The following article is excerpted, with permission, from an Information Sheet distributed by Osteopo-rosis Canada. The information is not intended to replace medical advice. Readers are advised to discuss their individual circumstances with their physician.

Osteoporosis is often considered to be a woman's disease. Although it is more common in women, osteoporosis is a serious health issue for men. According to a Canadian study of healthy men and women, the number of broken bones (also known as fractures) of the spine is similar in men and women over the age of 50. With age, men experience multiple vertebral fractures. As with women, the cause appears to be osteoporosis. Elderly men account for almost 30 per cent of hip fracture cases. Men are more likely to die after a hip fracture than women. Fractures, or broken bones, in both men and women often lead to significant physical and emotional problems. If you have had a fracture, the chances of having another one increase greatly.

Osteoporosis is less common in men than in women for a number of reasons. Men have greater peak bone mass and do not experience the accelerated bone loss women do at menopause. As well, they generally do not live as long and are less likely to fall than elderly women.

Fracture Risk and Diagnosis

• Prior fracture with minimal trauma after age 40, especially vertebral compression fractures.
• Glucocorticoid use (such as prednisone and cortisone) for more than three months. Diseases that are often treated with glucocoricoid medications include rheumatoid arthritis, asthma, Crohn's disease, colitis, and obstructive pulmonary disease.
• Age greater than 65.

• Excess alcohol (consistently more than two drinks a day)
• Primary or secondary hypogonadism (low levels of male hormones). Hypogonadism puts a man at risk at any age.
• Smoking
• Family history of osteoporosis or fracture
• Low BMI (Body Mass Index)

Younger men may experience bone loss because of another health condition or as a side effect of a medication. Men who have these secondary causes for bone loss (see below) and other key risks for fracture should also have a bone mineral density test.

• Primary or secondary hyperparathyroidism
• Medical conditions that inhibit absorption of nutrients, such as celiac disease or inflammatory bowel disease.
• Rheumatoid arthritis
• Hyperthyroidism
• Malignancy (e.g. myeloma or bony metastasis)
• Hepatic insufficiency (liver functions below normal range)
• Chronic lung disease
• Hypercalciuria (elevated calcium level in the blood)
• Insufficient vitamin D

Treatment for Men with Osteoporosis

Men should follow the same lifestyle changes recommended to women with osteoporosis such as weight-bearing exercise and a diet rich in calcium and vitamin D. For men who have been diagnosed with osteoporosis and require medication, drugs called bisphosphonates are the primary treatment. These drugs reduce the rate of bone loss and help prevent fractures. Alendronate (Fosamax® or Fosavance®) and risedronate (Actonel® or Actonel® Plus Calcium) are the recommended bisphoso\phonates for the treatment of osteoporosis in men. Testosterone therapy improves bone mineral density (BMD) and may be particularly beneficial for men with low levels of male hormones (hypogonadism). Parathyroid hormone therapy (FORTEO®) has also been shown to improve BMD in men. This medication, injected daily for 18 months, works by increasing the amount of new bone built.

Calcium and Vitamin D

Men of all ages taking medication to treat osteoporosis should be sure to consume 1500 mgs of calcium and 800 IUs of vitamin D each day. For men over 50, these amounts are recommended to help reduce the risk of osteoporosis.

All men over 50 are urged to discuss their risk factors for osteoporosis with their physician and to go for a bone mineral density test if the assessment indicates they are at risk. Osteoporosis Canada recommends bone mineral density testing for men aged 65 and older. If you would like more information, Osteoporosis Canada has a fact sheet called Diagnosis that discusses risk factors and bone mineral densitometry. Contact Osteoporosis Canada by telephoning 1-800-463-6842 or 416-696-2663 or by visiting www.osteoporosis.ca.