Postmenopausal women aren't the only victims of osteoporosis—men's skeletons weaken with age, too. In the United States, about 2 million of the estimated 10 million people with osteoporosis are male. The outlook, in fact, is worse for men who break a bone. If they fracture a vulnerable hip, they are twice as likely to die while they're hospitalized, and of those who get discharged, 31 percent die in the following year compared with 17 percent of women.
As far as the U.S. medical establishment is concerned, however, osteoporosis might as well be stamped "For Women Only." While Canadian men get a routine bone density screening at age 65 with DEXA—a special set of low-dose X-rays of the spine and hip—the words "men" and "male" don't even appear in osteoporosis screening guidelines for U.S. physicians. So unless a man has already experienced a medical event that revealed osteoporosis, how is he even to know if he's at high risk?
Angela Shepherd and colleagues at the University of Texas Medical Branch in Galveston have devised a "male osteoporosis risk estimation score" (MORES) that quickly determines relative risk by considering age, weight, and any history of chronic obstructive pulmonary disease. (The COPD link is explained below.) The test, described in the just-released issue of Annals of Family Medicine and available here, is claimed to be able to identify more than 90 percent of men at risk who might benefit from DEXA testing. Shepherd discussed men and osteoporosis with U.S. News.
Are men pretty much ignored in dealing with osteoporosis?
I don't think people even connect osteoporosis with men. That's true of doctors, too.
National Osteoporosis Foundation screening guidelines don't mention men. Why not?
That's a valid indicator of where things are. There aren't any large studies that have definitively shown the prevalence of osteoporosis in men. We're beginning to realize it's preventable and treatable in men as well as women. We didn't even have good treatments for men until the last five or 10 years. Now we have studies showing how men respond to medications, which is pretty much the same as women.
The concern is not so much a fracture as what can happen afterward, right?
A fracture in [older men] is not without risk, but most hospitals can repair a hip. The difficulty is the rehabilitation process. An older person may not want to get out of bed and literally relearn how to walk, so we have postoperative complications like pneumonia, blood clots, and urinary infections. When one body system goes wrong, it has a snowball effect.
Older men die after a hip fracture at twice the rate women do. That's huge. Why the difference?
I don't think we know why. I have not seen any research that has tried to explain it. That's another sign of the lack of attention paid to men.
Should U.S. men start being screened at 65 the way men in Canada are?
Our study did not support any particular age at which men should get a bone density test. We looked at men over 50.
You found that the single strongest predictor of osteoporosis was low weight. Men below 155 pounds had the highest risk, those from 155 to 175 pounds somewhat lower risk, and those at 176 pounds and up no increased risk. How could height not be taken into account?
When you're developing something you want people to use, you want to keep it simple, and there's nothing simpler than weight. Doctors are compulsive about putting patients on the scales every time they come in. So that figure will be right there and available. The theory is that lighter people have less adipose tissue and muscle, less padding to protect their bones. Also, the less you weigh, the smaller the load on the spine and hips. You need to put weight on bones to keep them strong.
Why is COPD a good indicator of osteoporosis in men?
Lots of smokers develop COPD. They tend to be the ones who smoked the most heavily for the longest time. We know that nicotine is not good for bones. Also, many people with COPD have been exposed to treatments like oral steroids that could cause bone problems. They also tend to be thinner. And they are less likely to be physically active.
Say I complete the MORES test at home on my own and it puts me in the highest-risk category. Would my doctor actually send me for a bone scan? Medicare would pay if I were 65 and a woman, but I'm a man. Would it be worth it for me to pay?
If you took the assessment to your physician, he or she might see a reason to do a DEXA scan. Spending $150 or so to see if you have osteoporosis isn't very much money to find out about something that could be very debilitating. People with very thin bones would benefit the most from therapy or medication.
What's the single most important thing to do to prevent osteoporosis?
To stay active, to do weight-bearing exercise like walking. And lift weights. They don't have to be heavy—five or 10 pounds is enough.