Osteoporosis, a man's issue

Prepared Foods, Jan, 2003 by Carol Lewis

Much has been written about women's health concerns. The subject of osteoporosis is a popular and serious topic. However, males also do not consume recommended quantities of calcium. This story, entitled "Osteoporosis and Men," first appeared in the September/October 2002 issue of FDA Consumer magazine, published by the U.S. Food and Drug Administration. It is meant to provide information to consumers on this subject. It may also be of interest to those in food and beverage marketing and product development as both an overlooked marketing niche and as background material for calcium fortified products.

More than 10 million Americans have osteoporosis, according to the National Institute on Aging. Eighteen million more have lost enough bone to make them more likely to develop the disease. The majority of these 28 million are women. But men are at risk for the bone-thinning disease, too.

Osteoporosis gradually weakens bones and can lead to painful and debilitating fractures. It is characterized by low bone density (how solid bones are) and structural deterioration of bone tissue.

Often called the "silent disease," osteoporosis usually progresses without symptoms until it is diagnosed following a fracture.

Osteoporosis is seen less often in men than in women because men generally have larger, stronger bones, and because men don't usually experience the abrupt and substantial hormonal changes that women do following menopause. Also, bone loss begins later and advances more slowly in men than in women. However, the National Institutes of Health says that the problem of osteoporosis in men recently has been recognized as an important public health issue, especially in light of estimates that the number of men above age 70 will double between 1993 and 2050.

Today, more than 2 million American men have osteoporosis, and another 3 million are at risk for the disease, according to the National Osteoporosis Foundation (NOF). Each year, men suffer one-third of all hip fractures, and one-third of these men will not survive more than one year. In addition to hip fractures, men most often experience fractures of the spine and wrist due to osteoporosis.

But changing attitudes and improved technology are brightening the outlook for men with osteoporosis. Although some bone loss is expected as men age, osteoporosis is no longer viewed as an inevitable consequence of aging. Diagnosis and treatment need no longer wait until bones break. New products are becoming available specifically to treat men with osteoporosis.

Bane Life

Bones grow in length and density during a person's younger years. Bone density relates to the mineral content of the tissue. People reach their maximum height during their teens, but bone density continues to increase until about age 30. After that point, bones slowly start to lose density and strength. Throughout life, bone density is affected by heredity, sex hormones, physical activity, diet, lifestyle choices, and the use of certain medications.

In their 50s, men do not experience the rapid loss of bone mass that women have in the years following menopause. "But some men do have a hormonal drop-off in testosterone, with skeletal consequences that are similar to those seen in women following reduction of estrogen," explains Bruce Schneider, a medical officer in the FDA's Division of Metabolic and Endocrine Drug Products. Testosterone may diminish as a result of hypogonadism, a condition marked by decreased function of the testicles. Testosterone levels also may decrease naturally as a man ages. This loss of sex hormone eventually can result in accelerated bone loss. Whether bone loss at this point translates into osteoporosis, however, depends on bow much bone a man has when the loss begins, and how quickly he loses it.

By age 65 or 70, men and women lose bone mass at similar rates, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes.

Prevention, Diagnosis and Treatment

In men, there are two main types of osteoporosis: primary and secondary. In primary osteoporosis, there may be no identifiable cause (idiopathic) or it may be the result of age-related bone loss. Often, these two conditions overlap, and distinguishing between them is arbitrary Secondary osteoporosis in men can be due to a variety of causes. Low testosterone (hypogonadism), medications such as prednisone that can lead to steroid excess, and alcoholism are among the important causes of secondary osteoporosis in men.

Once bone is lost, it cannot be completely replaced using currently available therapies. Therefore, it is essential that men be evaluated and treated before significant bone loss has occurred. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later.

Although it cannot be cured, osteoporosis can be slowed down, and steps can be taken to help prevent the disease. A special kind of X-ray, the bone mineral density (BMD) test, is a safe, accurate, quick, painless, and noninvasive way to diagnose osteoporosis, detect low bone density, monitor the effectiveness of treatments, and predict the risk for future fractures.