One in four men over 50 will break bones during their lifetime due to Osteoporosis. Up to 20% of vertebral fractures (broken bones in your back) and 30% of hip fractures occur in men. These fractures are associated with premature death possibly due to conditions associated with osteoporosis rather than the fracture itself.

All low trauma fractures (broken bones from a trip and fall or less) in men should be considered as due to Osteoporosis unless proven otherwise.

An Osteoporosis risk factor questionnaire should be filled out when any male has a “low trauma fracture” defined as a broken bone from a standing position or less. Examples include: broken bone/s from a trip and fall; cough; sneeze; getting up from a chair; turning over in bed; or unexplained broken bone/s.

There is an increased premature death rate from all major broken bones from Osteoporosis which is higher in men than women. 20% of people aged 60+ who fracture a hip will die within 6-12 months due to the secondary complications of the fracture. These include: blood clots; pneumonia; infection.

50% of people aged 60+ who fracture a hip will no longer be able to dress themselves, wash themselves or walk across a room unaided. Only 30% of people aged 60+ who fracture a hip will regain their independence.

Men, like women with broken bones in their back, commonly complain of intermittent back pain, loss of height and kyphosis (hump on back) but men have significantly less energy, poorer sleep, more emotional problems and impaired mobility compared with women.

The commonest cause of osteoporosis is hypogonadism. This refers to the lack of the male hormone testosterone.  This may be the result of a variety of conditions which include abnormal chromosomes, excessive stress, either physical or psychological.

Overtraining in athletes particularly those that must maintain a low body weight is usually associated with low levels of testosterone (the male sex hormone) and high levels of cortisol (high levels of stress) leading to bone loss.

Dietary problems, low caloric intake, inadequate calcium and vitamin D levels in your diet also play a role. Other risk factors include: alcohol abuse (more than 21 units of alcohol a week for a man); excessive caffeine intake; smoking; and lack of exercise.

Males with a Family history of Osteoporosis or a close relative with a history of a low trauma hip fracture or vertebral fracture (broken bone in your back) should be referred for a DXA scan. Genetics is one of the strongest links for osteoporosis, as 80% of bone is genetic. A low trauma fracture which is a broken bone from a trip and fall should not be considered normal at any age.  If your bones were healthy they would not break easily.

Osteoporosis can occur as the result of a wide variety of medical or surgical conditions or their treatment. These include use of any of the following treatments:

Corticosteroids;
some anticonvulsant therapy,(anti-epileptic drugs);
chronic Warfarin or Heparin;
long-term Lithium;
Antipsychotic Prolactin raising medication;
Proton pump inhibitors;
Chemotherapy and Radiation for cancer;
Aromatase inhibitors used for the treatment of prostate cancer; Immunosuppressive drugs; post organ transplant medications;
some Diuretics (water pills).

There is also a greater risk of hip fracture with conditions related to an increased risk of falling including: stroke; Parkinson’s Disease; dementia; vertigo; alcoholism; and blindness. A prospective study from Australia demonstrated a higher risk of hip fracture in men with low hip bone density (quality of bone), quadriceps weakness (front thigh muscles), increased body sway and history of falls in the past year.

We recommended that anyone with one or more risk factors, regardless of age or sex should consider having a DXA scan as the disease is silent and therefore you will not know if you already have lost a lot of bone. It is much cheaper and less painful to prevent broken bones than to treat them.

Diagnosis

The assessment of a male patient for osteoporosis should include: completion of an extensive risk factor questionnaire. This will help find the cause/s of your bone loss so it they can be addressed as well as your osteoporosis. A DXA scan of the spine and hips is the gold standard for measuring bone mineral density. Your risk of breaking bones or further bones is determined by the risk factors and the results of the bone mineral density of the spine and hips (BMD).

NOTE: The Irish Osteoporosis Society who are the National Experts on Osteoporosis do not ever recommend any type of heel or shin scan for the screening or diagnosis of osteoporosis or the treatment of this disease alternatively.

If you have a DXA scan and you have a normal result, you can then help to decrease your risk of developing Osteoporosis.

If you have a DXA scan and the result shows that you have low bone density (you have lost bone) you can take the appropriate steps to improve it, by contacting us for accurate advice.

Treatment

All men with osteoporosis should be given lifestyle advice on how to decrease bone loss. This advice should include: an adequate caloric intake; intake of calcium and vitamin D; 30 minutes of appropriate daily weight bearing exercise; cessation of smoking; reduction of alcohol intake. If there is a history of falls, attempts should be made to identify and modify underlying causes to help reduce the risk of further falls.

A pair of walking shoes should be worn inside the house to give maximum support. Open back slippers or sandals are not recommended along with walking in bare feet or in socks in your home.

All treatments should be prescribed on an individual basis. Any underlying cause/s of osteoporosis should be treated. Extensive blood tests should be done. Before starting an Osteoporosis treatment, the following tests should be carried out: testosterone levels; PTH; Vitamin D; calcium; Kidney function; Cortisol and bone turnover markers. before starting an Osteoporosis treatment.  If there is a marked reduction in the level of male hormone in a young patient, then treatment with replacement male hormone i.e. testosterone may be appropriate.

Note: Patients on steroids or on certain immuno-suppressant therapy for cancer or aromatase inhibitors should have a DXA scan.  They should be proactively protected with: calcium; Vitamin D3; protein; an Osteoporosis medication; appropriate weight-bearing exercise; monitored by repeat DXA scans.

Summary

Osteoporosis in men should be investigated to look for the underlying causes of their bone loss. If the causes of bone loss are not found and addressed, a person may be placed on an Osteoporosis treatment but continue to lose bone.

Patients on steroids or on immuno-suppressant therapy should all be treated preventively.  Calcium, Vitamin D3, protein and an appropriate weight bearing exercise programme, along with an Osteoporosis medication, are the principal therapies for osteoporosis in men.

Patients need to be monitored by having repeat DXA scans at a maximum every two years to ensure the treatment is working and to help increase patient compliance. Most patients will not feel any different after taking their osteoporosis medication. However, when a person has a repeat DXA scan it should show the improvement if all the cause/s have been found and addressed and the patient has taken the medication.

Note: Any decline in a person’s DXA scan results should be investigated and addressed.

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