Why is osteoporosis not only a women’s problem?

Ronald Klein was riding his bike through his neighborhood in North Wales, Pennsylvania, in 2006 when he tried to jump into a ditch. “But I was too slow, and I didn’t have enough momentum,” he recalls.

When the bike fell, he extended his left arm to cushion the fall. It didn’t look like a serious accident, but “I couldn’t get up.”

In the emergency room, X-rays showed that he had fractured his hip, which would require surgery, and his shoulder. Klein, a dentist, returned to work three weeks later using a cane. After about six months and a lot of physical therapy, he felt fine.

But he kept thinking about the damage the fall had caused. “A 52-year-old isn’t supposed to break their hip and shoulder,” he said. At a follow-up visit with the orthopedic surgeon, he said, “Maybe I should do a bone densitometry.”

As expected, the test revealed that she had osteoporosis, a progressive disease that worsens with age, weakens bones and can lead to serious fractures. Klein immediately began drug treatment and, now 70, continues to take it.

Osteoporosis is more common in women, for whom medical guidelines recommend it Comprehensive examination after the age of 65so a guy who wasn’t a health professional probably wouldn’t have thought about densitometry. The traumatologist did not mention this possibility.

But almost One in five Men over the age of 50 will suffer an osteoporosis-related fracture, and among the elderly almost all of them a fourth Hip fractures occur in men.

When that happens, “men’s prognosis is worse,” said Dr. Kathleen Colon-Emeric, a geriatrician at Durham Veterans Health Care System and Duke University, and lead author of a recent study on treating osteoporosis in male veterans.

“Men do not recover as well as women,” he said, with higher rates of death (between 25% and 30% per year), disability, and hospitalization. He added: “A 50-year-old man is more likely to die from complications of a major fracture due to osteoporosis than from prostate cancer.”

(What are considered “major” fractures? Fractures of the wrist, hip, femur, humerus, pelvis, or vertebra.)

In your Study with 3,000 veterans Ages 65 to 85 years, conducted at Department of Veterans Affairs health centers in North Carolina and Virginia, only 2% of those recruited into the control group underwent bone density measurement.

“It’s surprisingly low,” said Douglas Bauer, a clinical epidemiologist and osteoporosis researcher at the University of California, San Francisco, who published a study. Supplementary comment In JAMA Internal Medicine. “Awful. And this is at the Department of Veterans Affairs, where it’s funded by the government.” But the creation of a bone health service, overseen by a nurse who records orders, sends frequent appointment reminders and explains results, led to dramatic changes in the intervention group, which had at least one risk factor for the condition.

49% of them accepted ultrasound. Half of those screened had osteoporosis or a pre-existing condition called osteoporosis. When appropriate, most began taking medications to preserve or rebuild their bones.

“We were pleasantly surprised that so many agreed to get tested and were willing to begin treatment,” Colon-Emeric said.

After 18 months, bone density increased slightly in the intervention group, which continued to improve on their drug treatments, compared to osteoporosis patients of both sexes under real-world conditions.

The study did not last long enough to determine whether bone density increased further or if fractures decreased, but researchers plan to conduct a secondary follow-up analysis.

The findings revive a long-standing question: Given how serious and even fatal these fractures are, and the availability of effective medications to slow or reverse bone loss, should older men be screened for osteoporosis, like women? If so, to which men and when?

These problems were less important when life expectancy was shorter, Bauer explained. Men have larger, thicker bones and tend to develop osteoporosis five to ten years later than women. “Until recently, these men were dying from heart disease and smoking,” he added, before osteoporosis took their toll.

“Now, men generally live into their 70s and 80s, so they suffer from fractures,” he added. By then, they have also accumulated other chronic diseases that affect their ability to recover.

By testing and treating osteoporosis, “a man can see a clear improvement in his mortality rate and, more importantly, in his quality of life,” Bauer said.

However, patients and many doctors still tend to consider osteoporosis as a female disease. “There’s kind of a Superman idea,” said Eric Orwell, an endocrinologist and osteoporosis researcher at Oregon Health & Science University.

He added: “Men like to think they are indestructible, so the bill has not been given the importance it should have.”

For example, one patient resisted pleas for years from his wife, a nurse, to “see someone” because of a pronounced curvature of his back.

Bob Grossman, 74, a retired Portland public school teacher, decided to correct his situation and told himself to straighten up. “I thought: ‘It can’t be osteoporosis, I’m a man,'” he said. But it was.

There’s another hurdle to screening: “Clinical practice guidelines are very diverse,” said Dr. Colon-Emeric.

Professional societies such as the Endocrine Society and the American Society for Bone and Mineral Research recommend that men over age 50 who have a risk factor, and all men over age 70, Screening tests are performed.

However, American College of Physicians and Preventive Services Task Force From the United States the evidence for screening in men was considered “insufficient”.

Clinical trials have found that osteoporosis medications Increase bone density In men, as well as in women, but most studies in men were too small or did not have enough follow-up to show whether fractures were also reduced.

The task force’s position means that Medicare and many private insurance companies generally will not cover screening tests for men who have not had a fracture, although they do cover care for men diagnosed with osteoporosis.

“Things have been stagnant for decades,” Orwell said.

Therefore, it may be older male patients who ask their doctors about bone densitometry, which is widely available at a cost of $100 to $300. Otherwise, because osteoporosis is often asymptomatic, men (and women, who also receive few tests and treatments) don’t know their bones have deteriorated until they break.

“If you have a fracture after the age of 50, you should have bone density measured, as it is one of the main indicators,” Orwell said.

Other risk factors: falls, family history of hip fractures, and a long list of other conditions, including rheumatoid arthritis, hyperthyroidism, and Parkinson’s disease. Smoking and excessive alcohol consumption also increase the chances of developing osteoporosis.

“Many medications also affect bone density,” Colon-Emeric explained, especially steroids and prostate cancer medications. When an ultrasound detects osteoporosis, depending on its severity, doctors may prescribe oral medications such as Fosamax or Actonel, intravenous formulations such as Reclast, daily self-injections of Forteo or Tymlos, or semiannual injections of Prolia.

Lifestyle changes, such as exercising, taking calcium and vitamin D supplements, quitting smoking, and drinking in moderation, will help, but they are not enough to stop or reverse bone loss, Colon-Emeric said.

Although guidelines don’t recommend it universally, at least not yet, he would like all men over 70 to be screened, because the chances of developing disability after a hip fracture are so high (two-thirds of older people will never regain their previous mobility, he says), and because the drugs that treat it are often effective and inexpensive.

However, informing patients and health professionals that osteoporosis also threatens men has progressed “in Basso “Turtle,” Orwell said.

Klein remembers attending a seminar to teach patients like him how to use Forteo. “I was the only guy,” he said.

New Old Age is produced in collaboration with New York Times.