Men are not immune to osteoporosis Health: Bone loss is not a "woman's disease." Twenty percent of older men will suffer its consequences.

September 10, 1996|By Jane E. Brody | Jane E. Brody,NEW YORK TIMES NEWS SERVICE

Men may be justified, though incorrect, in thinking that they are invulnerable to osteoporosis.

This bone-wasting disease occurs slowly and silently and has been labeled "a woman's disease" because women are far more vulnerable to it and the fractures it causes. Half of all women develop it, and one woman in two over the age of 65 suffers one or more bone fractures because of it.

But men get osteoporosis, too, and 20 percent of American men will suffer at least one fracture because their bones have become too thin and weak to withstand the normal stresses of life.

A simple fall that in boyhood resulted in a scraped elbow or knee can mean a fractured wrist or hip for an older man. Hip fractures are serious; one-third of men who break their hips die within a year from complications of the fracture or its treatment. And because grown men rarely have their height checked, many are unaware of the inches they lose with age, the consequence of vertebral fractures caused by osteoporosis.

Sometimes these spinal fractures are all too apparent, causing severe back pain and a bent posture. Even then, many men wait for the discomfort to subside and ignore the developing spinal deformity. However, osteoporosis in men and women can nearly always be prevented. If the condition is detected early, treatment can prevent significant bone loss and fractures.

Who Is at Risk?

One and a half million men in this country already have osteoporosis, and 3.5 million more are at high risk of developing it. The most common risk factor is age. Bones in men and women continue to become more dense until about the age of 30, then gradually thin out.

In women, particularly those who do not take replacement estrogen, bone loss accelerates dramatically within the first five years or so after the onset of menopause. Since women usually start out with thinner bones than men, this loss puts them at great risk of fractures as they age. Men do not experience a sudden dramatic decline in bone mass, but their more gradual losses add up.

A low level of the male sex hormone testosterone, which is common in older men, fosters bone loss. Testosterone is converted to estrogen in the body and, as in women, estrogen is crucial to bone strength in men. Men are especially at risk if they have testosterone levels that are low enough to result in &L impotence and absence of nocturnal erections.

Chronic diseases that affect the kidneys, lungs, stomach or intestines or that alter testosterone levels also place men at a greater than average risk of osteoporosis.

But the most prevalent risk factors involve men's smoking and drinking habits, exercise patterns and diet. In a 16-year study of osteoporosis in men, Dr. Charles W. Slemenda and his colleagues at the Indiana University School of Medicine in Indianapolis found that smoking and drinking outweighed heredity as risk factors for osteoporosis. Their study of 111 men, including 48 pairs of twins, found that the more the men smoked, and the more alcohol they consumed, the greater their rate of bone loss was as they got older.

Most of the men in the Indiana study were so sedentary that it was not possible to make a full assessment of the benefits of physical activity. But the researchers could discern a trend indicating that vigorous activity slowed the rate of bone loss. Studies in women have demonstrated that exercising the body's long muscles -- in the arms, legs and torso -- against gravity can actually build new bone, even late in life.

As for diet, both men and women usually consume inadequate amounts of calcium and of vitamin D, which the body needs to absorb and use calcium.

As with women, heredity plays a role in the susceptibility of men to osteoporosis. Men with blood relatives who have developed osteoporosis and had osteoporotic fractures are at greater risk than those with relatives who aged without significant bone loss.

Prevention and treatment

While there is nothing a man can do about three common risk factors for osteoporosis -- age, heredity and being Caucasian -- habits that promote bone loss can certainly be modified. That means quitting smoking and limiting alcohol intake to one or two drinks a day, the amount believed to protect the heart. Regular exercise to build fitness and strength, through aerobic workouts and lifting weights or using resistance machines, is also important in preventing the disease.

But to stay strong, bones need the proper raw materials, primarily calcium and vitamin D: 1,000 milligrams a day of calcium before 65 and 1,500 milligrams after 65, and 400 international units a day of vitamin D. The best, and best-absorbed, sources of these nutrients are low-fat and nonfat dairy products, the daily equivalent of four 8-ounce glasses of skim milk or milk with 1 percent fat.

Other good sources include sardines and canned salmon (be sure to eat the bones) and some dark-green leafy vegetables, especially collard greens.

Pub Date: 9/10/96

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