Men Not Getting Needed Osteoporosis Treatments

Even though two million U.S. males have the disease, and another 12 million are at risk 

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 a recent 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, two 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. There were 194 surveys 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.

Treatment Options For Men Are Different

"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.

Physicians 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 healthcare system for all those years and not be treated for osteoporosis. The time to treat somebody is well before they have that fracture."

Keeping Bones Strong

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.

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

Archives of Internal Medicine

National Center for Chronic Disease Prevention and Health Promotion, part of the Centers for Disease Control and Prevention (CDC)

National Osteoporosis Foundation

Osteoporosis and Related Bone Diseases National Resource Center, part of the National Institutes of Health (NIH)

World Health Organization

November 2002

Men Much Less Likely Than Women to Receive Treatment for Osteoporosis 

Treatment Options For Men Are Different

Keeping Bones Strong

The ABC's of a Bone Density Test

Online Resources

The ABC's of a Bone Density Test

What to expect, how to interpret and when to repeat the screening for osteoporosis

As medical tests go, a bone mineral density test (BMD) is one of the simplest.

There is no pre-test fasting or other preparation. No poking or prodding or needles involved. The technician records your weight and height, and might ask you to remove clothing with zippers or metal parts, such as your bra.

Then, you simply lie flat and still on a table during the "gold standard" bone density test, called a DEXA (dualenergy x-ray absorptiometry) while a machine that uses small amounts of radiation passes overhead.

"The test tells you how much bone mineral, the stuff that absorbs the x-ray, is there," says Dr. Robert Heaney, professor of medicine at Creighton University and a scientist at its Osteoporosis Research Center. And it can give you a good idea of your risk for osteoporosis, the "fragile bone" disease that can result in painful, costly fractures of the hip, spine and other areas.

It is all over in 10 minutes or less.

Then comes the more difficult part: interpreting the results and figuring out what to do next.

Your results are compared with those of healthy young persons of your gender and ethnicity at their peak bone mass, at age 30. And you are also compared to persons of your gender and ethnicity in your age bracket. The results may be expressed in a variety of ways: as a percentile, as a percent or as a standard deviation.

Ask for your results to be given to you in standard deviation form, experts say.

"The standard deviation result may be the most useful," says Lynn Chard-Petrinjak, spokeswoman for the National Osteoporosis Foundation. And probably the easiest for consumers to interpret.

The World Health Organization has established categories based on standard deviations of what is normal and what is not for bone mineral density, she says, and the National Osteoporosis Foundation and others use these categories. In medical literature, when treatment is discussed, it is described for various standard deviations, she adds.

The result you should pay the closest attention to is how your bones compare to those of a healthy young persons of your gender and ethnicity.

Many experts recommend forgetting about age-matched controls, because many of them, especially if they are 50-plus, already have reduced bone mass density. Your fracture risk is more relative when you compare the quality of your bones to those of younger persons of your own gender and ethnicity.

The result compared to the younger group is often called the T-score; the result compared to persons your own age is the Z-score.

So what is normal and what is not so good? According to the World Health Organization categories, widely accepted by other experts, a normal bone density is within one standard deviation (SD) of the young adult mean, which means plus 1 or minus 1 SD.

Low bone mass is defined as 1 to 2.5 SD below the young adult, which means an SD of minus 1 to minus 2.5.

Bone density that is 2.5 SD or more below the young adult mean is defined as osteoporosis. So a result of minus 2.5 SD or greater is osteoporosis.

If you pass the test without evidence of bone mass loss, your physicians may recommend repeating the test in four or five years, Uszler says, depending on a variety of factors such as your age and other risk factors. If your bone mass is not as good as it should be but you have no evidence of osteoporosis, he/she may suggest a repeat test in two years or so.

Always consult your physician for more specific information relating to bone density testing and your individual medical condition.