The Dangers of Thinning Bones as Men Age

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By Becky McCall

WebMD Health News

Oct. 10, 2014 — One-third of all hip fractures happen in men, and up to 37% of men die in the first year following the fractures. That’s according to a new report, which highlights the lesser-known issue of thinning bones, or osteoporosis, in men as opposed to women.

Men and women with osteoporosis are at risk for fragility fractures, which are bone breaks caused by falls from standing height or less. Hip fracture is the most serious of the fragility fracture, causing pain and loss of independence.

“Men are currently not being adequately treated for osteoporosis,” author Peter Ebeling, MD, tells Medscape Medical News. Ebeling is president of the Endocrine Society of Australia. “In fact, 1 in 5 men over the age of 50 years will sustain a fracture due to osteoporosis in their lifetime.” This is in contrast to 1 in 3 women over 50 who will have an osteoporosis-related fracture.

The new report comes from the International Osteoporosis Foundation (IOF).

‘Change Needs to Happen’

Ebeling says fracture rates are increasing in men as they live longer and become more urbanized in lifestyle.

“In the U.S., while hip fractures in men will increase by 51.8% from 2010 to 2030, they will decrease by 3.5% in women. This means the message about osteoporosis awareness is not getting through to men.”

He also says deaths after all fractures were higher in men than in women. “It is most dramatic in the first 12 months after a hip fracture, when the [death] rate is up to 37% in men compared with about 20% in women,” he says. “Men are definitely the weaker sex when it comes to fractures.”

In his foreword to the report, Ebeling writes that osteoporosis is “a disease that for far too long has been considered to be exclusively a problem for women.”

Health care services must face the challenge of caring for men who are at high risk of fragility fractures, he says, pointing out that bone health in men is simply being ignored by many.

For example, one study from the U.S. has shown that men were 50% less likely to receive treatment than women.

“Change needs to happen, and it needs to be led by both governments and patients themselves. Importantly, men who have already sustained a fragility fracture need to be identified and treated to prevent further fractures,” he tells Medscape Medical News.

Echoing Ebeling’s comments, John A. Kanis, MD, president of the IOF, says the lifetime risk of an osteoporosis-related fracture in men over the age of 50 is up to 27%, higher than the risk of getting prostate cancer (11.3%).

“Yet an inadequate amount of health care resources are being invested in bone, muscle, and joint diseases. People should not have to live with the pain and suffering caused by osteoporosis, as we can help prevent and control the disease,” he stresses in an IOF statement.

Osteoporosis Risk Factors

Testosterone levels gradually drop as men age. That’s in contrast to the more rapid decline in sex hormones at menopause that happens in women, Ebeling says.

“When sex hormones fall in men after the age of 70 years, there is increased bone breakdown and a decrease in bone density,” he says.

Other things contribute to osteoporosis in men, he says, including:

  • Smoking
  • Drinking more than two standard drinks of alcohol per day
  • Low vitamin D levels
  • A family history of osteoporosis
  • The use of some medications, including:
    • Hormone-deprivation therapy for prostate cancer
    • Steroids
    • Anti-seizure drugs
    • Selective serotonin-reuptake inhibitors (SSRIs) for depression

As for why men appear to have a greater risk of death after fracture, the reasons are less clear, he says.

But rates of infections and heart problems, which are higher after some fractures, may play a role. Also, fractures that happen after little trauma may point to frail health in men, he says.

Dr. Ebeling has declared that he has received research funding from Amgen, Merck, Novartis, Eli Lilly, and GlaxoSmithKline and honoraria from Amgen. Dr. Kanis has acted as an occasional advisor to AgNovos, Amgen, D3A, Lilly, Medimaps, Unigene, Taylor Wessing, and Radius Health and has received speaker’s fees from Amgen, Pfizer Japan, and Servier and research support from Asahi, Amgen, Eli Lilly, Medtronic, Novartis, Pfizer, Sanofi, Servier, and Warner-Chilcott.

SOURCE:Medscape Medical News: “Report: Men With Osteoporosis Are Neglected.”

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