When a 77-year-old tennis player fell during a match and fractured his hip while on vacation in Key Largo, Fla., he became part of a little known, serious and growing problem among older men.
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Three years after the accident, E. Neil Moore of suburban Philadelphia, not only can’t play tennis or run -- he feels too fragile to visit Florida on his own. When he broke his hip, Moore, now 80, was suffering from osteoporosis, a disease of fragile bones usually associated with women. Even though he's an expert in the electrophysiology of the heart who taught at the University of Pennsylvania’s Perelman School of Medicine for 40 years, wasn’t aware he had the condition.
“I feel lucky to have survived,” Moore says.
Male osteoporosis has been a silent problem for decades but is becoming more prevalent as Baby Boomers age, doctors say. Osteoporosis-related fractures in men cost $4.1 billion in direct medical expenses as of 2005, with the total expected to rise to more than $6 billion by 2025, according to a 2006 study in the Journal of Bone and Mineral Research.
Yet men, many other doctors, and the health care system itself, are in the same boat as Moore: All seem largely unaware of male osteoporosis.
“I can tell you when I went to medical school, osteoporosis and men were never used in the same sentence,” Robert Adler, chief of endocrinology and metabolism at Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia, says. “I think it is still thought by many clinicians to be a disorder of women.”
When the U.S. Preventive Services Task Forcerecently issued its controversial new recommendations discouraging the use of Vitamin D and calcium supplements to prevent broken bones, there was virtually no mention of male osteoporosis. A few doctors have been trying to raise awareness, with some small success, but there's a long way to go, Adler says.
In fact, men account for more than 29 percent -- about 595,000 -- of the estimated 2 million osteoporosis-related bone fractures in the United States each year, and more than 30 percent of hip fractures, according to the 2006 bone study.
Men also have far greater risk of dying as a result of a hip fracture than women do. Experts suggest men who have hip fractures may be older and sicker than women who do, or that the lengthy period of enforced inactivity after a fracture is more detrimental to men.
“With men, one out of three are dead after a hip fracture within a year,” Adler says. “And those who survive have a lower chance of being independent.”
Most risk factors of osteoporosis in men are similar to the risks for women -- smoking, low vitamin D and calcium levels, lack of weight-bearing exercise, hormonal changes with aging, genetics. But men also carry unique risks. Prostate cancer patients may undergo bone-damaging, long-term androgen deprivation therapy to keep male hormones low.
“We did a study of 115 men from our urology clinic [who were undergoing androgen deprivation therapy] and about one-third had osteoporosis,” Adler says. “Totally unsuspected…None of the patients had been asked to get a bone density [test] by their primary physician or anybody else.”
Steroids like glucocorticoids for a condition such as COPD (chronic obstructive pulmonary disease) can also hasten bone loss.
Women are often screened for the disease starting at menopause. But because you can’t feel osteoporosis and male patients don’t complain about it, their doctors often don’t think to screen for it.
Even when they do, that screening might not be complete. Moore, for example, unlike most men, had been receiving DXA scans, an X-ray test for bone density. It did show he had osteopenia, lower bone density than optimum, but not osteoporosis. His physician didn’t think he needed therapy.
While DXA is important, it's not definitive for osteoporosis, says Dr. Robert Pignolo, director of the Ralston-Penn Clinic for Osteoporosis and Related Bone Disorders at Perelman, and a professor of geriatric medicine at the University of Pennsylvania, who treated Moore. “A DXA scan tells you nothing about how the bones are put together," he said.
Instead, a question-based screening tool called FRAX, available free online, can be used by any doctor (or anybody) to assess a patient’s risk for osteoporosis.
To help prevent the condition, weight bearing exercise -- which does not only mean lifting weights, but doing any work against gravity -- is especially important because it stimulates bone growth and strengthening. Cycling and swimming, for example, while excellent cardiovascular workouts, don’t do much to work the skeleton.
Drugs to treat osteoporosis are tested almost exclusively on women to get FDA approval, but they also work for men.
Men should ask their primary care doctors about osteoporosis and suggesting a FRAX screening, says Pignolo.
“If a doctor has all the information at his fingertips,” he says, “he could complete the screening in five minutes.”
Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," ( www.TheChemistryBetweenUs.com), now on sale.
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