Male Osteoporosis The Growing Problem of Shrinking Bones

By Jessica K. Lambert, MD

Bones are amazing structures. Think about it: they help us to move, support and protect our bodies, make blood cells, and store important minerals. Unfortunately, as people get older, their bones start to become weaker.

Osteoporosis [ah-stee-oh-pore-OH-sis] is caused by a lower bone density, which leads to loss of bone strength and a higher risk of fracture (broken bone), especially of the hip and spine. When most people think about osteoporosis, they often think it is a disease of aging women.

But believe it or not, osteoporosis affects many men too! As a matter of fact, almost 40% of all new fractures from osteoporosis happen in men.

An even scarier thought is that men are more likely than woman to die from or have complications from their fractures caused by osteoporosis.

Many men are not aware of their risk for osteoporosis. It is a “silent” disease: it happens slowly over time without the person feeling or looking any different until it may be too late.

Why Do Men Lose Bone?

In men, osteoporosis happens because of changes to the skeleton caused by older age or from other things that speed up bone loss, or sometimes even both.

What effect does aging have on men’s bones?

  • Bone is constantly changing and growing
  • As men get older, the cellular changes that cause bone to break down occur faster than the changes that build bones.
  • Getting old can cause the bones to become thin, and this can cause weak, fragile bones that easily break.

What are other causes of osteoporosis that men should know about?

  • Drinking too much alcohol: 18 ounces or more of beer or 7 ounces or more of wine or 2 ounces or more of hard liquor each day is considered too much
  • Smoking
  • Having low calcium or vitamin D levels measured in the blood
  • Using steroids long term
  • Having a low testosterone [tes-TOS-tuh-rone] level: this is an important hormone in men
  • Not getting enough exercise
  • Being underweight or having an eating disorder that leads to low weight
  • Having other hormone disorders: Cushing’s syndrome, hyperthyroidism [hie-per-THIGH-roid-is-m], type 1 or type 2 diabetes, hyperparathyroidism [hie-per-pah-ruh-THIGH-roid-is-m]

How Do Men Get Evaluated for Osteoporosis?

Osteoporosis is diagnosed by a test called a DXA scan, which is a special x-ray that measures a person’s bone strength, or bone mineral density (BMD). The test comes up with a score, called a T-score, which doctors use to decide if someone has weak bones.

Experts say that all men aged 70 or older should get a DXA scan to make sure they do not have osteoporosis.

Men younger than 70 years old who get broken bones very easily, or who take steroid pills regularly, or who have low testosterone should also get a DXA scan.

Which Men Should Be Treated for Osteoporosis and How?

Men who have a low bone density on their DXA scan (a T-score lower than -2.5), men who already have a fracture from weak bones, or men whose ten-year facture risk (FRAX) is worse than 20% overall or 3% in the hip, should talk to their doctors about treatment. Your doctor can calculate this for you.

The first step is to stop any habits that might be making bones weaker—like drinking too much alcohol, smoking, or not getting enough exercise.

Men can also take calcium and vitamin D pills to keep bones strong.

Some men with low testosterone may need testosterone replacement therapy. This is not safe for all men, especially with older age. Doctors and patients need to talk about the pros and cons very carefully.

Another special case is men getting hormone treatment for prostate cancer. They should talk to their doctor about preventing osteoporosis, which might mean taking a drug to keep bones strong.

The good news is there are drugs to treat osteoporosis: these medications can slow down the disease or even help to build new bone faster. Most of the drugs were studied in older women, so there is not much information about how well they work in men with osteoporosis. But so far it looks promising!

Some of the best drugs for men with osteoporosis are in a group called bisphosphonates [bis-FOS-fuh-nates]. Examples are alendronate [uh-LEN-dro-nate] or risedronate [rih-SEH-druh-nate]. These drugs are pills taken every day or sometimes once a week.

If these drugs don’t work or cause side effects, there are other medications that can be tried instead, like teriparatide [teh-rih-PAH-ruh-tide].

What the future holds:

The number of people with osteoporosis is on the rise! Doctors and patients need to pay more attention to this problem. Because men are at risk for getting this disease too, they should learn about what puts them at risk and what they can do to keep their bones strong.

Jessica K. Lambert, MD is a second year Endocrinology fellow in training at Mount Sinai School of Medicine. She received her undergraduate degree at the University of North Carolina at Chapel Hill. She spent two years at the National Institutes of Health/National Human Genome Research Institute working on a research project investigating the genetic basis of type 2 diabetes. Dr. Lambert then attended Temple University School of Medicine. Afterwards, she completed her residency training in Internal Medicine at New York University School of Medicine. She is board certified in Internal Medicine.