Even as I’ve gradually come to acknowledge my vulnerability to the various ailments that commonly affect a good portion of septuagenarians, certain potential afflictions remain beyond my radar. I’ve become well aware of the cardiovascular and auditory effects of aging in recent years, for instance, while also recognizing neurological challenges, arthritic annoyances, and lurking cataracts. But I have never given a moment’s thought to osteoporosis.
Cathleen Colón-Emeric, MD, suggests that I’m not alone in my obliviousness. The Duke University geriatrician recently surveyed some 3,000 men between the ages of 65 and 85 and found that a mere 2 percent had undergone the bone-density screening that physicians use to diagnose osteoporosis. It’s indicative of a cultural blind spot: We tend to think of weak and brittle bones as a condition that only strikes aging women. But research shows that about 20 percent of men over the age of 50 will eventually suffer an osteoporotic fracture. And when they do, they tend to recover more slowly than women — when they recover at all.
“A 50-year-old man is more likely to die from the complications of a major osteoporotic fracture than from prostate cancer,” Colón-Emeric tells KFF Health News.
Research shows that about 20 percent of men over the age of 50 will eventually suffer an osteoporotic fracture
Men and women both reach their peak bone mass in their 20s, but guys typically develop heftier bones. And because men also don’t have to cope with the bone-dissipating effects of menopause, signs of their bone loss generally take from five to 10 years longer to appear than they do in women. That may partly explain why it’s taken so long for researchers to focus on osteoporosis in men — our forefathers seldom lived long enough to display the symptoms.
Men are living longer lives these days, and our extended lifespans come with physical challenges that can make recovery from a fracture more problematic — all the more reason for older men to begin thinking more seriously about their odds of developing osteoporosis. Risk factors include smoking, immoderate alcohol use, and a family history of hip fractures. A variety of chronic diseases, including rheumatoid arthritis, hyperthyroidism, and Parkinson’s, may also contribute to bone loss. And some research suggests that androgen deprivation therapy, often used to treat advanced prostate cancer, may also increase the risk.
The clearest indicator of osteoporosis, however, is a fracture itself. If you’ve suffered one after the age of 50, experts recommend getting a bone scan.
Colón-Emeric was able to convince almost half of her study participants to undergo a screening. The results, published in JAMA Internal Medicine, revealed osteoporosis or osteopenia, a precursor to the disease, in half of that cohort. The willingness to submit to testing, she says, was even more noteworthy than the test results. “We were pleasantly surprised that so many agreed to be screened and were willing to initiate treatment.”
Various prescription drugs have been approved to treat the condition. Colón-Emeric doesn’t divulge the specific medications prescribed for her study participants, but her study did reveal improved bone density results after 24 months of treatment with a specially trained bone health nurse.
More importantly, she argues, her results indicate that a centralized bone-health service (BHS) approach could persuade more at-risk men to consider screening and treatment. “[We] found that the BHS model was associated with significantly improved osteoporosis screening, treatment, and adherence compared with usual care, with high patient and clinical acceptance,” she writes.
The Endocrine Society and the Bone Health and Osteoporosis Foundation recommend that at-risk men over 50 years old — and all men over 70 — get a bone scan.
More research, including a longer follow-up period, will be required before her results are likely to attract much attention from public health organizations, which have reached little consensus on the need for screening. The Endocrine Society and the Bone Health and Osteoporosis Foundation recommend that at-risk men over 50 years old — and all men over 70 — get a bone scan. That view is at odds with the U.S. Preventive Services Task Force, which argues that there’s insufficient evidence to make such a recommendation, and the American College of Physicians, which only recommends screening for at-risk patients who would be candidates for drug therapy.
As a result, Colón-Emeric notes, “Clinical practice guidelines are all over the place.”
That lack of agreement creates a conundrum for men at risk for the disease: Medicare and most private insurers won’t cover the cost of a bone scan (which ranges from $100 to $300), but they will cover treatment costs once a patient is diagnosed with osteoporosis.
While that may be just another sign of a fractured healthcare system, it shouldn’t keep me and my contemporaries from at least investigating the odds that our aging bones are growing brittle. Physical fractures, after all, are a good deal more painful than the systemic variety.
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