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Men Not Getting Needed Osteoporosis Treatments

Even though 2 million U.S. males have the disease

TUESDAY, Oct. 29, 2002 (HealthDayNews) -- The gender gap is alive and well in the treatment of hip fractures, with men much less likely than women to receive treatment for osteoporosis after such a fracture.

"It's been known for the last couple of years that women were under-treated for osteoporosis. We suspected that it was the same or worse for men, and that's what we found," says Gary M. Kiebzak, lead author of an article that appears in the current issue of the Archives of Internal Medicine.

Osteoporosis is a disease in which bone density decreases, making bones more fragile and likely to break.

According to the study authors, hip fractures are the most significant type of osteoporosis-related fracture, accounting for more deaths as a result of osteoporosis, more disability and higher medical costs.

Today, 2 million American men have osteoporosis, and another 12 million are at risk for the disease, according to the National Osteoporosis Foundation.

In the United States, men account for some 20 percent to 30 percent of all hip fractures, but no one had done a systematic study to see if they are treated for osteoporosis after a fracture.

In this study, the researchers looked at data from 363 patients (110 men and 253 women) with an average age of about 80 who had been admitted to St. Luke's Episcopal Hospital in Houston with what appeared to be osteoporosis-related hip fractures. Questionnaires were mailed to surviving patients to get information on what treatments, if any, they had been given. One hundred ninety four surveys were returned.

Only 4.5 percent of the men reported receiving treatment for osteoporosis upon discharge from the hospital, compared with 27 percent of the women. And at one- and five-year follow-ups, only 27 percent of the men were taking treatment for osteoporosis, compared with 71 percent of the women.

Of the patients who were receiving treatment, 67 percent of men and 32 percent of women were taking calcium and vitamin D only. At the one- and five-year follow-up marks, 11 percent of men had had their bone mineral density measured, compared with 27 percent of women.

The study authors found that, after discharge, there was an increase in the number of both men and women who relied on wheelchairs and canes, as well as a rise in the number of individuals living in institutions.

"A problem that we've had for men is that we have not had the range of treatment choices that we have for women, " Kiebzak says. "You wouldn't give a man estrogen, for example. About the only thing that was available that was widely used was calcium and vitamin D."

More aggressive medications such as phosphonates were not being given to men. Nor were men even getting calcium or vitamin D in many cases, Kiebzak says.

"There was a general lack of appreciation for the problem of low bone density in men," says Kiebzak, who is also chief research scientist for the Center for Orthopedic Research and Education at St. Luke's Episcopal Hospital and an associate professor of orthopedics at Baylor College of Medicine in Houston.

One of the reasons for the low profile of osteoporosis in men is that scientists had lacked the ability to measure bone density until the early 1990s. The problem was recognized in women largely because they had more fractures.

The ability to measure bone density has also given scientists a good definition of osteoporosis.

"We used to define osteoporosis as the presence of a fragility fracture, that is a fracture that's caused after a low-energy event," Keibzak explains. In 1994, however, the World Health Organization provided a definition based on bone density.

Doctors no longer had to wait for a person to break a bone before starting treatment for the disease.

"We aren't necessarily saying that all these people with hip fractures should immediately be put on treatment," Kiebzak says. "The point is that these are people with an average age of 80 who have managed to go through the health-care system for all those years and not be treated for osteoporosis. The time to treat somebody is well before they have that fracture."

The National Osteoporosis Foundation offers these tips to help ward off weakening of the bones:

  • Change unhealthy habits, such as smoking, excessive alcohol consumption and inactivity.
  • Ensure a daily calcium intake of 1,000 milligrams to age 50, and 1,200 milligrams after age 51.
  • Ensure adequate vitamin D intake. Normally, the body produces enough vitamin D from as little as 10 minutes of sun exposure a day. If exposure to sunlight is inadequate, then vitamin D intake from supplements should be at least 400 IU daily, but not more than 800 IU a day.
  • Engage in a regular regimen of weight-bearing exercises, in which bones and muscles work against gravity. These exercises include walking, jogging, racquet sports, stair climbing and team sports. Also, lifting weights or using resistance machines appears to help preserve bone density.

What To Do

To learn more about men and osteoporosis, visit the National Osteoporosis Foundation or the U.S. Food and Drug Administration.

SOURCES: Gary M. Kiebzak, Ph.D., chief research scientist, Center for Orthopedic Research and Education, St. Luke's Episcopal Hospital, and associate professor in orthopedics, Baylor College of Medicine, Houston; Oct. 28, 2002, Archives of Internal Medicine
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