When Samuel Schneeweiss was diagnosed with osteoporosis, he was flabbergasted. “That’s a woman’s disease,” he thought. “That happens when they go through menopause and stop producing the hormone estrogen.”
The Manhattan resident, now 80, assumed that his back pain was caused by a youthful passion for soccer and skiing. But five years ago, when his doctor gave him a bone-density test, he learned his bones were frail and brittle. He has since lost about an inch in height.
The masculine struggle with osteoporosis, the “silent” disease that causes bones to deteriorate and break easily, is only now coming into the medical limelight. And the bad news is that these aren’t isolated cases.
The good news is that if younger men in their 20s, 30s and 40s take the necessary steps, they stand a good chance of dodging the illness later in life. The recommendations: Don’t smoke, don’t drink excessively, get plenty of calcium and vitamin D, exercise and drink milk, says Dr. Manish Suthar of the Texas Back Institute in Dallas.
The disease affects an estimated 2 million men in the United States, according to current figures from the National Osteoporosis Foundation (NOF). Another 3 million men are at risk, particularly in the 60-and-older age range. Although an estimated 80 percent of osteoporosis is found in women, men make up about one-third of those who suffer hip fractures.
Yet, the disease in men still is underdiagnosed, underreported and inadequately researched, NOF reports. Treatments to date for male osteoporosis are scant, compared to the hormones available for women. Schneeweiss relies mainly on exercise and getting a lot of calcium in his diet, along with vitamins C and D.
And there is little specific drug treatment available so far, although several medications are being tested. The U.S. Food and Drug Administration (FDA) has given its approval to a drug called Fosamax, a brand name for alendronate sodium, which increases bone density and decreases height loss in men. Other treatments or preventives include testosterone replacement therapy, along with calcium and vitamin D.
Significant research planned
Now that men are living longer and there are more diagnosed cases, researchers are paying more attention.
In what will be the largest study of its kind, the National Institutes of Health (NIH) has awarded a seven-year, $23 million grant to a team of researchers, headed by Dr. Eric Orwell, professor of medicine at Oregon Health Sciences University in Portland, to examine osteoporosis in men. And several universities, including the University of Alabama in Birmingham, and Beth Israel Medical Center in New York City already have male-osteoporosis research projects under way.
“It takes a long time for consciousness to change and for people to change long-standing perceptions,” Orwell says of the current spurt in research and the fact that osteoporosis in men has long been neglected.
“That (Fosamax) looks very good and I think it will actually change the horizon quite a bit as people understand there is effective treatment available,” he adds.
As women already know, osteoporosis can have a devastating impact on quality of life, resulting in bone fractures and surgery that can be painful and expensive.
Fewer men than women suffer from osteoporosis — about one man for every four women — mainly because men start off with larger, stronger bones, their bone loss begins later and progresses slower, and they don’t have a rapid hormonal change, as women do in menopause.
However, for men who live into their 70s and 80s and beyond, the bone loss is about the same as women’s. Male risk increases from medications, including steroids used to treat asthma or arthritis, anticonvulsants, chemotherapy, and even aluminum-containing antacids, according to the NIH’s Osteoporosis and Related Bone Diseases National Resource Center.
Early detection is the goal
Chronic diseases, low levels of the sex hormone testosterone, and low calcium intake also take their toll.
“Because we’re all living longer, we’re living with chronic diseases, and many of them, such as lupus or rheumatoid arthritis, can cause osteoporosis,” says Dr. Paula Rackoff, the assistant chief of rheumatology at Beth Israel Medical Center.
Detecting the disease in men is random. “There are no agreed-upon guidelines as to when men should be screened,” says Dr. Pamela Taxel, an endocrinologist and assistant professor of medicine at the University of Connecticut in Farmington. “We do know men on certain medicine, such as steroids, or those who have X-rays showing bone thinning, or who are losing sexual function should be looked at.”
And podiatrists and dental hygienists can actually spot the disease early on. Dr. Rodney Tomczak, assistant professor of orthopedics at Ohio State University in Columbus, says the disease can be detected in podiatric patients because small foot fractures tend to signal a warning of osteoporosis.
The same is true of dental hygienists who can tell when your X-rays show bone loss.
“The real value is finding it early and treating the medical condition and trying to reverse the osteoporosis,” Tomczak says.
What To Do
While bone loss increases with age, you can help slow it down by stopping smoking, drinking alcohol moderately, taking 1,000 mg. daily of calcium to age 50 and 1,200 mg. a day after that, and getting into weight-bearing physical exercise, like team sports, climbing stairs and lifting weights.
For additional information, check out the National Osteoporosis Foundation, or this osteoporosis overview from the National Institutes of Health.