When does bone loss begin in men?
While men naturally have a higher peak bone mass than women, age-related bone loss is a natural process that occurs in both sexes. This gradual decline typically begins around age 50, but the impact and rate of bone loss differ. Due to their greater initial bone density, men generally experience a slower, more delayed onset of osteoporosis compared to women, who undergo accelerated bone resorption during menopause. For men, the incidence of fractures related to osteoporosis begins to rise sharply around age 75.
Primary vs. Secondary Osteoporosis in Men
Unlike in women, where the condition is primarily linked to hormonal changes after menopause, a significant portion of male osteoporosis cases—as high as 40% to 60%—have an identifiable secondary cause.
Primary Osteoporosis
This type is primarily age-related, also known as 'senile osteoporosis.' It occurs in men typically over the age of 70 due to a natural reduction in bone formation and calcium absorption over time.
Secondary Osteoporosis
This is a more common form in men and is caused by underlying medical conditions, lifestyle choices, or medications. Identifying and addressing these factors is crucial for management and prevention.
Common Secondary Causes:
- Hypogonadism: Low testosterone levels can significantly accelerate bone loss. This can be caused by delayed puberty, aging, or androgen deprivation therapy for prostate cancer.
- Glucocorticoid use: Long-term use of steroid medications for conditions like asthma or rheumatoid arthritis is a major risk factor.
- Gastrointestinal diseases: Conditions like Crohn's disease or celiac disease can cause malabsorption of key nutrients like calcium and vitamin D.
- Lifestyle Factors: Excessive alcohol consumption, smoking, and a sedentary lifestyle weaken bones over time.
- Other Conditions: Kidney disease, hyperthyroidism, and certain hematologic disorders like multiple myeloma can also contribute to bone loss.
Comparing Osteoporosis in Men and Women
| Feature | Men | Women |
|---|---|---|
| Typical Age of Onset | Later, often increasing sharply after 70. | Earlier, typically post-menopause around age 50. |
| Peak Bone Mass | Higher on average. | Lower on average. |
| Rate of Bone Loss | Slower and more gradual. | Rapidly accelerates during menopause. |
| Incidence of Secondary Causes | Higher, with 40-60% of cases linked to other factors. | Lower, primarily linked to hormonal changes. |
| Fracture Mortality | Higher mortality rates following a hip fracture. | Lower mortality rates, though overall fracture incidence is higher. |
| Screening Frequency | Less common, guidelines often recommend for ages 70+ or with risk factors. | More common, routine screening typically starts earlier. |
The challenge of diagnosis and screening
Osteoporosis is often called a 'silent disease' because bone loss occurs without symptoms. A fracture is often the first sign, and unfortunately, men are less likely than women to be screened for osteoporosis after a fracture, leading to underdiagnosis and undertreatment.
Medical organizations, such as the National Osteoporosis Foundation and the Endocrine Society, recommend routine bone mineral density (BMD) testing with a Dual-energy X-ray Absorptiometry (DXA) scan for all men aged 70 and older. Screening for younger men (ages 50-69) with specific risk factors is also advised. A T-score of -2.5 or lower at the hip or spine is used to diagnose osteoporosis.
Prevention and management strategies for men
Managing male osteoporosis involves addressing underlying causes and adopting healthy lifestyle practices. For those at high risk or already diagnosed, medical treatment may also be necessary.
Lifestyle Adjustments:
- Nutrition: Ensure adequate intake of calcium and vitamin D through diet and/or supplements. Most experts recommend 1,000–1,200 mg of calcium and 800–1,000 IU of vitamin D daily.
- Exercise: Regular weight-bearing and muscle-strengthening exercises are crucial for building and maintaining bone density.
- Avoidance: Limit alcohol intake and quit smoking, as both are detrimental to bone health.
Medical Intervention:
- Medications: Bisphosphonates, such as alendronate, are commonly prescribed to slow bone loss. Denosumab and teriparatide are other options, with new treatments continually being investigated.
- Addressing Secondary Causes: Treating underlying conditions like hypogonadism or making medication adjustments can halt or reverse bone loss. Your doctor can help determine the best course of action.
For more detailed guidance on bone health, consult the National Institutes of Health.
Conclusion
While the onset of age-related osteoporosis typically occurs later in men, it is a significant health concern that should not be ignored. The higher prevalence of secondary causes and lower rates of screening among men contribute to a higher mortality risk following fractures. By understanding risk factors, engaging in preventive lifestyle measures, and seeking timely medical advice, men can take proactive steps to maintain their bone health and reduce their risk of osteoporosis.
