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When men battle brittle bones

Men who aren't concerned about their bone health could be in for a big surprise in later life.

Osteoporosis—often thought of as a woman's disease—represents a threat to the health of millions of American men as they grow older. And, in many cases, men don't know that their bones are at risk.

"Osteoporosis is significantly underdiagnosed and undertreated in men," says Amir Qaseem, MD, PhD, vice president of clinical policy for the American College of Physicians (ACP). "It is not just a woman's disease."

In fact, one in four men over age 50 will have an osteoporosis-related fracture, according to the National Osteoporosis Foundation (NOF). These fractures often occur after age 65, when men begin to lose bone at about the same rate as women, according to the National Institutes of Health.

Men at risk

While not every man needs to be tested for osteoporosis, the ACP recommends that men older than 65 be checked periodically by their doctor for risk factors such as low body weight, unplanned weight loss, lack of physical activity and broken bones that were not caused by a substantial trauma, such as a fall.

The following factors may also increase a man's osteoporosis risk, according to the NOF and other experts:

  • A family history of the disease.
  • A diet low in calcium and vitamin D.
  • Smoking and alcohol abuse.
  • Treatment with corticosteroid drugs or drugs sometimes used to treat prostate cancer.
  • Prolonged bed rest.
  • Low levels of testosterone.
  • Long-term exposure to certain medicines, such as steroids, anticonvulsants and antacids containing aluminum.
  • Diseases of the stomach and intestines. Some of these conditions make it difficult for the body to absorb dietary nutrients, such as vitamins D and K.

In addition to being aware of risk factors, men should be sure to tell a doctor if they experience loss of height, a change in posture or sudden back pain, as these could be signs of osteoporosis.

Testing for osteoporosis

A bone mineral density (BMD) test is advised for any man at increased risk for bone loss who might benefit from drug therapy, regardless of age, Dr. Qaseem says.

Currently, the most accurate test for osteoporosis is dual-energy x-ray absorptiometry (DXA). During this painless procedure, x-ray beams penetrate the body to measure BMD.

"DXA results are useful because we have good evidence that treating people who have low BMD values with certain medications can result in decreased fracture rates," says Hau Liu, MD, MPH, who helped develop the ACP screening recommendations for men.

Strengthening bones

Treatment can prevent or slow osteoporosis when bone loss is detected early. Medications such as alendronate, risedronate and teriparatide are all approved to treat osteoporosis in men. And men with low testosterone levels may benefit from testosterone replacement therapy.

Men can also help themselves by taking these bone-sparing steps recommended by the NOF:

  • Ask your doctor about treatments for health conditions that may affect bone strength. If you use medicines known to cause bone loss, discuss alternatives.
  • Avoid smoking and alcohol use.
  • Get enough calcium and vitamin D. Men over 50 need 1,000 milligrams (mg) of calcium—that goes up to 1,200 mg after age 70—and 800 to 1,000 IU (international units) of vitamin D every day. Supplements may be needed to meet these goals.
  • Engage regularly in weight-bearing and muscle-strengthening exercises if your doctor approves. Examples include walking, jogging, climbing stairs, lifting weights and using resistance machines.

"It is really important that people continue to be physically active," says Jeffrey A. Ross, DPM, MD, a fellow of the American College of Sports Medicine. "But they need to think logically about how to remain active as they age."

reviewed 5/26/2016

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