Many people believe osteoporosis is a women-only disease. But this is not true: 20 to 30 percent of those affected with osteoporotic fractures are men. Scientists believe that: The incidence of osteoporosis in men will continue to rise in the future due to increasing life expectancy and lifestyle changes. Learn what you should know about osteoporosis in men here.
Where does osteoporosis in men come from?
It is likely that the factors that can lead to osteoporosis in men are little different from those that also cause osteoporosis in women. Osteoporosis is a chronic bone disease in which the balance between consistently occurring bone formation and breakdown processes is disturbed. As a result, the density of the bones decreases – they become brittle and porous, and the risk of bone fractures increases. A distinction can be made between two different forms of osteoporosis, which can occur in both men and women.
Primary osteoporosis in men
Primary osteoporosis, which includes senile osteoporosis, often occurs at older ages. For one thing, the likelihood of a disturbed balance in the buildup and breakdown of bone mass increases during this phase of life. On the other hand, hormone levels decrease with increasing age. However, estrogen and testosterone are of central importance for the absorption of calcium into the bones and thus for their stabilization. Since hormone levels often fall more sharply in women during menopause than in men at an older age, they are significantly more likely to be affected by primary osteoporosis. Thus, approximately 80 to 90 percent of all women with osteoporosis have a primary form. In men, the figure is only 40 percent. 60 percent of men are thus affected by so-called secondary osteoporosis.
Secondary osteoporosis in men
Secondary osteoporosis can develop as a result of existing pre-existing conditions or long-term use of medications. Conditions commonly associated with osteoporosis include:
- Chronic inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis.
- Chronic kidney disease
- Hyperparathyroidism
- Parkinson’s disease
In addition, therapies with drugs such as cortisone and antiepileptic drugs or chemotherapy can be causes of osteoporosis. Other risk factors that promote osteoporosis in men and women are:
- Being underweight (body mass index less than 19) or unintentionally losing more than 10 percent of your original body weight
- Disturbances of food absorption in the digestive tract (malabsorption syndrome: past gastric emptying, sprue).
- Alcoholism
- Hyperthyroidism of the parathyroid or thyroid gland.
- Familial predisposition (relatives with osteoporosis, hunchback, forearm, vertebral body or femoral neck fracture).
- Inflammatory rheumatic diseases
- Calcium or vitamin D deficiency, for example due to increased calcium excretion (hypercalcuria).
- Heavy smoking (more than 20 cigarettes a day).
- Lack of exercise, especially when bedridden or physically disabled.
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Symptoms of osteoporosis
Because osteoporosis is still increasingly seen as a “women’s disease”, men are often diagnosed particularly late. However, early diagnosis of the disease is crucial to counteract long-term consequences as much as possible. The following symptoms may indicate the presence of osteoporosis:
- Frequent falling or falling (two or more times within six months).
- Past or current fractures that occurred from minor causes.
- Suspicion of vertebral body fracture, for example, because of acutely occurred persistent severe back pain or a loss of height of more than 4 cm and formation of a hunchback (“widow’s hump”)
- Wobbling or falling out teeth
Hormone deficiency in men
The hormone testosterone plays a special role in the development of osteoporosis in men. It promotes natural muscle and bone formation and helps to keep the skeletal system resilient. If men do not have enough testosterone, bone loss (osteoporosis) occurs within a few weeks. In contrast to women, menopause does not occur in men.Nevertheless, men over the age of about 40 may also experience lower production of sex hormones and thus a deficiency of testosterone. This hormone is produced in the testicles. In addition to age, damage to the testicles, for example, as can occur after viral diseases (for example, mumps), are therefore causative factors in men. Testosterone deficiency also occurs if the testicles had to be removed due to a disease such as prostate cancer. In addition, a disorder of the pituitary gland (hypophysis), which controls hormone production in the body, can trigger a testosterone deficiency. A hormone deficiency in men manifests itself, for example, through the following symptoms:
- Erectile dysfunction or fewer nocturnal erections.
- Weaker sexual desire
- Decreasing body hair, less beard growth
- Decreased sperm production
- Sleep disturbances, listlessness, mood swings.
- Decreasing muscle mass and increasing abdominal fat
Diagnosis: osteoporosis clarification in men.
As in women, a careful risk assessment and cause clarification must also be carried out in men if osteoporosis is suspected. In addition to a physical examination, in which, for example, mobility and body size are determined, this also includes an anamnesis interview. During this interview, the physician asks about the use of certain medications or the occurrence of osteoporosis in the family. If osteoporosis is suspected, a bone density measurement (osteodensitometry) is then usually performed. This is used to determine the bone mineral content and compare it with the values of a healthy person. If necessary, the testosterone level in the blood of men is also determined. In rare cases, a bone sample (biopsy) is also useful in men. However, this is mainly performed in the case of atypical progression of osteoporosis, for example, in the absence of successful therapy or in the case of osteoporosis in young men.
Osteoporosis in men: therapy
As “basic therapy” of osteoporosis, sufficient administration of calcium and vitamin D as well as muscle-building training and fall prophylaxis are indispensable, in addition to hormone-replacing or bone-stabilizing drugs. In contrast to postmenopausal osteoporosis (i.e. osteoporosis in women caused by menopause), for which a large number of drugs are approved, only the highly effective, bone-stabilizing bisphosphonates alendronate, risedronate and zoledronate are available for the treatment of osteoporosis in men. Therapy with analgesics as well as physiotherapy or physical therapy (including massage and heat treatment) may be used in addition.
Correct testosterone deficiency – treat osteoporosis.
If testosterone deficiency is involved in the development of osteoporosis, sex hormone-replacing therapy may be considered (in addition). Treatment with medications that increase testosterone must be discussed in detail by the physician with the affected person and, if necessary, with his or her life partner. A 2017 U.S. study convincingly demonstrated that bone density in older men increased significantly after one year of treatment with a gel containing testosterone. However, the study participants were not affected by osteoporosis. Whether this effect also occurs in the case of already existing osteoporosis has not yet been adequately proven. However, scientific studies have shown that the bisphosphonate alendronate is also effective in men in whom a testosterone deficiency was involved in the development of osteoporosis. With alendronate, the duration of treatment is usually two to three years.
