Men Face Increasing Osteoporosis Risks, Yet Screening Lags

A recent study highlights the growing concern of osteoporosis among men, challenging the long-held belief that this condition predominantly affects women. Ronald Klein, a dentist from North Wales, Pennsylvania, experienced the harsh reality of this disease after a seemingly minor biking accident in 2006 resulted in fractures to his hip and shoulder. At age 52, he learned he had developed osteoporosis, a condition that thins and weakens bones, making fractures more likely.

Dr. Cathleen Colon-Emeric, a geriatrician at the Durham VA Health Care System and Duke University, emphasizes that while osteoporosis is often considered a women’s issue, one in five men over the age of 50 will suffer from an osteoporotic fracture in their lifetime. Furthermore, approximately 25 percent of hip fractures occur in men, and they face worse recovery outcomes compared to women, with a 25 to 30 percent mortality rate within a year of such fractures.

Klein’s experience was not unique. After his diagnosis, he initiated a drug regimen that has continued into his 70s. However, many men do not consider osteoporosis screening until a fracture occurs. Dr. Colon-Emeric’s study involving 3,000 veterans aged 65 to 85 revealed that only 2 percent of participants in a control group had undergone bone density screening. “Shockingly low,” noted Dr. Douglas Bauer, a clinical epidemiologist at the University of California, San Francisco, highlighting the need for increased awareness and testing.

The Need for Screening and Awareness

Despite the evident risks, clinical practice guidelines regarding osteoporosis screening for men remain inconsistent. While organizations such as the Endocrine Society and the American Society for Bone and Mineral Research recommend screening for men over 50 who have risk factors, others like the American College of Physicians have deemed the evidence insufficient.

Dr. Colon-Emeric’s research shows that establishing a dedicated bone health service can significantly improve screening rates. In her study, 49 percent of those with risk factors agreed to a scan after being prompted. Of those who were tested, half were found to have osteoporosis or its precursor, osteopenia, and most began appropriate medications. This approach could lead to improved outcomes, as patients demonstrated better adherence to treatment compared to historical data.

The study raises critical questions about whether men should be screened for osteoporosis in a manner similar to women. Dr. Bauer notes that men typically develop osteoporosis later in life but are now living longer, increasing the chances of fractures. With other chronic conditions often complicating recovery, timely screening could significantly enhance both life expectancy and quality of life for older men.

Overcoming Stigma and Improving Guidelines

Public perception often portrays osteoporosis as a condition affecting only women, which can discourage men from seeking help. Dr. Eric Orwoll, an endocrinologist at Oregon Health and Science University, points out the stigma surrounding men’s health issues. Many men hold onto the belief that they are invulnerable, leading to delays in diagnosis and treatment.

Bob Grossman, a 74-year-old retired public-school teacher from Portland, is an example of this mindset. He ignored advice from his wife, a nurse, to seek treatment for his back issues, mistakenly attributing them to poor posture. Ultimately, he was diagnosed with osteoporosis.

The current clinical guidelines remain fragmented. While some recommend screening for men over 70 or those with risk factors, others do not endorse routine tests. This inconsistency results in limited insurance coverage for screenings, particularly for men without a prior fracture history.

Despite the challenges, Dr. Colon-Emeric advocates for increased screening, especially for men over 70. Given the high risk of disability following hip fractures—where two-thirds of older individuals do not regain their previous mobility—early detection and treatment of osteoporosis could make a significant difference.

As the discourse surrounding osteoporosis evolves, it is crucial for both patients and healthcare professionals to recognize that men are equally at risk. Dr. Orwoll emphasizes the importance of early intervention, advising that men over 50 who have experienced a fracture should undergo a bone density scan. Risk factors such as a family history of hip fractures, falls, and certain health conditions, including rheumatoid arthritis and hyperthyroidism, should not be overlooked.

Ultimately, addressing the silent threat of osteoporosis in men requires a multifaceted approach—raising awareness, improving clinical guidelines, and encouraging proactive screening. With appropriate medications available and lifestyle changes that can aid in bone health, early detection could lead to a marked improvement in mortality rates and quality of life for older men.