Men
Not Getting Needed Osteoporosis Treatments
Even
though two million US males have the disease, and another 12 million
are at risk
The
gender gap is alive and well in the treatment of hip fractures, with
men
much less likely than women to receive treatment for osteoporosis after
such a fracture.
"It's
been known for the last couple of years that women were under-treated
for osteoporosis. We suspected that it was the same or worse for men,
and that's what we found," says Gary M. Kiebzak, lead author of an article
that appears in a recent issue of the Archives of Internal Medicine.
Osteoporosis
is a disease in which bone density decreases, making bones more fragile
and likely to break.
According
to the study authors, hip fractures are the most significant type of
osteoporosis-related fracture, accounting for more deaths as a result
of osteoporosis, more disability, and higher medical costs.
Today, two
million American men have osteoporosis, and another 12 million are at
risk for the disease, according to the National Osteoporosis
Foundation.
In
the United States, men account for some 20 percent to 30 percent of
all hip fractures, but no one had done a systematic study to see if
they are treated for osteoporosis after a fracture.
In
this study, the researchers looked at data from 363 patients (110 men
and 253 women) with an average age of about 80 who had been admitted
to St. Luke's Episcopal Hospital in Houston with what appeared to be
osteoporosis-related hip fractures. Questionnaires were mailed to surviving
patients to get information on what treatments, if any, they had been
given. There were 194 surveys returned.
Only
4.5 percent of the men reported receiving treatment for osteoporosis
upon discharge from the hospital, compared with 27 percent of the women.
And at one- and five-year follow-ups, only 27 percent of the men were
taking treatment for osteoporosis, compared with 71 percent of the women.
Of
the patients who were receiving treatment, 67 percent of men and 32
percent of women were taking calcium and vitamin D only. At the one-
and five-year follow-up marks, 11 percent of men had had their bone
mineral density measured, compared with 27 percent of women.
The
study authors found that, after discharge, there was an increase in
the number of both men and women who relied on wheelchairs and canes,
as well as a rise in the number of individuals living in institutions.
Treatment
Options For Men Are Different
"A
problem that we've had for men is that we have not had the range of
treatment choices that we have for women, " Kiebzak says. "You wouldn't
give a man estrogen, for example. About the only thing that was available
that was widely used was calcium and vitamin D."
More
aggressive medications such as phosphonates were not being given to
men. Nor were men even getting calcium or vitamin D in many cases, Kiebzak
says.
"There
was a general lack of appreciation for the problem of low bone density
in men," says Kiebzak, who is also chief research scientist for the
Center for Orthopedic Research and Education at St. Luke's Episcopal
Hospital and an associate professor of orthopedics at Baylor College
of Medicine in Houston.
One
of the reasons for the low profile of osteoporosis in men is that scientists
had lacked the ability to measure bone density until the early 1990s.
The problem was recognized in women largely because they had more fractures.
The
ability to measure bone density has also given scientists a good definition
of osteoporosis.
"We
used to define osteoporosis as the presence of a fragility fracture,
that is a fracture that's caused after a low-energy event," Keibzak
explains. In 1994, however, the World Health Organization
provided a definition based on bone density.
Physicians
no longer had to wait for a person to break a bone before starting treatment
for the disease.
"We
aren't necessarily saying that all these people with hip fractures should
immediately be put on treatment," Kiebzak says. "The point is that these
are people with an average age of 80 who have managed to go through
the healthcare system for all those years and not be treated for osteoporosis.
The time to treat somebody is well before they have that fracture."
Keeping
Bones Strong
The
National Osteoporosis Foundation offers these tips
to help ward off weakening of the bones:
-
Change
unhealthy habits, such as smoking, excessive alcohol consumption,
and inactivity.
-
Ensure
a daily calcium intake of 1,000 milligrams to age 50, and 1,200
milligrams after age 51.
-
Ensure
adequate vitamin D intake. Normally, the body produces enough vitamin
D from as little as 10 minutes of sun exposure a day. If exposure
to sunlight is inadequate, then vitamin D intake from supplements
should be at least 400 IU daily, but not more than 800 IU a day.
-
Engage
in a regular regimen of weight-bearing exercises, in which bones
and muscles work against gravity. These exercises include walking,
jogging, racquet sports, stair climbing, and team sports. Also,
lifting weights or using resistance machines appears to help preserve
bone density.
Always
consult your physician for more information.
Online
Resources
Archives
of Internal Medicine
National
Center for Chronic Disease Prevention and Health Promotion, part of
the Centers for Disease Control and Prevention (CDC)
National
Osteoporosis Foundation
Osteoporosis
and Related Bone Diseases National Resource Center, part of the National
Institutes of Health (NIH)
World
Health Organization
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November
2002
Men
Much Less Likely Than Women to Receive Treatment for Osteoporosis
Treatment
Options For Men Are Different
Keeping
Bones Strong
The
ABC's of a Bone Density Test
Online
Resources
Find
a St. John's Mercy Physician
The
ABC's of a Bone Density Test
What
to expect, how to interpret and when to repeat the screening for
osteoporosis
As
medical tests go, a bone mineral density test (BMD) is one of the
simplest.
There
is no pre-test fasting or other preparation. No poking or prodding
or needles involved. The technician records your weight and height,
and might ask you to remove clothing with zippers or metal parts,
such as your bra.
Then,
you simply lie flat and still on a table during the "gold standard"
bone density test, called a DEXA (dualenergy x-ray absorptiometry)
while a machine that uses small amounts of radiation passes overhead.
"The
test tells you how much bone mineral, the stuff that absorbs the
x-ray, is there," says Dr. Robert Heaney, professor of medicine
at Creighton University and a scientist at its Osteoporosis Research
Center. And it can give you a good idea of your risk for osteoporosis,
the "fragile bone" disease that can result in painful, costly fractures
of the hip, spine and other areas.
It
is all over in 10 minutes or less.
Then
comes the more difficult part: interpreting the results and figuring
out what to do next.
Your
results are compared with those of healthy young persons of your
gender and ethnicity at their peak bone mass, at age 30. And you
are also compared to persons of your gender and ethnicity in your
age bracket. The results may be expressed in a variety of ways:
as a percentile, as a percent or as a standard deviation.
Ask
for your results to be given to you in standard deviation form,
experts say.
"The
standard deviation result may be the most useful," says Lynn Chard-Petrinjak,
spokeswoman for the National Osteoporosis Foundation.
And probably the easiest for consumers to interpret.
The
World Health Organization has established categories
based on standard deviations of what is normal and what is not for
bone mineral density, she says, and the National Osteoporosis
Foundation and others use these categories. In medical
literature, when treatment is discussed, it is described for various
standard deviations, she adds.
The
result you should pay the closest attention to is how your bones
compare to those of a healthy young persons of your gender
and ethnicity.
Many
experts recommend forgetting about age-matched controls, because
many of them, especially if they are 50-plus, already have reduced
bone mass density. Your fracture risk is more relative when you
compare the quality of your bones to those of younger persons of
your own gender and ethnicity.
The
result compared to the younger group is often called the T-score;
the result compared to persons your own age is the Z-score.
So
what is normal and what is not so good? According to the World
Health Organization categories, widely accepted by other
experts, a normal bone density is within one standard deviation
(SD) of the young adult mean, which means plus 1 or minus 1 SD.
Low
bone mass is defined as 1 to 2.5 SD below the young adult, which
means an SD of minus 1 to minus 2.5.
Bone
density that is 2.5 SD or more below the young adult mean is defined
as osteoporosis. So a result of minus 2.5 SD or greater is osteoporosis.
If
you pass the test without evidence of bone mass loss, your physicians
may recommend repeating the test in four or five years, Uszler says,
depending on a variety of factors such as your age and other risk
factors. If your bone mass is not as good as it should be but you
have no evidence of osteoporosis, he/she may suggest a repeat test
in two years or so.
Always
consult your physician for more specific information relating to
bone density testing and your individual medical condition.
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