Osteoporosis in Men: What You Need to Know

Medication Options for Osteoporosis in Men


This article was adapted from information on the website of the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Osteoporosis is a disease that causes the skeleton to weaken and the bones to break. It poses a significant threat to more than 2 million men in the United States. After age 50, 6% of all men will experience a hip fracture and 5% will have a spine fracture as a result of osteoporosis.

Despite these facts, a majority of American men view osteoporosis solely as a woman’s disease. Moreover, among men whose lifestyle habits put them at an increased risk, few recognize the disease as a significant threat to their mobility and independence.

What Is Osteoporosis?

Bone is constantly changing; that is, old bone is removed and replaced by new bone. During your childhood, more bone is produced than removed, so your skeleton grows in both size and strength. For most people, bone mass peaks during the third decade of life. By this age, men typically have accumulated more bone mass than women. After this point, the amount of bone in your skeleton typically begins to decline slowly as removal of old bone exceeds formation of new bone.

Men in their 50s do not experience the rapid loss of bone mass that women do in the years following menopause. By age 65 or 70, however, men and women are losing bone mass at the same rate, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes.

Excessive bone loss causes bone to become fragile and more likely to fracture.

Fractures resulting from osteoporosis most commonly occur in the hip, spine and wrist and can be permanently disabling. Hip fractures are especially dangerous because such fractures tend to occur at older ages in men than in women; men who sustain hip fractures are more likely than women to die from complications.

What Are the Osteoporosis Risk Factors for Men?

Several risk factors have been linked to osteoporosis in men:

  • chronic diseases that affect your kidneys, lungs, stomach, and intestines or alter your hormone levels
  • regular use of certain medications, such as certain types of steroids, drugs that suppress your immune system and drugs used to treat epilepsy
  • undiagnosed low levels of the sex hormone testosterone
  • unhealthy lifestyle habits, including smoking, excessive alcohol use, low calcium intake and inadequate physical exercise
  • age – the older you are, the greater your risk
  • race - white men appear to be at a particularly high risk, but all men can develop this disease

How Is Osteoporosis Diagnosed in Men?

Osteoporosis can be effectively treated if it is detected before you have significant bone loss. Your doctor may order a bone density test. This test can identify osteoporosis, determine your risk for fractures and measure your response to osteoporosis treatment.

It is common for women to be diagnosed with osteoporosis using a bone density test, often at midlife when doctors begin to watch for signs of bone loss. In men, however, the diagnosis is often not made until a fracture occurs or a man complains of back pain and sees his doctor.

This makes it especially important for you to inform your doctor about risk factors you may have for developing osteoporosis, loss of height or change in your posture, a fracture or sudden back pain.

What Treatments Are Available for Osteoporosis in Men?

If you have been diagnosed with osteoporosis, your doctor may prescribe one of the medications approved by the U.S. Food and Drug Administration (FDA) for this condition.

The FDA has approved the following medications for treating osteoporosis in men:

  • The bisphosphonates Actonel(risedronate) and Fosamax (alendronate). This class of drugs slows bone loss, reduces fracture risk and (in some cases) increases bone density. These drugs decrease the activity of bone-dissolving cells.
  • Forteo (teriparatide), a form of human parathyroid hormone, stimulates new bone formation. Given as a daily injection for up to 24 months, it increases bone tissue and bone strength, and has been shown to reduce the risk of spine and other fractures.

Other medications used to treat osteoporosis, such as Evista (raloxifene), Estrogen, and Miacalcin (calcitonin), are only approved for women who are past menopause. These medications are not prescribed for men.

Glucocorticoids (such as hydrocortisone and prednisone) are steroid medications used to treat diseases, such as asthma and rheumatoid arthritis. Bone loss is a very common side effect of these medications. If your bone loss is due to glucocorticoid use, your doctor may prescribe a bisphosphonate, monitor your bone density and testosterone levels and suggest that you use the minimum effective dose of glucocorticoid. Your doctor may also suggest discontinuing the drug when practical, and/or administering it through your skin.

If your osteoporosis is the result of a testosterone deficiency, your doctor may prescribe a testosterone gel or patch available as brand-name Androgel and Testim.

How Can I Prevent Osteoporosis?

There have been fewer research studies on osteoporosis in men than in women; however, experts agree that all people should take the following steps to preserve their bone health:

  • Avoid smoking, reduce alcohol intake and increase your level of physical activity.
  • Ensure a daily calcium intake that is adequate for your age.
  • Ensure an adequate intake of vitamin D. Normally, your body makes enough vitamin D from exposure to as little as 10 minutes of sunlight a day. If exposure to sunlight is inadequate, dietary vitamin D intake should be between 200 and 600 IU per day.
  • Engage in regular weight-bearing exercises, in which your bones and muscles work against gravity. This may include walking, jogging, racquet sports, stair climbing, team sports, lifting weights and using resistance machines.
    Your doctor should evaluate your exercise program if you are already diagnosed with osteoporosis to determine if you need to limit twisting motions and impact activities, such as those used in golf, tennis or basketball.

More Information About Calcium and Osteoporosis

Original article updated by Naveed Saleh, MD, MS, on 4/29/2016. Original article written by another author.

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