OSTEOPOROSIS IN MEN OFTEN NEGLECTED

One-third of all hip fractures occur in men, with mortality of 37% in the year following fracture, says a new report highlighting the lesser-known issue of osteoporosis in men as opposed to women.

The new publication, from the International Osteoporosis Foundation (IOF), entitled "Osteoporosis in men: Why change needs to happen," highlights the fact that the ability of men to have independent pain-free lives into old age is being seriously compromised by osteoporosis.

"Men are currently not being adequately treated for osteoporosis," author Peter Ebeling, MD, professor of medicine, University of Monash, Victoria, Australia, and president of the Endocrine Society of Australia, told Medscape Medical News. "In fact, 1 in 5 men over the age of 50 years will sustain a fracture due to osteoporosis in their lifetime."

Dr. Ebeling explained that fracture rates are increasing rapidly in men as they live longer and become more urbanized in lifestyle and that by 2050 the number of men aged 60 years or over will increase 10-fold.

"In the US, while hip fractures in men will increase by 51.8% from 2010 to 2030, they will decrease by 3.5% in women. This means the message about osteoporosis awareness is not getting through to men."

Reinforcing the message, he noted also that deaths after all fractures were higher in men than in women, and while this excess in mortality is greatest in the first 5 years after a fracture, it is still increased 10 years afterward.

"It is most dramatic in the first 12 months after a hip fracture, when the mortality rate is up to 37% in men compared with about 20% in women," he emphasized. "Men are definitely the weaker sex when it comes to fractures."

Lifetime Risk for Osteoporosis in Men Higher than Prostate Cancer

The report was compiled from a literature review and from information sourced from 2 previous documents of the Eastern European and Central Asian Regional Audit in 2011 and the Asia-Pacific Regional Audit of osteoporosis from 2013. Dr. Ebeling was coauthor of these audits.

In his foreword to the report, Dr. Ebeling writes that osteoporosis is "a disease that for far too long has been considered to be exclusively a problem for women. While improving management of osteoporosis for women is critical, the time has now come for a radical reappraisal of osteoporosis management in men."

Healthcare services must face the challenge of revising care for men who are at high risk of fragility fractures, he said, pointing out that bone health in men is simply being ignored by many.

For example, one study from the US has shown that men were 50% less likely to receive treatment than women (J Bone Miner Res. 2014;29:1929-1937).

"Change needs to happen, and it needs to be led by both governments and patients themselves. Importantly, men who have already sustained a fragility fracture need to be identified and treated to prevent further fractures," he told Medscape Medical News.

Dr. Ebeling emphasized that fracture liaison services represent an opportunity to do this on a global scale and noted that this is reflected in an important IOF initiative, the "Capture the Fracture" program, designed to support fracture liaison services internationally.

Echoing Dr. Ebeling's comments, John A. Kanis, MD, president of the IOF and emeritus professor in human metabolism at the University of Sheffield, United Kingdom, remarked that the lifetime risk of experiencing an osteoporotic fracture in men over the age of 50 years is up to 27%, higher than the risk of developing prostate cancer.

"Yet an inadequate amount of healthcare resources are being invested in bone, muscle, and joint diseases. People should not have to live with the pain and suffering caused by osteoporosis, as we can help prevent and control the disease," he stressed in an IOF statement.

Osteoporosis and Fracture in Men

Bone mass throughout the life cycle [Source: International Osteoporosis Foundation] For a larger image, click here

In men there is a gradual reduction in testosterone and estradiol with aging, in contrast to the more rapid decline in sex hormones at menopause that occurs in women, explained Dr. Ebeling.

"When sex hormones fall in men after the age of 70 years, there is increased bone breakdown and a decrease in bone density," he observed.

He added that other important factors contribute to osteoporosis in men, including smoking, drinking more than 2 standard drinks of alcohol per day, low vitamin D levels, a family history of osteoporosis, and the use of some medications, including androgen-deprivation therapy for prostate cancer, glucocorticoids (cortisone), antiepileptic drugs, and selective serotonin-reuptake inhibitors (SSRIs) for depression.

As to why men appear to have a greater risk of mortality after fracture, the reasons are less clear, he said.

But rates of infections and cardiovascular events, which are increased following some fractures, may play a role, and minimal trauma fractures may also be a marker of general frailty in men, he concluded.

The report, published online October 9, 2014 is produced by the International Osteoporosis Foundation.

Dr. Ebeling has declared that he has received research funding from Amgen, Merck, Novartis, Eli Lilly, and GlaxoSmithKline and honoraria from Amgen. Dr. Kanis has acted as an occasional advisor to AgNovos, Amgen, D3A, Lilly, Medimaps, Unigene, Taylor Wessing, and Radius Health and has received speaker's fees from Amgen, Pfizer Japan, and Servier and research support from Asahi, Amgen, Eli Lilly, Medtronic, Novartis, Pfizer, Sanofi, Servier, and Warner-Chilcott. 

Ebeling P. Osteoporosis in men: Why change needs to happen. Nyon, Switzerland: International Osteoporosis Foundation, 2014.  Report