July
2007
Osteoporosis in Men
Osteoporosis occurs in more than 2 million American men. By 2025 it is predicted the increase in bone fractures in men will be a greater rate than women. Osteoporosis is a bone disorder of decreased bone strength which increases the risk of fractures. The bone density and quality go decrease leading to demineralization, poor architecture, increased bone turnover, and damaged accumulation. On DEXA (bone mineral density test), osteoporosis is defined as more than a 2.5% standard deviation under the mean (a.k.a T score)
So you probably think osteoporosis is only a problem for women. Overall it has been true because boys probably develop stronger bones during adolescence and puberty compared to girls. Androgens (like testosterone) are known to increase periosteal bone formation (the covering of the bone) while estrogen inhibits this. Also male muscles and weight bearing exercising might contribute to stronger bones. But as we all get older, we all lose bone mass and architecture, women more than men.
The main fractures due to osteoporosis are the vertebrae (spine), hip, and wrist. Less common are upper arm, ribs, collar bone, shoulder gone, sternum, and pelvis. After the age of 50, lower BMD (bone mineral density) is associated with increased fractures. Boys being boys, fractures are more common in boys and young men, but then dips below that of women by age 50.
Fractures lag 10 years behind that of women after age of 50. It is estimated 1/7 men after 50 years age will have an osteoporotic fracture. Unlike women, men are 50% less likely to have a vertebral fracture on x-ray or a hip fracture; and 33% less likely to have a clinical vertebral fracture (that means pain). So 2/3 of men with vertebral fracture don’t know it until diagnosed by a physician.
50% of reasons for male osteoporosis are: lack of testosterone, steroids, and alcohol abuse. In Otherwise other causes include high thyroid, high parathyroid, multiple myeloma, high urine excretion of calcium, low vitamin D – such as in malabsorption syndromes, smoking, anticonvulsants, COPD, kidney stones.
Even though estrogen mentioned above inhibits the “coating” of bones, it is vital in bone resorption – meaning reforming the matrix of the bone which occurs all the time to keep the bone fresh and strong. So young men who have CYP12 aromatase gene or estrogen receptor defects, they might be more prone to osteoporosis. Kyphosis and losing height can be a sign of osteoporosis because the vertebral bodies shrink.
Elder men can develop problems with calcium and vitamin D in the GI system and kidney processing. Also elder men who experience a hip or vertebral fracture have a high mortality rate than women. Why? Not sure. But at 6mo after a hip fracture for a man, there is a 9x increased risk of death compared to someone without a fracture. The cost of male osteoporotic fractures was $2.5 billion in 1995 in the US. It is expected to be 310% more in 2025.
Sign of kyphosis: can’t stand straight and put the occiput against the wall. Also the lowest of the ribs to the upper part of the hip in the line of the armpit is less than 2 fingerbreadths in width.
Treatment includes calcium 500mg three times a day (which can also be taken in by dairy products), 1000IU of Vitamin D a day. But if someone has calcium kidney stones that might not be possible. If man has andropause, testosterone replacement can be considered. Alendronate and Risedronate are bisphosphonates to help the bone density increase. Weight bearing exercises including walking. Also life style modifications like alcohol moderation (<25g a day) and not smoking.
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drjohnhong 
Men issues, Bones & Muscles 
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