Osteoporosis overlooked in men

Dr. Jocelyn Rapelyea, associate director of breast imagining at George Washington University Medical Faculty Associates works with the Automated Breast Ultrasound System. (WTOP/Paula Wolfson)

WASHINGTON – Osteoporosis is not just a disease for mom and grandma. Men can get it too.

“I think we underestimate the prevalence of osteoporosis in men,” says Dr. Assil Saleh with Foxhall Internists in D.C. “It is an overlooked problem and under-diagnosed. And it is actually becoming an important public health issue as our population is aging.”

While post-menopausal women still make up the bulk of patients with osteoporosis, the condition is becoming more and more common in men, particularly those older than 65.

An estimated two million American men have the disease and another 12 million are at risk, according to the National Osteoporosis Foundation.

Some have underlying health conditions, such as problems with joints or tendons, low testosterone, or conditions that require prolonged treatment with medications that can affect bone mass. But the lifestyle choices men make while they are young can have a big impact on bone health decades later.

The National Institutes of Health says alcohol abuse can affect bone density, as can smoking and a lack of exercise.

Saleh, who is both a rheumatologist and an internist, says the most important thing young men can do to prevent osteoporosis as they age “is to exercise and keep active throughout their adult life.”

She says getting enough vitamin D is also important.

The NIH recommends 600 IU (international units) a day before age 70, and 800 IU daily for men older than 70 — the same as for women. Calcium intake is also fairly similar — 1,000 mg a day for most adults, rising to 1,200 mg daily for women at 51 and for men at 70.

Screening is likely to be more intense for women, starting with a baseline bone scan similar to an X-ray at the onset of menopause. Men are less likely to get a bone scan until after they suffer a fracture.

That is what happened with Saleh’s own father, who was diagnosed with osteoporosis 10 years ago after he broke a bone.

“I was surprised because osteoporosis in men was not really on my radar screen at the time — even as a physician, even as a rheumatologist in training,” she says.

Saleh says her father’s diagnosis made her more aware of the problem and these days, she is vigilant when it comes to screening her patients for risk factors.

As for her dad, the proud daughter and physician says he is doing well. Like many elderly men with osteoporosis, he is taking a prescription medication originally developed just for women to prevent fractures and further bone loss.

Not all drugs for osteoporosis are cleared for use by both sexes. But the four that have been approved for men include some of the most popular brand name medications for the disease: Fossomax and Actonel.

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