Source: American Association for Clinical Chemistry (AACC)
Think osteoporosis only affects women? Think again. NIH data suggests 1-2 million men in the US have osteoporosis, and an additional 8-13 million have low bone mass, with prevalence among white males. Few realize their risk for osteporosis-realted fracture is greater than their risk for prostate cancer (news - web sites).
According to the National Osteoporosis Foundation, men over 50 are at greater risk of osteoporosis-related fracture than they are for prostate cancer. One in eight such men will experience an osteoporosis-related fracture and among Caucasian men 65 years of age and older, some 80 percent of their hip fractures will be attributable to osteoporosis. Mortality in men one year after a hip fracture is nearly twice as high as it is for women. Given these data coupled with the aging of the baby boomers, the National Institutes of Health (news - web sites) (Institute of Arthritis, Musculoskeletal and Skin Diseases) in 1999 earmarked nearly $24 million for a multi-year, multi-site study of males over 65 in an effort to identify the prevalence and primary male risk factors for the disease.
Male Osteoporosis: More Common Than We Think
Male osteoporosis is more common than most believe, probably due to the fact that it is under-diagnosed by physicians who have not traditionally considered it a part of the "Male Health Profile." The disease, which causes bones to become brittle thus making them susceptible to breaking, appears in men as it does in women: with a fracture. As is the case for women, earliest diagnosis is through a bone density test. However, until the prevalence of male osteoporosis is better known, male bone density screening for men 50 years of age is not currently recommended.
Secondary Risk Factors
Alcohol (and smoking to a lesser degree) tends, in higher doses, to damage the liver, which can effect Vitamin D metabolism, as well as suppress the production of male hormone in the testes. Alcohol probably damages bone through a direct negative effect on the bone forming cells. Nutrition is a secondary factor. Those who are malnourished have very low bone density.
Presentation at the 55th Annual Meeting of the AACC
Clifford J. Rosen, M.D., Director of the Maine Center for Osteoporosis Research and Education in Bangor, ME, recently presented "Male Osteoporosis," an update on the status of his laboratory's work, at the 55th Annual Meeting of the American Association of Clinical Chemistry (AACC), which was conducted July 20-24, 2003, in Philadelphia, PA.
The Center's study involving mice show that there are gender-specific genetic factors at play; therefore, even without the presence of secondary factors such as alcohol, smoking and male hormone, males tend to have some higher risk when it is associated with some genetic predispositions.
It is not practical to screen every male at the present time using a bone density screen. The development of a genetic screening tool would make it easier to identify those at risk. From a primary care physician standpoint, Rosen says he believes that men who are over 50 and complaining of unexplained back pain or other secondary causes such as history of kidney stones, alcoholism, and steroids usage, should be screened with bone density testing.
For those men they are trying to identify who have no identifiable risk factors there are no current markers to use. They have been working with one protein -- IGF profactor-1 -- as a potential risk factor in men with osteoporosis. The relationship is not direct between IGF and low bone mass.
What Is the Cause?
The cause of male osteoporosis is not yet understood, but Rosen observes that men with the following history are at greatest risk:
- Genetics: If a man's mother or father had osteoporosis, that individual is significantly more likely to have it than a male whose parents had no such history.
- Kidneys stones: men with kidney stones, a somewhat common disorder among males, are at high risk.
- Pituitary problems or problems with male hormone production: men who have experienced either problem are at very high risk.
- Treatment with glucocorticoids: Men who have been treated with glucocorticoids (cortisone or prednisone) for other conditions such as asthma, chronic obstructive pulmonary disease (COPD), Crohn's Disease, rheumatoid arthritis, any of the post-transplant conditions are at risk.
Recommendations
Rosen recommends that men over 55 who have inexplicably lost two or more inches in height be tested immediately for bone density. So, too, should any man who has sustained a fracture in his adult life since the presence of a fracture is a very potent risk factor. After such a diagnosis is made, the first step in treatment is to remove any contributory factors, such as kidney stones, underlying factors such as alcohol, or improve other factors, such as diet and calcium intake should be improved. Then aggressively treat osteoporosis, such as Vitamin D along with using first line therapies to treat the disease such as Fosamax®. Vitamin D should also be used to treat the condition.