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Osteoporosis update for men

Do you need to be concerned about age-related bone loss? Yes—but not as much as women do.

With aging comes a greater risk for osteoporosis: a decline in bone strength that puts you at risk of fractures. The face of osteoporosis in America is primarily that of a postmenopausal woman, but men are not entirely immune. “Women start losing bone earlier, primarily because of menopause, but men do lose bone, too—starting about 10 years later,” says Dr. David Slovik, an endocrinologist and associate professor of medicine at Harvard Medical School.

Men can help to maintain their bone health by taking in adequate calcium and vitamin D (preferably from food) and engaging in regular weight-bearing exercise. Some may also benefit from a bone density scan at some point if their doctor thinks they are at risk.

Osteoporosis rates in men and women

Osteoporosis rates in men and women

The percentage of men who have osteoporosis increases from 3% in their 50s to 10% at age 80 and older.

In contrast, 7% of women in their 50s have osteoporosis, and it rises to 35% in those 80 and older.

Bone loss in men: The facts

Women begin to lose bone strength rapidly at menopause, typically in their late 40s to early 50s. For men it takes longer, and they never quite catch up. In a national study, women in their 60s with below-normal bone strength and osteoporosis outnumber men six to one. By the time they reach their 80s, women with bone loss or osteoporosis still outnumber men by a factor of two to one.

But bone loss isn’t really a problem unless you fracture a bone because of it. Hip and spinal fractures are particularly dangerous, because they come with a higher risk of death from various complications in the first six to 12 months after the break. One in four men 60 and older will have an osteoporotic fracture sometime in his life—typically in his 70s or 80s. Men who have serious fractures may be at higher risk of death than women.

Do men need to take calcium and vitamin D?

To prevent bone loss and fractures, take in adequate daily amounts of calcium and vitamin D and exercise regularly. The National Osteoporosis Foundation recommends that men and women over 50 should get 1,000 mg to 1,200 milligrams (mg) per day of calcium and 800 to 1,000 IU of vitamin D daily. (Vitamin D helps your body absorb the calcium.) Some experts recommend even more than 1,000 IU per day. The safe upper limit for vitamin D is 4,000 IU.

If you can get all your calcium and vitamin D from food, do that. If you can’t, make up the shortfall with a supplement.

Calcium heart risk?

Recent studies found that both men and women who take relatively large doses of supplemental calcium—up to 1,400 mg or more per day—tend to have more heart problems. The studies done to date could only reveal an association between calcium and heart problems, not prove that one causes the other.

On the other hand, heart disease is a serious health issue for older men, so caution is in order until the potential risks of supplementation are better understood.

“There’s uncertainty, but the studies do seem to show that it’s better to get calcium from your diet than to get it from supplements,” Dr. Slovik says. “You should get the recommended amount, which is in the range of 1,200 mg per day, and should get as much of that as possible from foods.” Remember: There are no downsides to eating a balanced and varied diet. It confers many benefits in addition to stronger bones.

Should men be tested for bone loss?

The gold standard for screening for osteoporosis—checking for hidden bone loss in a healthy person—is dual-energy x-ray absorptiometry (DEXA) scan, which measures bone strength. Experts disagree on when and whether men should have a DEXA scan. The National Osteoporosis Foundation and the Endocrine Society recommend that men should be screened at 70, or earlier if they have certain risk factors, like being a smoker, taking medications known to cause bone loss, or having low testosterone.

However, the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts composed of primary care providers, does not recommend routine DEXA scans for men at 70—or any age. After reviewing the science, the USPSTF concluded that the current evidence isn’t clear on whether the benefits of screening for men clearly outweigh the potential harms—like the side effects of medications, prescribed to slow bone loss, which a person may not ultimately benefit much from.

What should you do?

Experts often disagree on the fine points of health screening and treatment. What should you do? The answer is to talk to your own personal health expert—your physician. If he or she thinks you should be tested, then consider it. Otherwise, get the calcium and vitamin D you need and stay physically active to maintain your bone strength.

Posted by: Dr.Health

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