Men, Aging and Bone Loss

Osteoporosis, a weakening of bone that increases the risk for fracture, is usually thought of as a postmenopausal woman's problem. However, about 20% of the 44 million Americans who have osteoporosis or low bone mineral density are men.(1) And men fare less well with this potentially painful and debilitating condition.

30% - 40% of osteoporosis related fractures occur in men.(2) In those cases involving hip fracture, men have a mortality rate two to three times greater than women.(3,4,5) Because this represents a significant public health issue the Endocrine Society recently released a review of the topic with updated practice guidelines.

All adult men should have osteoporosis on their radar as one of the chronic conditions to monitor and take steps to prevent. Here is a brief overview of this condition and summary of the Endocrine Society's recommendations.

The increased risk of fracture due to osteoporosis occurs approximately 10 years later in men than women. Race, ethnicity, location and lifestyle all contribute to one's risk. North American and Northern European men have the highest rates of fracture due to osteoporosis, while Blacks and Asians have the lowest. (6)  Interestingly, the female to male ratio among Caucasians is about 3-4:1 whereas it is around 1:1 in Asians.(7) Smoking, sedentary lifestyle, and excessive alcohol consumption significantly increase risk.

Hormone levels play an important role. There is no question that the anabolic effects of testosterone are beneficial. But relatively recent investigation has demonstrated that estrogen is at least as important in men for healthy bone maintenance.(8)

Recommendations(9)

Who is at risk and should be evaluated?
All men over 70 years of age and 50-69 year olds with a history of delayed puberty, hypogonadism, hyperparathyroidism, hyperthyroidism, chronic obstructive pulmonary disease, glucocorticoid or GnRH agonists, alcohol abuse or smoking.

Lifestyle recommendations include reduced alcohol intake for those men who consume three or more units of alcohol per day. Smoking cessation should also be a priority. They suggest weight-bearing activities for 30-40 minutes per session, three to four times per week. If vitamin D levels prove to be low (<30ng/ml) supplementation is encouraged targeting a blood 25(OH)D level of at least 30ng/ml. Men at risk for osteoporosis should consume 1000-1200 mg of calcium daily. Ideally this should come from dietary sources rather than supplements. A recent study suggests that calcium supplements may increase the risk for heart attack in women. This association has not been observed in men.

These interventions, in conjunction with a variety of medications when necessary, can prevent the progression of osteoporosis, a condition which need not compromise the quality of life.

References
(1) Burge R et al. 2007 Incidence and economic burden of osteoporosis-related fractures in the United States. J Bone Miner Res 22:465-475
(2) Bliue D et al. 2009 Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513-521
(3) Frosen L et al. 1999 Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73-78
(4) Haentjens P et al. 2010 Meta-analysis: excess mortality after hip fracture among older women and men. Ann Int Med 152:380-390
(5) Holt G et al. 2008 Gender differences in epidemiology and outcome after hip fracture: evidence from the Scottish Hip Fracture Audit. J Bone Joint Surg 90B:480-483
(6) Maggi S et al. 1991 Incidence of hip fractures in the elderly: a cross-national analysis. Osteoporos Int 1:232-241
(7) Kanis JA et al. 2002 International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237-1244
(8) Gennari L et al. 2008 Estrogen land fracture risk in men. J Bone Miner Res 23:1548-1551
(9) Watts NB et al. June 2012 Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. J Clin Endo Metab: 97(6):1802-1822