Bone is living tissue that is continually broken down and rebuilt, a process involving calcium, vitamin D and other nutrients; genes, hormones, physical activity and other lifestyle habits also play a key role. Both men and women reach peak bone density in early adulthood and begin to lose bone in middle age. Men tend to develop osteoporosis about 10 years later, though, because they generally have bigger, stronger bones to begin with. And it comes on more gradually because they don’t go through menopause, when bone loss accelerates dramatically in women.
Most risk factors for osteoporosis in men are the same as for women:
• Older age.
• Family history of fractures.
• Being white or Asian.
• Low body weight or small stature.
• Smoking, heavy drinking and a sedentary lifestyle.
• Long-term use of steroids, immunosuppressive drugs, anticonvulsants, some antidepressants and other medications; habitual use of aluminum-containing antacids.
• Certain illnesses, including gastrointestinal, liver and thyroid disease.
• Dietary deficiencies of calcium, vitamin D and other bone-building nutrients.
A major risk factor unique to men is low testosterone, especially due to disease or hormone-suppression therapy for prostate cancer.
How to prevent osteoporosis in men:
Men at risk for osteoporosis should take the same steps as women to help prevent it—and it’s never too late to start:
• Get adequate calcium (1,000 milligrams a day). Low-fat or nonfat dairy products are the best sources; leafy green vegetables, canned salmon and sardines (with the bones) and fortified orange juice, soymilk and cereals are also good choices. A calcium supplement can help make up for dietary shortfalls.
• Pay attention to vitamin D (the official recommendation is 600 IU a day through age 70, 800 IU after age 70—but we advise 800 to 1,000 IU of supplemental D a day for most people). Not only does it help your body absorb calcium, it may increase muscle strength in the legs, which helps prevent falls, a major cause of broken bones. Your skin makes vitamin D when exposed to sunlight, though this depends on factors such as geographical location, time of year and your age. Milk and a few other foods are fortified with D. To reach recommended levels, you likely need a supplement.
• Do weight-bearing exercise, such as brisk walking, jogging, stair climbing and weight lifting.
• If you smoke, stop.
• Keep alcohol consumption moderate—no more than two drinks a day for men.
• Talk to your doctor about any medications you are taking that may cause bone loss, particularly corticosteroids, or may make you prone to falling. You may be able to change the dose or switch to another medication.
Warning signs and testing
Tell your doctor if you have noticed a loss of height or have sudden back pain, which may indicate a collapsed vertebra. Also talk to your doctor if you have been on long-term steroids, if osteoporosis runs in your family (especially in males), if you have had a previous fracture (especially a “low-trauma” one) or if you have multiple risk factors.
There are no official recommendations for bone mineral density testing in men. Some experts suggest that men 65 and older with a prior fracture and all men 80 and older should be screened; others recommend screening for all men over 65 (same as for women) and younger men with prior fractures.
Be well,
Dr. S
Dennis E. Sandler M.D.e-mail: dsandlermd@gmail.com
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