Men and Osteoporosis

with Sanford Baim, M.D., Rheumatologist, Columbia St. Mary’s

Posted: Sept. 1, 2004

While most people do not immediately think of osteoporosis as a man’s disease, experts say the reality is altogether different. In fact, the National Osteoporosis Foundation estimates 2.3 million of the 10 million Americans suffering from the brittle bone disease are men. This equates to 19% of men over 50 with osteoporosis.

Another 12 million men have lower than normal bone density but are not classified as having osteoporosis. This group has been labeled as having “low bone mass” or osteopenia.

Sanford Baim, M.D., Rheumatologist, Columbia St. Mary’s "Unless we recognize the risks of low testosterone associated with prostate cancer treatment, there will be a dramatic increase in osteoporotic fractures..."

For one internationally recognized osteoporosis expert these figures signify a crisis in our community.

Having a diagnosis of osteoporosis, by bone density testing, provides us with a way to determine risk of future osteoporotic fractures, explains Sanford Baim, M.D., a rheumatologist at Columbia St. Mary’s.

The risk of having a fracture increases as bone density decreases.

“Osteoporotic fractures occur in men with low bone mass or osteopenia and in those having osteoporosis,” says Dr. Baim. He feels that male osteoporosis is unrecognized by the public at large and by many physicians.

Public Health Issue
Dr. Baim asserts that male osteoporosis is a major public health issue costing us $3 billion each year. He explains that we should not forget the tremendous human suffering that our father or grandfather may experience after a hip or spine fracture.

“Published data show when a woman suffers an osteoporotic hip fracture, there is a 20% chance of dying within the first year of that fracture,” he says. Men are even less likely to survive a hip fracture, according to Dr. Baim. And if dad or grandpa survives a hip fracture, there is a very good chance he will never be able to care for himself, requiring placement in a long-term health facility.

Low Hormone Levels
While one third of men develop osteoporosis due to aging, the other two thirds have other causes that may be treatable. Dr. Baim explains that the most common causes of osteoporosis in men, other than aging, are long-term use of prednisone medication, alcohol abuse, and lack of testosterone, called hypogonadism.

“Just as post-menopausal women lose bone density from low estrogen levels, so too men lose bone from lack of testosterone,” says Dr. Baim. Low testosterone is one of the side effects of prostate cancer treatment.

Shots of gonadotropin releasing hormone (GNRH) drugs are extremely effective in treating prostate cancer, but unfortunately shut down testosterone production, resulting in bone loss and increased risk of fractures. Dr. Baim believes this is avoidable with appropriate medical treatment, and he is extremely concerned with the baby boomer generation that is beginning to reach the age of increased risk of prostate cancer.

“Unless we recognize the risks of low testosterone associated with prostate cancer treatment, there will be a dramatic increase in osteoporotic fractures in this generation of men that could have been avoided,” he says.

While debate still exists in the medical community over bone density screening, and while Medicare refuses to permit the screening in men as it allows in women, Dr. Baim insists men should have a bone density test when they’re over 70 years of age, and when risk factors for osteoporotic fractures exist.

The International Society for Clinical Densitometry has published screening guidelines for bone density testing in men and women that can be found at www.iscd.org.

“Only when these guidelines are accepted practices in our community will we successfully identify men at risk for osteoporotic fractures and thereby prevent and treat this condition effectively,” Dr. Baim emphasized.

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