Recurrent Breast Cancer

Thursday, October 30, 2014

Just for Men
   Most men with osteoporosis are not diagnosed. A third of all hip fractures occur in men. They are less likely to survive a hip fracture compared to women. Smoking, alcohol overuse, lung disease, and prostate cancer treatment enhance osteoporosis risk.

   Low body weight, sedentary activity, and previous fracture heighten the risk. For this reason, physicians recommend osteoporosis screening in men older than seventy. The evaluation includes x-ray bone density testing of the hip, spine, and forearm. 
   Prescription medicine osteoporosis treatment include flendronate (Alendronate), risedronate (Actonate), zoledronic acid (Zometa), testosterone (Androgel), Calcitonin (Miacalcin), and teriparatide (Forteo). These drugs increase bone density. A newer medicine, denosumab (Prolia,) enhances bone density in men who are on testosterone treatment. 

   Vertebral (spine) compression fractures are diagnosed by X-ray. DXA (Dual Energy X-ray Absorptiometry) screening evaluates bone thickness and fracture risk.
Men under seventy should have a DXA scan. 

The most important test is a thorough physician’s exam to look for other causes of osteoporosis. Treatment improves bone health. Osteomalacia, or bone softening, is due to low vitamin D levels. It is treatable with vitamin D. 

Men with no history of spine fracture could have fractures shown on x-ray with no pain or trauma.

Over time, hypogonadism (low testosterone levels) leads to osteoporosis. All patients, including men, should decrease their fracture risk. 

Smoking cessation and decreasing fall risk improve safety. Building lower body strength through weight-bearing exercises and limiting alcohol improve physical and mental function. Supplementation of Vitamin D and calcium is helpful. Ongoing trials of osteoporosis treatment include Vitamin D and calcium. 

 The Institute of Medicine recommends 1,000 to 1,200 milligrams of oral calcium daily and 600 to 800 milligrams of Vitamin D daily. 

The US Food and Drug Administration approved oral alendronate and risedronate to increase bone mineral density in men. In addition, the FDA approved one hundred fifty milligrams of risedronate for women with postmenopausal osteoporosis. 

Those with acid reflux who take these medicines might get heartburn. However, they are otherwise well tolerated. They should be taken early in the morning with water. Other medications, food, and liquids should be delayed for half an hour. Some people could develop esophagus irritation or dyspepsia (heartburn). 

Teriparatide is reserved for those men with the highest fracture risk. It is expensive and is given daily by injection.Testosterone could lower fracture risk by improving muscle mass and mobility. However, its long term safety is uncertain. 

   Osteoporosis might be considered a disease of older white women. However, all ethnic groups have some degree of fracture risk. 

   Older men with hip fracture have complications. A third of men seventy five to eighty four die within a year of fracture. Those who don’t die may never regain mobility and independence.
Secondary prevention is vital. A man who survives one fracture is at high risk for another. Prompt diagnosis and treatment could prevent further fractures and improve mobility.


Questions or comments? Contact Dr. Clem at

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