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Men and osteoporosis

One in five with bone deterioration is male. Scientists are now looking at risk based on advanced age, low weight and a history of lung disease.

December 24, 2007|Amber Dance | Special to The Times

When women reach a certain age, usually 50, their doctors routinely test their bones for signs of osteoporosis. But although men suffer from thinning bones as well, they rarely worry about the condition -- and their doctors rarely test for it.

"This is just not on the radar screen," said Dr. Angela Shepherd, a professor at the University of Texas Medical Branch in Galveston, Texas.

But one in five osteoporosis sufferers are male -- that's 2 million men in the U.S. -- and doctors are slowly starting to take notice.

Shepherd and her colleagues recently used data from nearly 3,000 men to devise a questionnaire that can identify men at risk for osteoporosis. They describe the tool in the current issue of the Annals of Family Medicine. Men or their doctors can use the questionnaire, which gives patients points for advanced age, low weight and a history of lung disease. Those who score six or more points are recommended for X-ray tests that can diagnose osteoporosis.

Doctors don't fully understand why men's bones deteriorate. In women, osteoporosis is associated with menopause, when the body stops producing the high levels of estrogen that protect bones.

"If I see a woman with a bone problem, I can usually figure out what happened," said Dr. Frederick Singer of the John Wayne Cancer Institute in Santa Monica. With more than half of his male patients, however, he sees no obvious reason for their disease. Men often aren't diagnosed until they break a bone.

Though the causes aren't always clear in men, the basic progression of the disease is the same as in women. The body is continually dismantling and rebuilding bones, but after about age 30, the loss rate starts to outpace the growth. If enough bone is lost, it causes osteoporosis, which affects mostly older people. Genes, lifestyle and medical history all play a role in how much bone a person will lose.

Men, who start with bigger, stronger bones, usually get osteoporosis at a later age than women. Patients, male and female, are particularly likely to fracture a hip, spine or wrist, often with life-altering consequences.

"It really affects your life completely, in kind of underground ways that you wouldn't normally think of," said retired engineer Graham Russell, 77, of Santa Monica, who has osteoporosis and started getting fractures around age 40. "Prior to this, if something was in the way, I moved it." Now lifting something heavy could break his bones.

Russell can hardly keep track of his injuries: He has four crushed vertebrae and has broken his legs, both arms more than once, his collarbone and "innumerable ribs," he said. The exact root of his osteoporosis is not known, although low weight and medication he used to take, prednisone, may be factors.

"The biggest risk is being skinny," Shepherd said. Her screening tool recommends a bone density test for men age 50 or older who weigh 154 pounds or less. "The jockeys that ride horses should be tested."

To identify the most important risk factors, the researchers used the government's National Health and Nutrition Examination Survey, which included bone scans and other information for nearly 3,000 men age 50 and older. Using data from half of the men, they searched for traits that went along with osteoporosis and identified age, weight, and a history of chronic bronchitis and emphysema as the most important. They focused on lung disease instead of smoking as a risk factor because some people might not be honest about tobacco use.

Then the scientists used the other half of the men in the survey to test their screening tool. Of the men who scored six points or higher, 10% had osteoporosis.

Many men who scored high didn't have osteoporosis but had thinning bones that could eventually lead to disease. Of those men who scored less than six, fewer than 1% had osteoporosis, so the test effectively ruled out men not at risk.

"This is preliminary, but it's exciting," Shepherd said. If the screen works in the clinic as well as it did with the survey data, it could allow doctors to cheaply and quickly identify men whose bones are at risk. Those men, once tested for osteoporosis, could benefit from treatment or changing their habits.

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(BEGIN TEXT OF INFOBOX)

How to keep bones strong

What men and women can do to keep bones strong:

* Work out. Doing exercises in which bones oppose weight or gravity tells the body to strengthen those bones, so they can handle that pressure in the future. Good exercises include walking, jogging, stair-climbing, racquet sports, team sports, dancing or lifting weights.

* Eat right. Healthy bones need calcium. Low-fat dairy products, leafy green vegetables, foods with added calcium and supplements are all good options. The National Osteoporosis Foundation recommends a daily intake of 1,000 milligrams for adults younger than 50 years old, and 1,200 milligrams for those 50 and older.

* Enjoy the sunshine. Your body can make enough vitamin D, which helps the body absorb calcium, if you spend 15 minutes in the sun three times a week. Supplements are also an option. The foundation recommends 400 to 800 units for those younger than 50 and 800 to 1,000 for those older, and some doctors suggest everyone should get 1,000 units or more.

* Don't smoke. Smoking has been linked with an increased risk of osteoporosis, though it's not clear why.

* Limit alcohol use. Regularly drinking to the point of drunkenness may decrease calcium levels and weaken bones.

* Talk to your doctor. Some medical conditions and medications, such as prednisone, can weaken the bones. If you experience constant low back or neck pain, a newly stooping posture, or lose more than an inch in height since the start of adulthood, see your physician.

-- Amber Dance

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