One in four men over 50 will break bones during their lifetime due to Osteoporosis. Up to 20% of vertebral fractures (broken bones in your back) and 30% of hip fractures occur in men. These fractures are associated with premature death, possibly due to conditions associated with osteoporosis rather than the fracture itself.
All low trauma fractures (broken bones from a trip and fall or less) in men should be considered Osteoporosis unless proven otherwise.
Any male who has a low trauma fracture (Breaks a bone from a standing position or less) should be investigated for bone loss. Examples include broken bone/s from a trip and fall or less, coughing, sneezing, getting up from a chair, turning over in bed, or unexplained broken bones.
There is an increased risk of dying prematurely from all major broken bones from Osteoporosis, and it is higher in men than women.
20% of people aged 60+ who fracture a hip will die within 6-12 months due to the secondary complications of the fracture. The person may develop a blood clot, pneumonia, or an infection. Therefore, broken bones should be treated very seriously. 50% of people aged 60+ who fracture a hip will no longer be able to wash, dress or walk across a room unaided. Only 30% of people aged 60+ who fracture a hip will regain their independence.
Men, like women with broken bones in their back, commonly complain of intermittent back pain, loss of height, and kyphosis (hump on back), but men have significantly less energy, poorer sleep, more emotional problems, and impaired mobility compared with women.
The commonest cause of osteoporosis in men is hypogonadism. This refers to the lack of the male sex hormone testosterone. This may be the result of a variety of conditions which include abnormal chromosomes, excessive stress, either physical or psychological.
Overtraining in athletes particularly those who must maintain low body weight, is usually associated with low levels of testosterone and high levels of cortisol (high levels of stress), leading to bone loss.
Dietary problems, low caloric intake, inadequate calcium, and vitamin D levels in your diet also play a role. Other risk factors include alcohol abuse (more than 3 units a day or 21 units of alcohol a week), excessive caffeine intake, smoking, and lack of weight-bearing exercise.
Males with a Family history of Osteoporosis or a close relative with a history of a low trauma hip fracture or vertebral fracture (broken bone in their back) should be referred for a DXA scan. Genetics is one of the strongest links for osteoporosis, as 80% of bone is genetics and preventing fractures will keep people mobile and independent, along with the health service saving a substantial amount of money.
A low trauma fracture is a broken bone from a trip and fall or less and should not be considered normal at any age. If your bones were healthy, they would not break easily.
Osteoporosis can occur as the result of a wide variety of medical or surgical conditions or their treatment.
These include the use of any of the following treatments:
There is also a greater risk of hip fractures with conditions related to an increased risk of falling: Stroke, Parkinson’s Disease, Dementia, Vertigo, Alcoholism, and blindness. A prospective study from Australia demonstrated a higher risk of hip fracture in men with low hip bone density (quality of bone), quadriceps weakness (front thigh muscles weakness), increased body sway, and a history of falls in the past year.
We recommended that men with one or more risk factors regardless of age should consider having a DXA scan. Why? This disease is silent and therefore you will not know if you already have lost a lot of bone. It is much cheaper and less painful to prevent broken bones than to treat them. The total cost of treating one hip fracture in the ROI is €55,000, a DXA scan is approximately €120.
The assessment of a male patient for osteoporosis should include investigating the reasons why he has lost bone, they should never be assumed.
Example; the person has a family history. The person may have high stress levels and if this is not addressed, the person will continue to lose bone. A DXA scan of your spine and hips is the gold standard for measuring bone mineral density. Your risk of breaking bones or further bones is determined by the risk factors and the results of the DXA scan of your spine and hips and your blood test results.
NOTE: The Irish Osteoporosis Society who are the National Experts on Osteoporosis, do not ever recommend any type of heel, shin or forearm ultrasound scan for the screening or diagnosis of osteoporosis or the treatment of this disease alternatively.
If you have a DXA scan and you have a normal result, you can then help to decrease your risk of developing Osteoporosis.
If you have a DXA scan and the result shows that you have low bone density (you have lost bone) you can take the appropriate steps to improve it, by contacting us for accurate advice.
All men with osteoporosis should be given lifestyle advice on how to decrease bone loss. This advice should include adequate caloric intake and calcium and vitamin D, 30 minutes of appropriate daily weight bearing exercise, stopping smoking, reducing alcohol intake. If there is a history of falls, attempts should be made to identify why the person has been falling and ensure any trip hazards in their home are taken away.
A pair of walking shoes should be worn inside the house to give maximum support, as many slippers give no support. Open back slippers or sandals are not recommended along with walking in bare feet or in socks in your home.
All treatments should be prescribed on an individual basis. Any underlying cause/s of osteoporosis should be investigated and addressed; NOT assumed.
Extensive blood tests should be done before starting any Osteoporosis treatment. The following tests we consider to be essential; Testosterone levels, PTH, Vitamin D, calcium, Kidney function, Cortisol and bone turnover markers. If there is a marked reduction in the level of male hormone in a young patient, then treatment with replacement male hormone testosterone may be appropriate.
Note: Patients on steroids or on certain immuno-suppressant therapy for cancer or aromatase inhibitors, should have a DXA scan and they should be treated proactively to prevent fractures occurring. They need to be taking calcium, Vitamin D3 and protein, preferably from food. Depending on their DXA scan results and medical history, will depend on which Osteoporosis medication is the most appropriate for them. Appropriate weight-bearing exercise is essential, and they should be monitored by repeat DXA scans, minimum every two years.
Any male who breaks a bone from a trip and fall or less should be screened for bone loss. Osteoporosis in men should be investigated to look for the underlying causes of their bone loss. If the causes of bone loss are not investigated and addressed, and they are placed on an Osteoporosis treatment, they could continue to lose bone and fracture (break bones).
Patients on steroids or on immuno-suppressant therapy should all be treated preventively. Calcium, Vitamin D3, protein and an appropriate weight bearing exercise programme, along with an Osteoporosis medication, are the principal initial therapies for osteoporosis in men. A person with bone loss should be assessed by a health care professional such as a Chartered Physiotherapist, to see what exercises are safe and appropriate for you.
Patients need to be monitored by having repeat DXA scans at a minimum every two years, to ensure the treatment is working and to help increase patient compliance. Most patients will not feel any different after taking their osteoporosis medication. However, when a person has a repeat DXA scan, it should show an improvement if all the cause/s have been found and addressed and the patient has taken their medication.
Note: Any decline in a person’s DXA scan results should be investigated and addressed.
