Osteoporosis in men: A Silent Health Crisis Demanding Greater Awareness
Table of Contents
Despite being widely recognized as a women’s disease,osteoporosis poses a notable and frequently enough overlooked threat to men’s health,with possibly deadly consequences. A growing body of evidence suggests that routine screening for men,notably those over 70,might potentially be crucial to preventing debilitating fractures and improving quality of life.
In 2006, Ronald Klein, a dentist from North Wales, Pennsylvania, discovered he had osteoporosis only after fracturing his hip and shoulder in a bicycle accident. “A 52-year-old person is not supposed to break their hip and shoulder,” he recalled, prompting him to seek a bone densitometry test. The test confirmed his suspicion: he had developed the disease, a progressive condition that weakens bones and increases fracture risk. He continues to undergo treatment at age 70.
The Underestimated Risk to Men
Osteoporosis is far more prevalent in women, leading to universal screening recommendations for women age 65 and older. However, approximately one in five men over 50 will experience an osteoporosis-related fracture, and a quarter of hip fractures among older adults occur in men.Alarmingly, men face worse prognoses following such fractures.
“Men don’t recover as well as women,” explained Dr. Cathleen Colon-Emeric, a geriatrician at the Durham Veterans Health Care System and Duke University. Men experience higher rates of mortality – between 25% and 30% within a year – and also increased disability and hospitalizations. In fact, a 50-year-old man is statistically more likely to die from complications of a major osteoporotic fracture than from prostate cancer. major fractures are defined as those of the wrist, hip, femur, humerus, pelvis, or vertebra.
Screening Gaps and the Impact of Intervention
A recent study involving 3,000 veterans aged 65 to 85 revealed a stark reality: only 2% of those in the control group had undergone bone densitometry. “Surprisingly low,” noted Douglas Bauer, a clinical epidemiologist and osteoporosis researcher at the University of California, San Francisco. “Terrible. And that’s at the Department of Veterans Affairs, where it’s funded.
Further complicating matters are inconsistent clinical practice guidelines. While organizations like the Endocrine Society and the American Society for Bone and Mineral Research recommend screening for men over 50 with risk factors, and all men over 70, the American Collage of Physicians and the Preventive Services task Force of the United States have deemed the evidence for male screening “insufficient.”
This stance impacts insurance coverage, with Medicare and many private insurers generally not covering screening tests for men without a prior fracture. “Things have been stagnant for decades,” lamented Eric Orwoll, an endocrinologist and osteoporosis researcher at Oregon Health & Science University.
Bone densitometry is widely available, costing between $100 and $300, but many men remain unaware of their risk or hesitate to proactively seek testing. A history of fractures after age 50, falls, family history of hip fractures, and conditions like rheumatoid arthritis, hyperthyroidism, and Parkinson’s disease are all risk factors. Smoking, excessive alcohol consumption, and certain medications – particularly steroids and prostate cancer treatments – can also contribute to bone loss.
Treatment options range from oral medications like Fosamax and Actonel to intravenous formulations like Reclast, daily self-injections of Forteo or Tymlos, and semiannual injections of prolia. Lifestyle changes, including exercise, calcium and vitamin D supplementation, and moderation of alcohol and tobacco use, are beneficial but often insufficient to halt or reverse bone loss.
Despite the lack of universal recommendations,many experts advocate for screening all men over 70,given the high risk of disability following a hip fracture – two-thirds of older individuals will not regain their previous mobility – and the effectiveness of available treatments. Though, progress in raising awareness among both patients and healthcare professionals has been slow.
As Ronald Klein, the only man in a Forteo education seminar, aptly observed, “I was the only man.”
