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Osteoporosis in men

Osteoporosis, a thinning and weakening of the bones, is frequently linked to women citing the female hormone as the predisposing factor for its development. 

Osteoporosis has been an underdiagnosed problem in men. Most people are not aware of the risk and incidence of osteoporosis in males so that it goes untreated in the majority of men with fractures. In fact, one third of all hip fractures worldwide affect men, with 20% of them will sustain a second hip fracture.

The male hormone, testosterone, also plays a critical role in bone strength and density. Low levels of testosterone (hypogonadism), which can occur as a result of aging or disease, leads to osteoporosis. Even younger men have been found to experience symptoms of hypogonadism such as loss of libido, impotence, decreased stamina and diminished strength. But men do not often get screened for testosterone levels, which was attributed to lack of official guidelines.

The Canadian clinical guidelines recommend screening in men 65 years of age or older. The said guidelines also recommend the use of bisphosphonates as first-line treatment for the above age group and for men over 50 years who experienced fractures. Those of any age who have osteopenia (decreased bone density), who are on steroids for 3 or more months, or who have hypogonadism are also recommended for bisphosphonates.

The National Osteoporosis Foundation guidelines recommend drug therapy in men 50 years of age or older with hip or back fractures.
Bisphosphonates, such as alendronate and risedronate, are approved for the treatment and prevention of osteoporosis in males. A hormone drug, teriparatide, is also approved for those who are under anti-androgen therapy for prostrate cancer or are taking steroid treatment. Anti-androgen therapy reduces testosterone production to limit the growth of cancer cells, while steroids contribute to bone demineralization.
Unless they are on androgen-deprivation therapy, males with reduced levels of testosterone may be treated with testosterone replacement.

Vitamin D deficiency is also associated with increased risk of fracture. Calcium and vitamin D supplements are recommended to maintain bone mineral density. Studies show that ingestion of calcium (1200 mg or more daily) and vitamin D (800 IU or more daily) reduced osteoporotic fractures. The recommended daily intake of calcium for men with osteoporosis is 1200 to 1500 mg.

Prevention of falls, which often cause hip fractures, is critical in the management of osteoporosis. Today, 2 million American men have osteoporosis, and another 12 million are at risk.


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