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Real Men

Real men

Real men build their strength from within

Appearances can be deceiving. Men who look strong on the outside, may actually be weak on the inside and don’t realize it. Worldwide approximately one in five men over the age of 50 years will break a bone due to osteoporosis. The vast majority of them are neither identified nor treated for this ‘silent’ disease, even after they’ve had a fracture.

Osteoporosis is a disease which gradually weakens bones, leading to painful and debilitating fragility fractures (broken bones). These can occur after a minor fall from standing height, as a result of a bump or sneeze and even from bending over to tie a shoelace. Any bone can break due to osteoporosis, but some of the most serious and common fractures are those of the spine and hip.

Dispelling the myths

There are still a lot of myths surrounding men and osteoporosis. Recognizing and debunking them is the first step in calling on men to embrace better bone health.

Myth 1 Osteoporosis is just a women's disease

  • Osteoporosis affects 1 in 5 men over the age of 50.
  • Men are twice as likely to die following a hip fracture than women.
  • Men are more likely to suffer an osteoporotic fracture than to develop prostate cancer.
  • 1/3 of the world's hip fractures occur in men.

Myth 2 Osteoporosis is a natural part of ageing and you can’t prevent it

  • Breaking a bone after a minor bump or fall is not normal at any age.
  • Actions can be taken early in life to reduce the risk of osteoporosis.
  • Modifiable risk factors that can be addressed are: eating foods rich in bone-healthy nutrients, including calcium and vitamin D; avoiding negative lifestyle habits e.g. excessive use of alcohol and smoking;getting regular weight-bearing and muscle-strengthening exercise.

Myth 3 Osteoporosis is not an urgent health concern

  • The population of men aged over 60 years is rapidly growing - the group most at risk of osteoporosis.
  • In Europe the total number of fractures in men will increase by 34% from 2010 to 2025.
  • Without effective prevention strategies, an enormous increase in fractures will place a heavy burden on individuals, families and communities as well as on health-care budgets.

Myth 4 Osteoporosis cannot be diagnosed or treated

  • Simple tests exist to help determine if you are at risk of osteoporosis and/or fracture. There are also effective treatments available.
  • A prior fracture is a clear sign that men must talk to their doctor, get tested and treated appropriately.
  • Taking the IOF one minute risk test is a good way to identify personal risk factors.
  • By adhering to prescribed medication, patients can substantially reduce their risk of future fractures.

Myth 5 Osteoporosis has a minimal impact on men and the family unit

  • Men play a critical role in families, providing care and support to other family members. A significant number of productivity is lost due to fractures in men aged between 50–65 years.
  • After sustaining a hip fracture, approximately 10-20% of formerly community dwelling men will require long-term nursing care.
  • Men have a lower life expectancy than women and hip fractures later in life can greatly decrease longevity.

What causes osteoporosis in men?

Beware of the risk factors that cause excessive bone loss. By young adulthood men typically have built more bone mass than women. After around age 30 years, the amount of bone in the skeleton begins to decline as the formation of new bone does not keep up with the removal of old bone.

Men in their fifties do not experience the rapid loss of bone mass women do in the years following menopause. But by 70 years old, men and women lose bone mass at the same rate, and the absorption of calcium (a mineral important to bone health) decreases in both sexes. Excessive bone loss causes bone to become fragile and more likely to fracture.

What are the risk factors in men?

Many of the same factors that put women at risk of osteoporosis and fractures apply to men too, although men must look out for testosterone deficiency and medications related to prostate cancer therapy.

Major risk factors

  • Age - bone loss accelerates more rapidly at around age 70 years in men
  • Family history of osteoporosis means you’re at higher risk
  • A previous broken bone at the age of 50 years or over
  • Long-term use of glucocorticosteroids (more than 3 months)
  • Primary or secondary hypogonadism (testosterone deficiency
  • Certain medications – in addition to glucocorticosteroids, other medications can also put you at increased risk. These include, but are not limited to, some immunosuppressants, thyroid hormone treatment in excess dosage, certain antipsychotics, anticonvulsants, anti-epileptic drugs, lithium, methotrexate, antacids and proton- pump inhibitors. 
  • Some chronic diseases – diseases that place you at risk include, but are not limited to, rheumatoid arthritis, inflammatory bowel disease (e.g. Crohn’s disease), diseases of malabsorption (e.g. celiac’s disease), type 1 and type 2 diabetes, hyperparathyroidism, chronic liver or kidney disease, lymphoma and multiple myeloma, hypercalciuria, and thyrotoxicosis.

Lifestyle-related risks

  • Smoking
  • Excessive alcohol consumption (more than 2 units a day)
  • Poor diet (low levels of calcium, less than 600 mg per day)
  • Vitamin D deficiency/insufficiency
  • Lack of physical exercise or excessive exercise that leads to low body weight
  • Low body mass index (BMI <20)

Should you be tested?

Speak to your doctor and get tested if you are aged 70 years or over. If you’re younger (aged 50-69 years) you should also be tested when risk factors are present. This is especially important if you have:

  • Suffered a fracture as a result of a fall from standing height or less since age 50 years
  • Take glucocorticoid treatment
  • Have low testosterone levels (hypogonadism)