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 clementhanson.blogspot.com
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