YOUR FAMILY AND BONE DENSITY: MEN AND BONE DENSITY
Osteoporosis has been thought of as a woman’s disease. National statistics show that 5 million men in this country have osteoporosis— and 20 million women. Less conservative ways of looking at it still indicate that men are only half as likely to get osteoporosis as women. Of the whopping annual bill for all the health care costs racked up by low bone density patients, about 20 percent is for men.
The medical community is twenty years behind in evaluating men for bone density, just as it is only in the last twenty years that women have begun to be screened, diagnosed, and counseled on prevention (though many people can remember similar symptoms for generations back in their own families). As more men are screened, more will be diagnosed, and the total number of people with osteoporosis will be higher, as will the proportion of male patients.
Even before men will be in the unenviable position of having “caught up” to women, don’t make the mistake of taking the “more women than men” outlook to mean that small numbers of men are affected. Best estimates are that between 4 and 9 million American men have low bone density. Bone loss severe enough to have health consequences plagues half of men over 75. Under 65, more women than men are affected—though surely not by as wide a margin as official numbers dictate, since we don’t really screen men for low bone density. After age 65, the rates equalize.
Men take longer to show the symptoms of extremely low bone density, but once they do, they fare even worse than women in similar circumstances. For example, one study showed that half of men who break a hip leave the hospital only to go to a nursing home—and the vast majority of them are still there a year later. Far fewer than half ever regain the full level of ability they had before the fracture.
Men have heavier body frames than women, generally weigh more and have more muscle mass, and tend to be more physically active, so they build up more bone density to begin with (about 30 percent more, according to best estimates). Their diets are higher in calories on average, so they are more likely to get enough calcium. Hormones play an important role in all bone growth, and for men it is their dominant sex hormone—testosterone—that promotes healthy bones. Testosterone levels in men do drop as they age, but not as early or as steeply as estrogen does in women. For men, bone loss doesn’t accelerate until ten years or more after it does for women, and then proceeds at a slower rate, around 1 percent a year. Men also don’t live as long as women, so they just plain don’t have as much time to add up bone losses—on average. In all, men lose just two-thirds the amount of bone women do. But that is still more than enough to lead to serious trouble.
Men share all the same risks as women, and I don’t want to see any more men have the first sign of any trouble with their bone density be a life-threatening hip fracture. Any men with significant risk factors as outlined in the upcoming chapters—and all men over 65—need to be every bit as concerned as women already are. The bone density diet will be good for any skeleton, male or female, and men should follow all the same guidelines as women. The one exception: for much of their lives, men’s calcium requirement is slightly different (lower) than women’s. They should get 1,000 mg a day after 25 and before 65. After that, men and women are even in calcium needs as well as low bone density risk, and should increase their intake to 1,500 mg a day. During the time everyone is building up bone mass to peak levels (before age 25), the recommendations for males and females are also the same.
Culturally, we just haven’t considered bone density to be something that concerns men. Doctors don’t ask men about it or talk to them about prevention; women talk among themselves about taking calcium and lifting weights, but don’t discuss osteoporosis with the men in their lives; health-savvy adult children broach the topic with their aging mothers but not their fathers; men don’t have the awareness they need to avoid this completely preventable condition. It is past time we all did.
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