Osteoporosis is not just a woman’s disease
The good news is that men are living longer. The bad news is that because they are living longer, more men are suffering from osteoporosis, a disease that is usually associated with women.
The National Osteoporosis Foundation estimates that 54 million Americans have osteoporosis, or decreased bone mass, and that about one in two women and up to one in four men age 50 or older will suffer a bone break, due to the condition.
In general, men get osteoporosis later in life than women, but it can pose the same problems. They have twice the one-year fatality rate after an osteoporotic hip break than women do.
Since osteoporosis is largely invisible to the naked eye and can go undetected until a fracture happens, screening is important.
“The general recommendations are to screen men over the age of 70 as well as women post-menopause, but some doctors don’t think of screening men unless they have other risk factors,” said Peter Crosson, MD an internal medicine physician at Emerald Physicians in West Yarmouth.
Dr. Crosson is certified in bone densitometry by the International Society of Clinical Densitometry and interprets bone density tests and recommends treatment for all of Emerald’s patients. Bone density is tested using duel-energy x-ray absorptiometry (DXA), which takes images of a patient’s hip, spine and forearm. The images are then evaluated as normal, osteopenia or osteoporosis.
Next, physicians at Emerald evaluate their patients using a score called the fracture risk assessment tool (FRAX), which gives a prediction of patients’ 10-year risk of fractures.
“It really helps to guide when we treat or don’t treat,” he said. “So if someone has a reasonable bone density, but a lot of other risk factors, we might treat them sooner.”
Factors that raise the risk of osteoporosis for both men and women include:
- Rheumatoid arthritis
- Other autoimmune disorders like lupus or multiple sclerosis
- Digestive disorders like inflammatory bowel disease or celiac disease
- Breast cancer or prostate cancer
- Chronic Obstructive Pulmonary Disease
- Using medications containing steroids
- Drinking three or more alcoholic beverages a day
- Inadequate calcium in the diet
Because taking calcium pills can increase the chance of calcification in the arteries, Dr. Crosson doesn’t recommend them for patients, especially men, who are naturally at a higher risk of heart disease than women.
“We really prefer if patients get calcium through their diet,” he said. “For men, the target is 1,000 milligrams a day. For women it is 1,200, which is really not difficult if they pay attention to it.”
The International Osteoporosis Foundation says foods naturally rich in calcium include:
- Collard Greens
- White beans
“Another one of our recommendations is weight-bearing exercises because they put stress on the bone,” Dr. Crosson said. “When bones are stressed, they essentially react by building more bone, so it’s a good way to try to keep the bone density strong.”
He gives patients handouts with instructions to do weight-bearing exercises such as jumping jacks or squats. Patients who can’t do strenuous exercises are advised to walk every day.
“A lot of what we do is try to prevent falls,” he said. “Falls are what cause fractures, so a lot of the exercises will also strengthen their core and make their quadriceps stronger, which makes them less likely to fall. We’ll often send them through a course of physical therapy so they can get stronger and take those exercises and do them at home.”
People with osteoporosis can break bones simply from a fall at ground level. For some frail patients, even a violent sneeze can cause a vertebral fracture, Dr. Crosson said. Patients who are weak and deconditioned are at an especially high risk. Falling and breaking a hip is a major cause of mortality, with up to 50 percent of patients dying within two years from complications like pneumonia, a blood clot or severe frailty, he added.
For that reason, Dr. Crosson recommends medications like bisphosphonates, despite stories in the media about the rare risks of side effects, like osteonecrosis (bone death) of the jaw and atypical fractures near the top of the femur. Both of those side effects are extremely rare and only occur after long-term use of medications, typically more than five years, he said.
Dr. Crosson has received some resistance to medication from patients who have seen or heard stories about the rare side effects. Statistics show that fear is overruling judgment. The use of the most commonly prescribed osteoporosis drugs dropped by 50 percent in the years between 2008 and 2012.
“The medications work, especially the bisphosphonates, which are our most commonly used drugs,” he said. “The data is there to show that they work very, very well. It’s our responsibility in primary care to educate the patient that their risk of hip fracture is significant and at a much higher risk than these rare side effects.”
Note: As of 5/1/2019, Emerald Physicians joined Medical Affiliates of Cape Cod (MACC), a division of primary and specialty care physicians from Cape Cod Healthcare.