Why Brittle Bones Aren’t Just A Woman’s Problem

Ronald Klein was biking astir his vicinity successful North Wales, Pennsylvania, successful 2006 and tried to jump a curb. "But I was going excessively slow — I didn't person capable momentum," he recalled.

As nan motorcycle toppled, he thrust retired his near limb to break nan fall. It didn't look for illustration a superior accident, yet "I couldn't get up," he said.

At nan emergency room, X-rays showed that he had fractured some his hip, which required surgical repair, and his shoulder. Klein, a dentist, went backmost to activity successful 3 weeks, utilizing a cane. After astir six months and plentifulness of beingness therapy, he felt fine.

But he wondered astir nan harm nan autumn had caused. "A 52-year-old is not expected to break a hep and a shoulder," he said. At a follow-up sojourn pinch his orthopedist, "I said, 'Maybe I should person a bony density scan.'"

As Klein suspected, nan trial showed he had developed osteoporosis, a progressive condition, expanding sharply pinch age, that thins and weakens bones and tin lead to superior fractures. Klein instantly began a supplier regimen and, now 70, remains connected one.

Osteoporosis occurs truthful overmuch much commonly successful women, for whom aesculapian guidelines urge cosmopolitan screening aft property 65, that a man who was not a wellness attraction master mightiness not person thought astir getting a scan. The orthopedist didn't raise nan prospect.

But astir 1 successful 5 men complete property 50 will suffer an osteoporotic fracture successful their remaining years, and among older adults, astir a 4th of hep fractures hap successful men.

When they do, "men person worse outcomes," said Cathleen Colón-Emeric, a geriatrician astatine nan Durham VA Health Care System and Duke University and nan lead writer of a caller study of osteoporosis curen successful antheral veterans.

"Men don't do arsenic good successful betterment arsenic women," she said, pinch higher rates of decease (25% to 30% wrong a year), disablement and institutionalization. "A 50-year-old man is much apt to dice from nan complications of a awesome osteoporotic fracture than from prostate cancer," she said.

(What's "major"? Fractures of nan wrist, hip, femur, humerus, pelvis aliases vertebra.)

In her study of 3,000 veterans ages 65 to 85, conducted astatine Veterans Affairs wellness centers successful North Carolina and Virginia, only 2% of those assigned to nan power group had undergone bone-density screening.

"Shockingly low," said Douglas Bauer, a objective epidemiologist and osteoporosis interrogator astatine nan University of California-San Francisco, who published an accompanying commentary successful JAMA Internal Medicine. "Abysmal. And that's astatine nan VA, wherever it's paid for by nan government."

But establishing a bony wellness work — overseen by a caregiver who entered orders, sent predominant assignment reminders and explained results — led to melodramatic changes successful nan involution group, who had astatine slightest 1 consequence facet for nan condition.

Forty-nine percent of them said yes to a scan. Half of those tested had osteoporosis aliases a forerunner condition, osteopenia. Where appropriate, astir of them began medications to sphere aliases rebuild their bones.

"We were pleasantly amazed that truthful galore agreed to beryllium screened and were consenting to initiate treatment," Colón-Emeric said.

After 18 months, bony density had accrued modestly for those successful nan involution group, who were much apt to instrumentality to their supplier regimens than osteoporosis patients of either activity successful real-world conditions.

The study didn't proceed agelong capable to find whether bony density accrued further aliases fractures declined, but nan researchers scheme a secondary study to way that.

The results revive a longtime question: Given really life-altering, moreover deadly, specified fractures tin be, and nan readiness of effective narcotics to slow aliases reverse bony loss, should older men beryllium screened for osteoporosis, arsenic women are? If so, which men and when?

Such issues mattered little erstwhile life spans were shorter, Bauer explained. Men person bigger and thicker bones and thin to create osteoporosis 5 to 10 years later than women do. "Until recently, those men died of bosom illness and smoking" earlier osteoporosis could harm them, he said.

"Now, men routinely unrecorded into their 70s and 80s, truthful they person fractures," he added. By then, they person besides accumulated different chronic conditions that impair their expertise to recover.

With osteoporosis testing and treatment, "a man could spot a clear-cut betterment successful mortality and, much importantly, his value of life," Bauer said.

Both patients and galore doctors still thin to respect osteoporosis arsenic a women's disease, however. "There's a spot of a Superman idea," said Eric Orwoll, an endocrinologist and osteoporosis interrogator astatine Oregon Health & Science University.

"Men would for illustration to judge they're indestructible, truthful a fracture doesn't person nan accusation that it should," he added.

One patient, for example, for years resisted entreaties from his wife, a nurse, to "see someone" astir his visibly rounded precocious back.

Bob Grossman, 74, a retired nationalist schoolhouse coach successful Portland, blamed mediocre posture alternatively and told himself to straighten up. "I thought, 'It can't beryllium osteoporosis — I'm a guy,'" he said. But it was.

Another obstacle to screening: "Clinical believe guidelines are each complete nan place," Colón-Emeric said.

Professional associations for illustration nan Endocrine Society and nan American Society for Bone and Mineral Research urge that men 50 and older who person a consequence factor, and each men complete 70, should activity screening.

But nan American College of Physicians and nan U.S. Preventive Services Task Force person deemed nan grounds for screening of men "insufficient." Clinical tests person recovered that osteoporosis narcotics summation bony density successful men, arsenic successful women, but astir antheral studies person been excessively mini aliases lacked capable follow-up to show whether fractures besides declined.

The task force's position intends that Medicare and galore backstage insurers mostly won't screen screening for men who haven't had a fracture, though they will screen attraction for men diagnosed pinch osteoporosis.

"Things person been stalled for decades," Orwoll said.

So it whitethorn autumn to older men themselves to inquire their doctors astir a DXA (pronounced DECKS-ah) scan, wide disposable astatine $100 to $300 out-of-pocket. Otherwise, because osteoporosis is typically asymptomatic, men (and women, who are besides undertested and undertreated) don't cognize their bones person deteriorated until 1 breaks.

"If you had a fracture aft property 50, you should person a bony scan — that's 1 of nan cardinal indicators," Orwoll advised.

Other consequence factors: falls, a family history of hep fractures, and a reasonably agelong database of different wellness conditions including rheumatoid arthritis, hyperthyroidism and Parkinson's disease. Smoking and excessive intoxicant usage summation nan likelihood of osteoporosis arsenic well.

"A number of medications besides do a number connected your bony density," Colón-Emeric added, notably steroids and prostate crab drugs.

When a scan reveals osteoporosis, depending connected its severity, doctors whitethorn prescribe oral medications for illustration Fosamax aliases Actonel, intravenous formulations for illustration Reclast, regular self-injections of Forteo aliases Tymlos, aliases twice-annual injections of Prolia.

Lifestyle changes for illustration exercising, taking calcium and vitamin D supplements, stopping smoking, and drinking only moderately will thief but aren't capable to extremity aliases reverse bony loss, Colón-Emeric said.

Although guidelines don't universally urge it, astatine slightest not yet, she would for illustration to spot each men property 70 and up beryllium screened, because nan likelihood of disablement aft hep fractures are truthful precocious — two-thirds of older group will not regain their anterior mobility, she noted — and nan medications that dainty it are effective and often inexpensive.

But informing patients and wellness attraction professionals that osteoporosis threatens men, too, has progressed "at a snail's pace," Orwoll said.

Klein remembers attending a seminar to instruct patients for illustration him successful utilizing nan supplier Forteo. "I was nan only antheral there," he said.