Although men are at lower risk for osteoporosis than women, men are not immune. In fact, men sustain nearly 30% of the 2 million fractures that happen in adults over the age of 50 each year in the US. Also, men are more likely than women to die after having a hip fracture. One in three men die within a year of sustaining a hip fracture. Hip fractures are killers.
Risk Factors for Male Osteoporosis
Age, steroids, emphysema or COPD – chronic obstructive pulmonary disease, smoking, alcohol, and low testosterone are major risk factors for low bone density and fractures in men. Those with risk factors should be evaluated for causes of osteoporosis with a comprehensive history, physical examination, laboratory tests, and DXA scan.
For those without risk factors, bone density screening in men has not been universally recommended. The International Society for Bone Densitometry and the National Osteoporosis Foundation recommend a screening DXA scan for all men age 70 and older.
Diagnosis of Male Osteoporosis
Diagnosis is based on DXA scan uses the same T-score categories for men 50 and older as for postmenopausal women:
- normal (T-score -1.0 and above)
- low bone mass, referred to as osteopenia (T-score between -1.0 and -2.5)
- osteoporosis (T-score -2.5 and below)
- severe osteoporosis (T-score -2.5 and below with history of a fracture)
If results are in the osteoporosis category, further evaluation should be done looking for any other contributing causes to low bone mass.
Treatment for Male Osteoporosis
Optimize lifestyle and ensure adequate intake of calcium and vitamin D each day. For those at high risk for fracture, treatment with a prescription medicine should be considered as part of the overall management to lower the risk of fracture. Five osteoporosis medicines are approved for use in men: Fosamax® or generic alendronate, Actonel® (risedronate), Reclast® (zoledronic acid), Forteo® (teriparatide), and Prolia® (denosumab).
Osteoporosis Medicines Approved for Use in Men
A summary of the medicines for prevention and treatment of osteoporosis is under FDA-approved medicines.