Osteoporosis, characterized by thinning bones and increased risk of fractures, is not just a woman’s disease. In fact, two million men in the U.S. have it (compared to eight million women), and anywhere from 13 to 30 percent of men over 50 will eventually have an osteoporosis-related fracture.
Millions more have low bone mineral density that puts them at risk for developing osteoporosis down the road. Moreover, compared to women, men who have hip fractures are more likely to die as a result.
But there are no official recommendations for osteoporosis screening in men because the U.S. Preventive Services Task Force, which advises the government about medical matters, says the current evidence is insufficient to weigh the benefits versus the risks. (In contrast, the Task Force has long recommended bone density screening for women 65 and older and for younger women with risk factors.)
That hasleft screening decisions in the hands of men’s physicians for the most part—and in most cases that has resulted in little or noscreening.
Now, the Endocrine Society, which represents more than 15,000 physicians and scientists specializing in hormonal issues, has released guidelines for men.
Here’s a brief look:
- All men 70 and older should have a bone density test of the hip and spine. So, too, should men ages 50 to 69 who have additional risk factors, such as a low-trauma fracture, low body weight, hypogonadism (inadequate testosterone production), hyperthyroidism, long-term use of corticosteroids (or certain other medications), or a history of alcohol abuse or smoking. Insurance, including Medicare, may pay for testing only under certain circumstances, however.
- Men found to be at high risk for fractures based on their bone density and clinical risk factors should be treated with medication and monitored with repeat testing every one to two years.
- At-risk men should consume 1,000 to 1,200 milligrams of calcium a day (from food first, then supplements if needed), do 30 to 40 minutes of weight-bearing exercise three or four times a week, and keep alcohol intake moderate; smokers should quit. That’s good advice for all men—and women.
- Men with low blood levels of vitamin D should take D supplements. Doses of 1,000 to 2,000 IU a day are usually enough to get blood levels to 30 ng/ml or above, which is considered optimal, but in some cases even larger doses are needed.