Osteoporosis, which women are more susceptible to, is becoming increasingly common in men. The Department of Endocrinology from Singapore General Hospital (SGH), shares more about how men can lower their risk and how the condition is treated.
Osteoporosis is increasingly being diagnosed in men, who are more likely to suffer from disability and death from osteoporotic fractures.
Osteoporosis is a disease of the bones that is commonly associated with women, but in fact, men are susceptible to it too. Though more women than men suffer from this progressive bone disease, with rising male expectancy and increasing awareness, it is being increasingly diagnosed in men too.
Men with osteoporosis are more likely than women to suffer disability and death from osteoporotic fractures, which they typically develop at an older age.
Osteoporosis is characterised by low bone mass and thinning of bone tissue. Bones become so weak and brittle that a fall or even bending over and coughing can cause a fracture. Osteoporotic fractures usually occur in the hip, spine and wrist.
In Singapore, it is estimated that one-third of osteoporotic fractures occur in men.
“About 34 per cent of men die after a hip fracture compared to 17 per cent of women,” shared Dr Manju Chandran, Senior Consultant and Director, Osteoporosis and Bone Metabolism Unit,
Department of Endocrinology,
Singapore General Hospital (SGH), and Committee Member, Council of Scientific Advisors of the International Osteoporosis Foundation (IOF).
“Hip fractures can result in substantial disability and even death.”
How to prevent osteoporosis in men
“Bones continually grow in a natural process called remodelling, in which old bone cells are replaced by new ones. To make new bone, your body needs plenty of calcium and vitamin D,” says Dr Chandran. In addition:
Maintain a healthy weight
Be physically active and do weight-bearing exercises to strengthen bones
Have a balanced diet (that includes the recommended amounts of calcium and vitamin D)
Know your risk of osteoporosis
Osteoporosis Self-Assessment Tool for Asians (OSTA) chart
Avoid smoking
Reduce your alcohol intake
Get treatment for any underlying medical conditions that can affect your bone health
Check with your doctor about adjusting or replacing any existing medications that can affect your bone health
How to diagnose and treat osteoporosis
Your doctor will study your medical history and carry out urine and blood tests as well as x-rays to diagnose osteoporosis.
A bone mineral density test, such as a dual energy x-ray absorptiometry or DXA test, will be carried out to determine your risk for fractures. This quick and painless test is similar to an X-ray but uses less radiation.
Osteoporosis treatment will depend on your age, the stage of the disease and your risk for fractures. If your osteoporosis is at an early stage, you may require only lifestyle changes to manage the disease. These lifestyle modifications will focus on nutrition and exercise to strengthen bones and prevent bone loss.
If you have a high risk of fractures, you will be prescribed medications such as bisphosphonates, e.g. Alendronate ,Risedronate or Zoledronate.
Other medicines such as Strontium Ranelate, Denosumab, Teriparatide are also approved for use in men. If you have testosterone deficiency, your doctor may recommend testosterone replacement therapy as part of your osteoporosis treatment.
Causes of osteoporosis in men
Osteoporosis usually affects older men. It can be caused by a variety of factors such as age-related bone loss, poor lifestyle habits, chronic medical conditions and prolonged exposure to certain medications. These factors may affect the absorption of bone-building nutrients such as calcium and accelerate loss of bone mass.
Age-related bone loss: Bone mass peaks by the age of 30 after which it gradually decreases. Men accumulate more bone mass than women and lose it less rapidly than women. However, by the age of 65-70, men and women lose bone mass at the same rate.
Hypogonadism (low levels of testosterone): This is the most common cause of osteoporosis in men. Hypogonadism can be caused by various factors such as cancer treatment and prolonged use of corticosteroid medication.
Lifestyle factors: For e.g. excessive consumption of alcohol, smoking, poor diet, lack of physical exercise, prolonged immobilisation.
Chronic medical conditions: For e.g. gastrointestinal disease, chronic pulmonary obstructive disease, asthma, ankylosing spondylitis, rheumatoid arthritis, hyperthyroidism, among others.
Hypercalciuria: This condition causes excess calcium loss through the urine.
Prolonged exposure to certain medications: For e.g. corticosteroids to treat asthma or rheumatoid arthritis, cancer drugs for prostate cancer, anticonvulsants.
Symptoms of osteoporosis in men
Osteoporosis is called a ‘silent disease’ because of the lack of symptoms in the early stages. Symptoms of osteoporosis may appear only at an advanced stage. Some common symptoms of osteoporosis include the following:
“A fracture can often be the first symptom of osteoporosis,” says Dr Chandran.
Ref: H24 (ed)
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Osteoporosis in Singapore
