Osteoporosis strikes many men

Almost as many men as women suffer from osteoporosis according to startling new evidence from a Canadian study. Moreover, men with the degenerative bone condition often don’t realize they have it, according to Dr. Wojciech Olszynski.He’s director of the Saskatoon Osteoporosis Centre and taking part in the Canadian MultiCentre Osteoporosis Study (CaMos).

“We found the old concept of how many men are suffering osteoporosis is wrong. We are looking at numbers almost identical to women. We are surprised to see that 25 to 27 per cent of all men and women over age 50 have some deformities in the spine. We are talking every fourth person. There’s no question that osteoporosis of the spine is coming in much higher numbers than we had expected.”

“And for men, it’s a significantly higher number than expected or estimated before. In American studies, they are already saying that the old concept of one in four women and one in eight men should be changed to one in four women, one in five men. We cannot find any other reason in men for fragility of the bone and susceptibility to fractures, so the only definitive diagnosis is osteoporosis,” says Dr. Olszynski.

&ltstong>Men suffer fractures
Moreover, Dr. Olszynski says many of the spinal deformities he finds are fractures men don’t even remember.

“They are working on the farm, for example, and they have a back pain. They consider this almost part of their life. They say-oh, I lifted something, I had back pain for two, three weeks, then everything was better, so I didn’t bother going to the doctor,” he says.

He and medical colleagues in centres across Canada are doing interviews, x-rays and ultra-sounds of almost 10 thousand Canadians for CaMos. The study began five years ago and has just been extended for another three years. The work is under the supervision of McGill University and Montreal General Hospital. Funding comes from the Medical Research Council of Canada and several drug companies.

Other centres for research include Halifax, Quebec City, Toronto, Saskatoon, Calgary, Edmonton and Vancouver. The multi-year study is providing an extensive database of information.

Hip fracture deaths
Dr. Olszynski says assessing a person’s risk for getting osteoporosis and prevention are critical health issues. Often, the disease is not recognized until the person falls and fragile bones, often the hip, fracture.

“A lot of people die within a year of hip fractures and the complications,” he says. And according to the Osteoporosis Society of Canada, men are more likely to die after a hip fracture than women.

Effective drug treatment
In some controlled clinical trials of men with osteoporosis, treatment with a class of drugs called bisphosphonates increased bone density. Dr. Olszynski has had similar results. 

“I’ve used all the biphosphonate medications for some time, and they work great. The main way they work is to slow down the bone turnover or re-absorption. We just don’t know why they work. The mechanism seems to be different in men than in women,” he says.

These drugs are also prescribed for women with osteoporosis.  For women, estrogen replacement hormones are sometimes prescribed as a prevention against osteoporosis. It has been suggested that a parallel prevention for men might be treatment with the male hormone testosterone.

Male hormone risk
“Men have a gradual drop in hormone levels as they grow older. Women have this drastic drop in a few years with menopause and no estrogen available. Of course this concept makes hormone replacement therapy for men very attractive-only it doesn’t work, ” says Dr. Olszynski.

According to the International Bone and Mineral Society, there are no studies demonstrating the testosterone replacement reduces the risk of bone fracture. Nor are there studies about the long-term safety of testosterone treatments.

“It is still under study. With testosterone, there is the potential of side effects with the prostate gland. We still debate that, and a lot of medical people say there is potential for problems,” says Dr. Olszynski.

“There is now a lot of controversy about how good hormone replacement therapy (HRT) really is for women. And we don’t know. It’s a problem. There is the extreme view that HRT may not be good for anything. This year, the Osteoporosis Society of Canada is finishing new guidelines for osteoporosis. So we will be delivering evidence based on more than 60 thousand medical papers. These guidelines will be evidence-based medicine recommendations,” he says. 

New guidelines coming
The Osteoporosis Society of Canada will meet at the beginning of December. The new recommendations on osteoporosis prevention and treatment are expected then.

In the meantime, the association recommends that men who think they are at risk of developing osteoporosis talk to their physicians. The society also offers a toll free number (1-800-463-6842) to find out about self-help groups in various parts of Canada.