A brittle topic

Osteoporosis has long been a focal point for women, but research is slowly showing how often the bone disease is overlooked in men.

By SUSAN ASCHOFF, Times Staff Writer
© St. Petersburg Times
published November 5, 2002

The blueprint for building strong bones may be one construction project in which the women have it all over the men.

A recent study found that men and their physicians too often overlook the potential for men, like women, to suffer from a loss of bone density as they age. The risk? Debilitating fractures and even death.

"We know so much less about male osteoporosis than about (the condition) in women," says Dr. Joanne Valeriano-Marcet, an associate professor at the University of South Florida School of Medicine who has examined the effectiveness of treatments and education for dealing with loss of bone density.

Research published last week in the Archives of Internal Medicine found that even men who had suffered fractures were rarely referred for a bone density test. Yet by age 65, men lose bone mass as fast as women. By 75, one-third of men have osteoporosis.

Of the estimated 10-million Americans afflicted with osteoporosis, 2-million are men, said the study's lead author, Gary Kiebzak of the Center for Orthopaedic Research and Education at St. Luke's Episcopal Hospital in Houston.

Men's lack of awareness puts some of them at risk for the same debilitating bone breaks suffered by women, who have for years been warned about osteoporosis and advised to take preventive measures, Kiebzak says.

The study is the latest reminder that everyone needs to do better by their bones.

Men fare better than women in maintaining bone density as they age because of differences in lifestyle and physiology, scientists believe. Men typically have larger frames, with more muscle and bone mass. And men do not go through the drastic hormonal changes women experience, particularly menopause's plunge in estrogen, which accelerates bone loss.

But neither gender escapes the body's script for aging. An individual deposits more bone mass than he or she loses through the mid 30s. Then bones begin to gradually lose density. Excessive loss is called osteoporosis.

Osteoporosis typically does not announce its presence until a wrist breaks in a minor mishap or back pain leads to discovery of compression fractures in the spine. Many cases are diagnosed after a hip is fractured in a fall.

No one knows for certain why some people's bones become dangerously fragile. Thin white women are particularly susceptible. A 50-year-old white female has a 14 percent chance that she will suffer a hip fracture in her lifetime. A white male has a 5 to 6 percent chance. The odds for a black male are 3 percent.

"We really don't know what to tell men. We're still studying the correlation between (bone) density and breaks and at what level a man would be at risk," Valeriano-Marcet says.

The rheumatologist has participated in several studies on bone thinning in men. She is currently looking at whether those who have medical conditions that accelerate bone loss will, if properly educated, adhere to a regimen to prevent osteoporosis.

The disease's consequences can be deadly. Although men are less likely to fracture a hip, they are at much higher risk than women of dying if it happens, Valeriano-Marcet says. She attributes the higher incidence to poorer health overall. Among all elderly nationally, nearly one-third of those who suffer a hip fracture are discharged to nursing homes within a year, the National Institutes of Health says. One in five dies as their health deteriorates.

The question of whether Americans are doing right by their bones was again raised this summer when researchers stopped the Women's Health Initiative study on hormone replacement after participants experienced more breast cancer, heart attacks and strokes. That news eclipsed the positive finding that women on hormones cut their risk of hip fracture by one-third.

Medical experts are also sounding an alarm about teenagers' bones. A diet of fast food and soft drinks may be setting up the next generation for osteoporosis at much earlier ages. If an individual does not reach peak bone mass while young, he or she may not have the bone density to outlast aging's inevitable loss, the National Institutes of Health reports.

The condition can be hereditary, a side effect of other diseases or their treatments, such as radiation for cancer, or the result of unhealthy lifestyles, from inactivity to lack of calcium (see accompanying list).

"What I see in men is alcohol (abuse) as a major factor," Valeriano-Marcet says.

Physicians recommend screening for osteoporosis if several risk factors are present. A test measures a patient's bone density and compares it with the normal range for his or her age.

Osteoporosis is treated with bone-building drugs such as Fosamax and Actonel, approved for men and women by the Food and Drug Administration.

The importance of building strong bones and new options for treatment when osteoporosis occurs garnered widespread attention from the public only in the last five to 10 years, experts say. The goal now is to get both genders and all ages to pay attention to the blueprints for skeletal health.

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