Osteoporosis and Men

Osteoporosis—it’s a term that is more likely to conjure up images of older women than of men. But it is a problem that will affect about 30 per cent of Australian men eventually.

Men in the dark

Most men probably don’t even realise that osteoporosis, the subject of much research and high-profile campaigns targeting women, is also a problem suffered by almost a third of men.

Both men and women begin to lose bone mass in their 30s, and although women generally lose this mass at a faster rate than men (especially in the menopausal years), men are also at significant risk of osteoporosis as they age.

Men not to blame

Men can’t really be blamed if they don’t consider themselves at risk for osteoporosis; the truth is that the medical world has not spent much time studying men’s bone health (as compared to women’s bone health) until very recently. As a result, there have been almost no education campaigns targeting men, and male osteoporosis has been sorely under-diagnosed.

One Danish study found that, in a random sampling of 600 men over the age of 60, more than 10 per cent were found to have osteoporosis, with 6 per cent already having at least one vertebral fracture. Only 1 per cent of these men had a known diagnosis of osteoporosis on entering this study, meaning that almost all of those found to have osteoporosis were previously undiagnosed.

In Australia, 25 per cent of a sample of men over the age of 70 was found to have osteoporosis on screening, but less than 10 per cent of these men were aware of their condition (most of them had not been diagnosed prior to this screening).

Studies such as these demonstrate how far we have yet to go in improving the screening of men for osteoporosis.

Fractures a major concern

The major concern when it comes to osteoporosis is the increased risk of fractures. According to the Australian Institute of Health and Welfare, hip fracture is the most common reason for hospitalisation among Australians with osteoporosis, aged 55 and over.

For both men and women, osteoporosis-related fractures take a significant toll. The lifetime risk of osteoporotic fracture after 50 years of age is 42 per cent in women and 27 per cent in men.

New South Wales’ Dubbo Osteoporosis Epidemiology Study (DOES)—the world’s longest-running large-scale study of osteoporotic fractures in men and women—has shown that women are initially twice as likely as men to have a fracture. But the risk of a second fracture is the same for both, once the first break occurs.

In the case of men, one of the most alarming statistics when it comes to osteoporosis involves the mortality rates associated with fractures (in other words, what percentage of those who suffer a fracture will die in the first year or two after the fracture occurs).

Although 28 per cent of women who suffer a hip fracture will die from associated complications, that number rises to 37 per cent in men. Men are also more likely than women to require ongoing institutional care after osteoporotic fractures.

Statistics such as these truly highlight the importance of osteoporosis screening and fracture prevention in men.

Men can take charge

So what’s a guy to do? With osteoporosis screening for men still lagging well behind women’s, men need to arm themselves with knowledge about osteoporosis, its risk factors and its prevention. Having this knowledge can improve men’s awareness of their level of risk and help them to know when they should be approaching the issue of osteoporosis screening with their doctors.

Know your risk

Factors increasing osteoporosis risk in men include

• high alcohol intake
• smoking
• lack of physical activity
• inadequate calcium or vitamin D intake; recommended intakes to prevent deficiency for adults:
  • calcium: 1000 mg per day (total from both diet and supplements)
  • vitamin D: 600 to 1000 IU (depending on fracture risk and vitamin D status) with even higher intakes being required in those with diagnosed vitamin D deficiency
  • androgen deprivation therapy (as used in treatment of prostate cancer)
  • chronic use of glucocorticoid medication (a steroid hormone generally used to reduce inflammation that can lead to bone loss in as little as three to six months of regular use)
  • malabsorption syndromes (disorders that interfere with nutrient absorption such as coeliac disease or cystic fibrosis)
  • chronic inflammatory diseases
  • low body weight (less than 60 kg) or substantial weight loss (more than 10 per cent of body weight)
  • family history of hip fracture

Feed your bones

Nutrition is the foundation for good health of any kind, including bone health. Bone is composed of a variety of minerals and a protein matrix.

Food

A diet rich in lean proteins, vegetables and fresh fruit, along with moderate intake of complex carbohydrates provides plenty of what bones need to grow.

Particular attention should be paid to ensuring that there are adequate calcium foods such as low-fat milk products (or calcium-fortified milk substitutes), lightly cooked dark leafy greens, almonds, sardines with bones in and tahini.

Supplements

Supplements that can be helpful, particularly if your diet is not always what it should be, include

• vitamin D: 600 to 2000 IU per day is a safe range for most people; higher doses may be required, but these should be monitored by your health care practitioner
• calcium: 1000 mg per day from a combination of diet and supplements (1200 mg for adults over 70 years)
• trace minerals and vitamin K: in small amounts, nutrients such as zinc, copper and vitamin K work together with calcium to keep bones healthy. (A number of calcium products now contain small amounts of these nutrients as well, to provide a more complete bone-supporting formula.)

Turf the bone wreckers

In addition to ensuring that you have adequate intake of bone supporting nutrients, you also want to kick things out of your diet that could be detrimental to bone health. Consider turfing the following.

High salt intake

Not only is salt potentially bad for your heart health, but high intake can also cause calcium loss, which is bad for your bones.

High caffeine intake

More than three to four cups a day of coffee (or other beverages containing high levels of caffeine) may also cause calcium loss from the body.

Too much alcohol

There are several ways that excess alcohol consumption can get you into trouble; increased risk of osteoporotic fracture is one of them.

Keep it moving

Bones, like muscle, require use to stay strong. Bones are a living tissue that is constantly being remodelled (broken down and rebuilt). Bones that are not challenged by exercise run a serious risk of growing weaker.

Resistance

Exercise that is helpful in prevention of fractures includes resistance exercises using such things as weights and resistance bands, which put a healthy stress on bones, encouraging them to stay strong.

Core strength and balance

Exercises that improve core strength and balance, such as yoga and tai chi, are also important in maintaining proper posture and stability, which helps to reduce the risk of falls, especially as we age.

Although medicine has a long way to go in understanding, diagnosing and treating men’s osteoporosis, we are at least beginning to pay much more attention to men’s bones. While the research into men’s osteoporosis is catching up, men can take the lead in reducing the threat of osteoporosis and fracture in their lives by better understanding their risk factors and taking active steps towards addressing them through diet and lifestyle choices.