Ask the Doctors - How is osteoporosis treated in men?


Dear Doctors: I am a 74-year-old man and have been diagnosed with osteoporosis. Is this common in men? I thought this was a disease that women get. What will the treatment be? Will it help?

Your diagnosis puts you among the estimated 2 to 5 million men in the U.S. who have osteoporosis. Another 12 million men are at risk of developing it. A progressive disease in which bone mass is lost more quickly than it is replaced, osteoporosis results in porous, brittle and weakened bones that are at greater risk of breaking.

While it’s true that osteoporosis is more common in women than in men, the reason for that turns out to be as much about timing as about gender. Both women and men go through the same cycles of bone growth and bone loss. However, the period of bone loss begins earlier in life for women than it does for men. Add in the fact that women tend to live longer than men, which means more years of bone loss, and they are more likely to develop the disease.

When we reach our 30s, the time at which bone growth generally peaks, men have accumulated more bone mass than women. This is believed to be due to the presence of androgens, which are hormones like testosterone, and which have a role in building the skeleton in young adults. Men produce significantly more androgens than women, and thus accumulate bone mass at a higher rate.

After bone production peaks, men and women begin to gradually lose bone mass at similar rates. However when women enter menopause, typically sometime during their 50s, the various protections offered by the so-called female hormones, estrogen and progesterone, begin to fade. One of the results of menopause is accelerated bone loss. At this point in life, women are losing bone at a faster rate then men are.

A decade or so later, though, men experience a drop in testosterone production. When that happens, men and women are once again losing bone mass at roughly the same rate. At the same time, calcium absorption for both women and men also slows. Some research has suggested that estrogen deficiency may play a role in osteoporosis in men as well.

In addition to the natural hormonal cycles, certain behaviors and conditions can accelerate bone loss. Alcohol abuse, smoking, gastrointestinal disorders, poor diet, lack of exercise or being immobile due to injury, all are risk factors for the disease. Caucasian men are at higher risk than men of other races.

In both women and men, fractures due to osteoporosis tend to occur in the hip, wrist, and spine. Although osteoporosis is four times more common in women than in men, men with hip fractures have a higher mortality rate.

Treatment is often a regimen of FDA approved medications, proper nutrition, weight-bearing exercise, and any needed lifestyle changes. If testosterone deficiency is detected, your doctor may craft a treatment plan to address the cause.

We’ll leave you with some good news -- when detected before significant bone mass is lost, osteoporosis can be effectively treated.

Eve Glazier, MD., MBA, and Elizabeth Ko, MD., are internists at UCLA Health. Dr. Glazier is an associate professor of medicine; Dr. Ko is an assistant professor of medicine.

Ask the Doctors is a syndicated column first published by UExpress syndicate.