Brittle Bones Can Affect Older Men As Well

Fractures less common but more lethal for men than for women, experts say

SUNDAY, July 10, 2005 (HealthDay News) -- Everyone knows that women need to fend off osteoporosis as they age. But what is less well-known is that 30 percent of elderly men who suffer a hip fracture will die within a year of that fracture -- double the rate for older female patients.

But despite this increased risk, experts say many men view brittle bones as a "woman's problem."

Too many doctors may also share that view: One recent U.S. study, published in the June issue of the journal Osteoporosis International, "validated what we thought -- that men who have fractures are woefully undertreated. Just one in every six men who had a spine or hip fracture was treated with osteoporosis medications" to strengthen ailing bones, said Dr. Thomas J. Weber, an assistant professor of medicine at Duke University Medical Center.

According to the same study, just 1.1 percent of men brought to the hospital for a serious fracture received a bone density test to evaluate their overall risk.

"Now, doctors wouldn't hesitate to do that for a woman, but it seems we just don't think of it in terms of men," Weber said.

It's true that men start out with denser, healthier bones than women.

"Women have less bone to begin with, and then they get a big hit at menopause," said Dr. Joseph Lane, chief of the metabolic bone disease service at the Weill Cornell Medical College's Hospital for Special Surgery in New York City.

"The overall rate of bone loss for men and women is the same, but because men start higher they don't get into trouble as quickly -- osteoporosis isn't an issue for men until 70 and beyond," he said.

But when a fracture occurs in the elderly, brittle bones can quickly become a life-or-death concern.

"There are a number of reasons people can die after fracture," Weber said. "They may have underlying cardiovascular disease that leads to congestive heart failure. They may develop infection and there's a suggestion, based on some evidence, that perhaps in 25 percent of male patients death is related to the consequences of the hip fracture itself."

While menopause is a major cause of bone deterioration in women, factors such as smoking, alcohol consumption and the use of certain medicines increase fracture risks for men, Lane said. The gradual age-related decline in circulating testosterone is another factor. "A young guy has a testosterone value of about 1,000 and older men are down to about 300," he said.

All of these risk factors are preventable, either through quitting smoking and heavy drinking, or via pharmaceutical means, said Lane, who is also a spokesman for the American Academy of Orthopaedic Surgeons.

Then there's diet and exercise.

"In general, men over the age of 50 should be getting 1,200 mg of calcium a day from diet, or diet and supplements combined," Weber said. Lane advises men to use calcium citrate -- not bicarbonate -- supplements, because the bicarbonate formulation raises risks for kidney stones.

The current recommended daily allowance for another bone-strengthener, vitamin D, is 400 International Units (IU) per day for older men, but Weber said that level is currently under review and will no doubt be revised.

"I think maybe upwards of 800 to 1,000 IU can be safely recommended for men," he said. Many foods, including milk, come fortified with vitamin D (check the label) and cod liver oil capsules are particularly high in the nutrient.

Skin also manufactures vitamin D under strong sunlight. "It has to do with the sun's angle, though, so go out there between 10 a.m. and 2 p.m. rather than taking a walk in the early morning," Weber said.

As for exercise, its benefits are more about balance than bones, according to Weber. "Exercise's effects on the skeleton tend to be fairly modest," he explained. "When we prescribe exercise for older people we're doing it not only to help bone density but to increase strength and reduce their risk of falls."

Lane agreed. "You need two things for a fracture: bad bones and a fall. There's an easy way to tell if you're at high risk for falling: try standing on one leg for 12 seconds. If you can't do that, then by definition you're an unsteady individual who needs fall protection" such as sturdy shoes, a cane or walker, he said.

But failing balance can be restored, and one of the world's oldest interventions remains among the most effective.

"The most successful method is Tai Chi," Lane said. "All of the YMCAs in New York now teach Tai Chi, and we send all the people who fail the one-leg test to the Y to learn it."

More information

Bone up on bone loss at the American Academy of Orthopaedic Surgeons.

SOURCES: Thomas J. Weber, M.D., assistant professor, medicine, division of endocrinology, metabolism and nutrition, Duke University Medical Center, Durham, N.C.; Joseph Lane, M.D., chief, metabolic bone disease service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York City, and spokesman, American Academy of Orthopaedic Surgeons
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