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Osteoporosis in Men, a neglected & underreported problem

by : Dr. Amit Sharma

23-Jul-2024

Osteoporosis in Men, a neglected & underreported problem

Osteoporosis is a condition that causes bones to become weak and making them break more easily than normal bones. It is called a “silent killer” because osteoporosis progresses without symptoms until a fracture occurs. Most people view osteoporosis solely as a “woman’s disease". However, in the past few years, the problem of osteoporosis in men has been recognized as an important public health issue, particularly in men above the age of 70. Estimates of lifetime fracture risk due to osteoporosis in men range from 13% to 25%.


Bone across the lifespan

Bone mass peaks during the third decade of life.After this point, the amount of bone in the skeleton typically begins to decline.After the age of 60 years,excessive bone loss with added decreased calcium absorption causes bone to become fragile and more susceptible to fractures. Hip fractures are especially dangerous in men as they tend to have more complications than women.


Risk factors associated with osteoporosis in men

Non modifiable risk factors include:

  • Age: Risk increases after the mid sixties
  • Reduced sex hormones: Lower levels of testosterone
  • Ethnicity: White people and Asian people have a higher risk
  • Height and weight: tall and thin elderly men(with relatively less skeletal muscle mass) are more susceptible
  • Genetic factors: Having a close family member with a diagnosis of osteoporosis
  • Fracture history: A person over 50 years of age with previous fractures after a low-level injury

Modifiable risk factors include:

  • Inactivity:
  • Smoking:
  • Excessive alcohol intake:
  • Inadequate regular exercise:

Health conditions related to osteoporosis in men

  • Chronic diseases that affect the kidneys, lungs, stomach, intestines & thyroid.
  • Regular use of certain medications, such as glucocorticoids/steroids
  • Undiagnosed low levels of the sex hormone testosterone.
  • Androgen deprivation therapy for prostate cancer

Diagnosis of osteoporosis in men

  • Osteoporosis can be effectively treated if it is detected early.
  • The gold standard for diagnosis of osteoporosis is DXA Scan. This test can identify
  • osteoporosis, determine risk for fractures and measure
  • response to treatment. It is like having an x-ray but with much less
  • radiation exposure. It measures bone density at your hip & spine.
  • Another important tool for assessing the probability of osteoporotic fracture in a person is The
  • FRAX ( fracture risk assessment) tool developed by the WHO . It calculates fracture probability from risk factors such as smoking, alcohol intake, steroid intake and patient characteristics (age, weight, height, etc.). The output of FRAX is the 10-year probability of a major osteoporotic fracture DXA scan combined with FRAX score are very helpful in diagnosing and treating osteoporosis.

How can osteoporosis be prevented

All elderly men should take the following steps to preserve bone health:

  • Avoid smoking & excessive alcohol
  • Ensure a daily calcium & Vitamin D 3 intake that is adequate for age after consultation with the Doctor.
  • Engage in a regular low-impact exercise in which bones and muscles work against gravity such as walking, and gentle resistance band exercises. Such exercises place controlled stress on bones & skeletal muscles making them stronger.
  • Practicing exercise that helps with balance & flexibility such as yoga
  • Recognize and seek treatment for any underlying medical condition

Current treatment of osteoporosis in men

Treatment of established osteoporosis includes bisphosphonates (alendronate, risedronate and zoledronic acid),anti-resorptive antibody denosumab and anabolic agent teriparatide.

These drugs act by either decreasing resorption of calcium from bones or by increasing calcium formation/deposition in bones.

Treatment of osteoporosis, once started, has to be continued for a long duration, with periodic tests.

Supportive therapies in form of physiotherapy, regular exercising, adequate calcium & vitamin D intake are of equal importance.

Most importantly, patients should be properly counselled regarding long duration of treatment because just as osteoporosis is a silent disease with no apparent symptoms, its recovery, too, is silent with no immediate apparent recovery signs. This might cause many patients to leave treatment without completion.

If you are facing any joint, bone or sports injury-related issues, contact us