density over the same period.
Participating in regular exercise for men is important for the fight against osteoporosis. But if you are living with a chronic disease, it may affect your bone health too.
#4 Medical Conditions: There are two main types of osteoporosis: primary and secondary. Primary osteoporosis is known as either being age-related osteoporosis, or an unknown cause. Secondary osteoporosis on the other hand is when the loss of bone is caused by certain lifestyle behaviors, diseases or medications. Unfortunately, there is a long list of medical conditions or diseases that lead to low bone mass. They range from genetic conditions such as diabetes, cystic fibrosis to blood disorders such as anemia. If you have a chronic condition and have been taking medication for some time, it’s even more crucial to focus on diet and exercise.
#5 Medications: If you are taking medication, it may contribute to bone loss. The following are classes of medications that which are currently known to play a cause in osteoporosis:
- NSAIDS – Non-steroidal Anti-inflammatory Drugs pain relief, especially arthritic pain
- Corticosteroids a wide variety of conditions
- Aromatase Inhibitors cancer treatment
- Gonadotrophin releasing agonists endometriosis, breast cancer, prostate
- Anticonvulsants epilepsy, bipolar, neuropathic pain
- Benzodiazepines depression, schizophrenia, insomnia
- Antidepressants depression, anxiety
- Insulin sensitizing agents type 2 diabetes
- Opioid Pain Medications severe pain management
- Calcineurin inhibitors immune system suppression
- Antacids/Proton Pump Inhibitors indigestion, heart burn
- Loop diuretics blood pressure, liver cirrhosis
- Blood coagulants prevent excessive blood clotting
- Thyroid Medications hypothyroidism
There are some things you can’t control when it comes to your bone health. You age, genetic predisposition or gender. But you can control your lifestyle. And there are certain lifestyle factors that contribute to bone loss.
#6 Lifestyle Factors: It’s no secret that smoking is associated with lung cancers and cardiovascular diseases, but studies show that it also affects your bones. A majority of the studies that have been done trying to establish a link between smoking and bone health have had a few common evidences and they are:(6)
- The more the number of years one smokes, the greater their chances of fractures in old age
- Older men and women who smoke have significant bone loss than those who do not in the same age group.
- Fractures when they do occur in smokers take longer to heal when compared to non-smokers.
- Compared with nonsmokers, women who smoke often produce less estrogen and tend to experience menopause earlier, which may lead to increased bone loss.
So if you’re a smoker, cut it out. It will not only be better for an overall healthier you, but your bones.
#7 Sleep Deprivation: Getting your Zzzz’s is no joke. Researchers have shown that a lack of sleep in rats can halt bone formation and decrease bone density. Researchers suggest that this can also be true in humans. Sleep deprivation can affect how your bones repair themselves. The National Sleep Foundation recommends that adults (ages 26-64) get 7-9 hours of sleep and that older adults (65+) get 7-8 hours of sleep.
Where Do Men Get Osteoporosis?
The common areas of osteoporosis are in the hip, femur, and spine/vertebrae, and wrists for both men and women. But after age 75, the incidence of hip fractures in men sharply increases. And the first 12 months after a hip fracture, men have a higher mortality rate than women.(7)
Vertebral fractures are also more common in men under the age of 50, but after 50, vertebral fracture incidence is higher in women.
While these areas (hip and vertebrae) have a higher incidence depending on age, men can get osteoporosis in all of the common osteoporosis area sites. Men (and women) can also get osteoporosis in other areas too, such as the forearm and shoulders.
Male vs. Female Osteo
During adolescence, the different musculoskeletal effects of testosterone and estrogen in males and females begin to emerge.
In males, the changes of muscle and bone during puberty is due to increasing levels of testosterone and IGF-1 (insulin like growth factor, which plays a role in bone growth and development). This results in increased muscle mass and strength.
Why is this important?
Because skeletal fragility in old age has to do with peak bone mass in young adulthood.
The more you accrue when you’re younger, the better your chances for reducing your risk of osteoporosis later in life. And males tend to accrue a higher peak bone mass.
This is due to the fact that before puberty, males and females gain bone mass at similar rates. But after puberty, males tend to acquire more bone mass.(8)
A study examining 373 women and 323 men (age 20-97 years) assessed gender difference in bone geometry and volumetric BMD in the lumbar spine, femoral neck, distal radius and distal tibia.(9)
The study showed that men had 35-42% larger bone areas than women. And while bone area increased equally over life in both sexes, men increased more in peripheral sites.
Age-related bone changes are complex. But because men generally have a higher peak bone mass it may explain in large part why fragility fractures are more common in elderly women than elderly men.
- Family History: Having a family member with osteoporosis puts you at greater risk as osteoporosis is genetic.
- Medications: Such as anti-depressants and treatment for prostate cancer may affect your bone health.
- Poor lifestyle habits: Such as smoking, lack of sleep, low calcium intake and inadequate exercise can increase your risk of fragility fracture.
- Race: Caucasian men seem to be at a higher risk of osteoporosis. Although all men can develop osteoporosis.
- Chronic diseases: Such as diabetes, anemia, low testosterone levels, hyperparathyroidism can lead to bone loss.
Bone Density and Signs of Bone Loss
To measure your bone density, the gold standard test is called a DXA scan, which we will discuss in the section below.
While osteoporosis has many risk factors like the ones above, there are no signs or symptoms, making it difficult to pinpoint.
But there are a couple of physical signs of bone loss.
- Wrinkles. By simply using a mirror and looking at the depth of your face and neck skin wrinkles, researchers have learned that it is a rather accurate picture of bone density. Now, you’re probably thinking that everyone develops wrinkles over time, and that’s true. But there is a difference between ‘life’ wrinkles: from age or sunshine and wrinkles from serious bone decline. So how can you tell? One study says that wrinkles are caused by collagen depletion. Remember, both your skin and bones are largely composed of type 2 collagen. Also, wrinkles can be caused by deteriorating facial bones. As we start to lose our bone density year after year, that includes our face, too! Which causes the skin to sag and wrinkle.(10)
- Dowager’s Hump. Is a forward curvature of the spine resulting in a stoop. If you have osteoporosis in your spine, it can cause your vertebrae to fracture. This can result in Kyphosis or spinal back hump. In other words, Dowagers humps (Kyphosis) are usually caused by wedge fractures. And yes, you can fracture your back without knowing! For prevention, practice postural exercises regularly. In particular, this dart exercise was featured in studies for improving posture and prevention and reduction of the dowager’s hump!
Why Men Are Less Likely To Seek Treatment
The statistics on osteoporosis in men bring out the ugly truth on how older men do not report their deteriorating bone health to doctors and consequently do not seek corrective measures. It is suspected that as many as 25% of all hip fractures occur in men. (11) Of these patients, as many as 20% die in the first year of the fracture. This mortality figure is reported to be higher than for women with the same condition as the complications arising out of injury in men are of more serious nature and reported late so that efficient management becomes difficult. (12) As per the National Osteoporosis Foundation as many as 80,000 men fracture their hips every year.
In the U.S alone, a minimum of 3 million men over 50 years of age are afflicted with osteoporosis and approximately 17 million men in the same age group have low bone mass, yet the chances that they seek consultation from a primary healthcare doctor is slim for their debilitating condition. (13)
In a recent study, scientists found that men who see a primary healthcare physician for low bone mass or fractures/broken bones are more likely to get started on an osteoporosis treatment regimen and bisphosphonates (medication) and continue them. However, of the total male population for osteoporosis lesser than 25% of the people visited such healthcare professionals during the study.
The statistics are further corroborated by an analysis done on the insurance claims records of men in the state of Texas. A team from the Medical Branch of University of Texas sifted through the records of more than 17,600 men who were over 65 years of age and had claimed compensation for fracture treatments between the five year period between 2000 and 2005.
To bring further coherence and clarity to the survey, the team went on to classify the resulting data further into demographic, diagnostic, procedural and clinical parameters. This lead them to another startling discovery: before sustaining a fracture a mere 2.7% of the elderly men were detected with osteoporosis but as many as 17.2% were detected positive following a fracture. This brought out how important it is to have osteoporosis detected on time for men (as well as for women).
Researchers are insistent that visiting a physician and testing for bone density following a fracture incidence may improve the rate of bisphosphonate use among men at high risk for osteoporosis.
How is Osteoporosis Treated in Men?
The gold standard test to see if your bones are healthy and strong is called a DXA scan.
This is the best test for both men and women. The National Osteoporosis Foundation recommends all men over 70 should get tested. This is much later than what is recommended for women (age 65). And while men don’t need to get tested as early as women if they have not experienced a fracture, they should get tested before age 70. Why? By the time men reach this age, they may already have or be well on their way to developing osteoporosis. Prevention is key. So if you can get tested before age 70, do so.
Once you have your baseline DXA scan done, you will know where you bone health stands. From there, you will be able to discuss the results with your physician or naturopathic doctor and outline a treatment plan.
The following are common natural treatment plans for osteoporosis in men:
- Supplementation: Calcium and vitamin D, plus magnesium, vitamin K2, boron, vitamin C and trace minerals are crucial for bone health. For a plant-based, whole food supplement that has all of the bone building nutrients you need, go here. To see a success stories of osteoporosis in men who overcame their bone loss, go here.
- Exercise: Regular weight-bearing exercise is key to maintaining and increase bone strength and density. Sports like soccer, basketball, volleyball and running are all great ways to stress your bones (in a good way) and build bone strength.
- Lifestyle changes: Cutting out smoking, focusing on better sleep patterns, and eating well are lifestyle changes you can control for healthy bones.
- Seeman E, The Dilemma of Osteoporosis in Men, Am J Med 98:76S, 1995.
- Center JR, Nguyen TV, Schneider D, et al., Mortality After All Major Types of Osteoporotic Fracture in Men and Women: An Observational Study, Lancet 353:878, 1999.
- Prevalence Report- Osteoporosis and Low Bone Mass – Males, National Osteoporosis Foundation, 2002. http://www.nof.org/advocacy/resources/prevalencereport