Osteoporosis is a common but often overlooked disease in men – a broken bone may be the first sign you have it. Often, osteoporosis in men can be secondary to an underlying cause, be it a pre-existing condition, lifestyle-related factors, or certain medications.
Men at Risk – Shocking Numbers That Demand Attention
According to Osteoporosis Canada, at least one in five men will break a bone as a result of osteoporosis. Men account for 25% of the 30,000 hip fractures caused by osteoporosis in Canada, and 33% of them will die within one year. Men are also less likely to receive any intervention after experiencing an osteoporotic fracture. A Canadian multi-centre study showed that 90% of men with fragility fractures remained undiagnosed and untreated for osteoporosis1. According to Statistics Canada, of the patients that received osteoporosis management care, men were 3.6 times less likely to have a BMD test and 4 times less likely to receive osteoporosis treatment than women. Hip fractures that are associated with osteoporosis are known to be a sign of an increased risk of future fractures. Studies have shown that less than 25% of male patients received medication to prevent a future fracture after a hip fracture. In contrast, 80% of male patients received medication to prevent a future heart attack after an initial incident2,3.
“Men, far too many men, get osteoporosis too…. the fragility fractures I had been receiving were the most obvious but far too often missed warning of osteoporosis.”
– Larry Funnell, a man living with osteoporosis and COPN member
Important Considerations for Men Who Might Be at Risk of Osteoporosis:
1. Get assessed. It is not normal to have a fragility fracture, to break a bone from a minor fall or standing height.
Who should be assessed for osteoporosis and fracture risk?
- Men (and women) taking certain kinds of medication(s) that may increase bone loss and/or fall risk. For instance, the long-term use of glucocorticoids can interfere with bone formation. Glucocorticoids are used to treat various medical conditions such as rheumatoid arthritis, COPD, and asthma, among others;
- Canadians 70 and older are considered to be at increased risk of osteoporosis or fractures;
- Canadians under the age of 70 who have already experienced a fragility fracture or who have additional risk factors for fracture;
- Men who have hypogonadism (low levels of testosterone that lead to low bone mass);
- Men being treated with androgen deprivation therapy for prostate cancer. This therapy can accelerate bone loss to a rate similar to that of menopausal women. Androgens are essential for developing and maintaining bone mass;
- Men (and women) whose lifestyle habits (such as the high daily consumption of alcohol) negatively impact their bone health. Research shows an increased risk of osteoporosis for those who regularly consume 3 or more alcoholic drinks per day. Increased alcohol intake also contributes to an increased risk for falls and is often associated with poor nutrition.
2. Educate yourself about osteoporosis. Osteoporosis Canada’s website, National E-Newsletter and the COPN “Unbreakable” E-Newsletter provides timely, science-based information on how to live well with Osteoporosis – including treatment, nutrition, exercise, support and much more.
- Talk with your healthcare provider to determine your risk of osteoporosis.
- Speak with your pharmacist about any possible contraindications of medications you are taking that may affect your bone health.
- Have a conversation with your physiotherapist and/or occupational therapist about fall prevention, strengthening, how to safely move your body, safe lifting etc.
- Learn to exercise safely. Keeping fit is important to maintaining and supporting bone health
3. Communicate openly. Talk to those around you about osteoporosis
- Ask for help when you need it to prevent placing unnecessary stress on your bones. You may not “look” like you need help, but few will refuse when you say something like, “Excuse me, would you be able to lend me a hand?”
- Most of us want to help others, but when you are asked to help, consider doing so without the heavy lifting. You might say, “I would love to help you, but I am unable to do the lifting. Let me find someone who can.” Openly sharing your knowledge of osteoporosis will help reduce the stigma men living with this disease may feel and could open the door to help others who may be at risk.
Communicating openly gives you the opportunity to talk about osteoporosis so you can help others gain a better understanding of this disease.
4. Seek treatment.
- Bisphosphonates and denosumab have been shown to reduce the risk of vertebral fractures in men.
- There is no evidence that testosterone reduces fractures in men.
- If your doctor has recommended medication for osteoporosis, talk to them or your pharmacist to find the best option for you.
Credit: COPN, the Canadian Osteoporosis Patient Network is the patient arm of Osteoporosis Canada, a national network of people living with osteoporosis.
References:
1. Papaioannou, A., Kennedy, C. C., Ioannidis, G., Gao, Y., Sawka, A. M., Goltzman, D., Tenenhouse, A., Pickard, L., Olszynski, W. P., Davison, K. S., Kaiser, S., Josse, R. G., Kreiger, N., Hanley, D. A., Prior, J. C., Brown, J. P., Anastassiades, T., Adachi, J. D., & CaMos Research Group (2008). The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 19(4), 581–587. https://doi.org/10.1007/s00198-007-0483-0
2. X. Canada PHA of. Government of Canada [Internet]. / Gouvernement du Canada; 2022 [cited 2023 Jun 15]. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/osteoporosis-related-fractures-2020.html
3. Y. Austin PC, Tu JV, Ko DT, Alter DA. Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction. Cmaj. 2008 Oct 21;179(9):901-8.
Credit to: Dalton Budram MD, BSc (PGY-1 Internal Medicine, UofT).
