{"id":8315,"date":"2025-12-23T08:44:52","date_gmt":"2025-12-23T13:44:52","guid":{"rendered":"https:\/\/www.silvercentury.org\/?p=8315"},"modified":"2025-12-23T08:44:52","modified_gmt":"2025-12-23T13:44:52","slug":"why-brittle-bones-arent-just-a-womans-problem","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2025\/12\/why-brittle-bones-arent-just-a-womans-problem\/","title":{"rendered":"Why Brittle Bones Aren\u2019t Just a Woman\u2019s Problem"},"content":{"rendered":"

Women are more likely to develop osteoporosis than men are, but that doesn\u2019t mean men are in the clear. As journalist Pamela Span explains in this article, it does mean that they\u2019re seldom screened for the disease or treated for it in time to make a difference. <\/span><\/i>KFF Health News<\/span><\/a> posted Span\u2019s piece on October 14, 2025; it also ran in the <\/span><\/i>New York Times<\/a>.<\/span> Funding from the Silver Century Foundation helps <\/span><\/i>KFF Health News<\/span> produce articles (like this one) on longevity and related health and social issues.<\/span><\/i> <\/span><\/p>\n

Ronald Klein was biking around his neighborhood in North Wales, PA, in 2006 and tried to jump a curb. \u201cBut I was going too slow\u2014I didn\u2019t have enough momentum,\u201d he recalled.<\/span><\/p>\n

As the bike toppled, he thrust out his left arm to break the fall. It didn\u2019t seem like a serious accident, yet \u201cI couldn\u2019t get up,\u201d he said.<\/span><\/p>\n

At the emergency room, X-rays showed that he had fractured both his hip, which required surgical repair, and his shoulder. Klein, a dentist, went back to work in three weeks, using a cane. After about six months and plenty of physical therapy, he felt fine.<\/span><\/p>\n

But he wondered about the damage the fall had caused. \u201cA 52-year-old is not supposed to break a hip and a shoulder,\u201d he said. At a follow-up visit with his orthopedist, \u201cI said, \u2018Maybe I should have a bone density scan.\u2019\u201d<\/span><\/p>\n

As Klein suspected, the test showed he had developed osteoporosis, a progressive condition, increasing sharply with age, that thins and weakens bones and can lead to serious fractures. Klein immediately began a drug regimen and, now 70, remains on one.<\/span><\/p>\n

Osteoporosis occurs so much more commonly in women, for whom medical guidelines recommend <\/span>universal screening after age 65<\/a>, <\/span> that a man who was not a health care professional might not have thought about getting a scan. The orthopedist didn\u2019t raise the prospect.<\/span><\/p>\n

But about <\/span>one in five men<\/span> over age 50 will suffer an osteoporotic fracture in their remaining years, and among older adults, about <\/span>a quarter of hip fractures occur in men<\/a>.<\/span> <\/span><\/p>\n

When they do, \u201cmen have worse outcomes,\u201d said Cathleen Col\u00f3n-Emeric, MD, a geriatrician at the Durham VA Health Care System and Duke University and the lead author of a recent study of osteoporosis treatment in male veterans.<\/span><\/p>\n

\u201cMen don\u2019t do as well in recovery as women,\u201d she said, with <\/span>higher rates of death<\/span><\/a> (25 to 30 percent within a year), disability and institutionalization. \u201cA 50-year-old man is more likely to die from the complications of a major osteoporotic fracture than from prostate cancer,\u201d she said.<\/span><\/p>\n

(What\u2019s \u201cmajor\u201d? Fractures of the wrist, hip, femur, humerus, pelvis or vertebra.)<\/span><\/p>\n

Should some (or all) older men be screened for osteoporosis, as women are? <\/b><\/p><\/blockquote>\n

In her <\/span>study of 3,000 veterans<\/span><\/a> ages 65 to 85, conducted at Veterans Affairs health centers in North Carolina and Virginia, only 2 percent of those assigned to the control group had undergone bone-density screening.<\/span><\/p>\n

\u201cShockingly low,\u201d said Douglas Bauer, MD, a clinical epidemiologist and osteoporosis researcher at the University of California-San Francisco, who published an accompanying <\/span>commentary<\/span><\/a> in <\/span>JAMA Internal Medicine<\/span><\/i>. \u201cAbysmal. And that\u2019s at the VA, where it\u2019s paid for by the government.\u201d<\/span><\/p>\n

But establishing a bone health service\u2014overseen by a nurse who entered orders, sent frequent appointment reminders and explained results\u2014led to dramatic changes in the intervention group, who had at least one risk factor for the condition.<\/span><\/p>\n

Forty-nine percent of them said yes to a scan. Half of those tested had osteoporosis or a forerunner condition, osteopenia. Where appropriate, most of them began medications to preserve or rebuild their bones.<\/span><\/p>\n

\u201cWe were pleasantly surprised that so many agreed to be screened and were willing to initiate treatment,\u201d Col\u00f3n-Emeric said.<\/span><\/p>\n

After 18 months, bone density had increased modestly for those in the intervention group, who were more likely to stick to their drug regimens than osteoporosis patients of either sex in real-world conditions.<\/span><\/p>\n

The study didn\u2019t continue long enough to determine whether bone density increased further or fractures declined, but the researchers plan a secondary analysis to track that.<\/span><\/p>\n

The results revive a longtime question: given how life-altering, even deadly, such fractures can be, and the availability of effective drugs to slow or reverse bone loss, should older men be screened for osteoporosis, as women are? If so, which men and when?<\/span><\/p>\n

Men would like to believe they\u2019re indestructible, so a fracture doesn\u2019t have the implication that it should. <\/b><\/p>\n

\u2014Eric Orwoll, MD<\/b><\/p><\/blockquote>\n

Such issues mattered less when lifespans were shorter, Bauer explained. Men have bigger and thicker bones and tend to develop osteoporosis five to 10 years later than women do. \u201cUntil recently, those men died of heart disease and smoking\u201d before osteoporosis could harm them, he said.<\/span><\/p>\n

\u201cNow, men routinely live into their 70s and 80s, so they have fractures,\u201d he added. By then, they have also accumulated other chronic conditions that impair their ability to recover.<\/span><\/p>\n

With osteoporosis testing and treatment, \u201ca man could see a clear-cut improvement in mortality and, more importantly, his quality of life,\u201d Bauer said.<\/span><\/p>\n

Both patients and many doctors still tend to regard osteoporosis as a women\u2019s disease, however. \u201cThere\u2019s a bit of a Superman idea,\u201d said Eric Orwoll, MD, an endocrinologist and osteoporosis researcher at Oregon Health & Science University.<\/span><\/p>\n

\u201cMen would like to believe they\u2019re indestructible, so a fracture doesn\u2019t have the implication that it should,\u201d he added.<\/span><\/p>\n

One patient, for example, for years resisted entreaties from his wife, a nurse, to \u201csee someone\u201d about his visibly rounded upper back.<\/span><\/p>\n

Bob Grossman, 74, a retired public school teacher in Portland, blamed poor posture instead and told himself to straighten up. \u201cI thought, \u2018It can\u2019t be osteoporosis\u2014I\u2019m a guy,\u2019\u201d he said. But it was.<\/span><\/p>\n

Another obstacle to screening: \u201cClinical practice guidelines are all over the place,\u201d Col\u00f3n-Emeric said.<\/span><\/p>\n

Professional associations like the Endocrine Society and the American Society for Bone and Mineral Research recommend that men 50 and older who have a risk factor, and all men over 70, should seek screening. <\/span><\/p>\n

As osteoporosis develops, it typically produces no symptoms, so without screening, men don\u2019t know their bones have deteriorated until one breaks. <\/b><\/p><\/blockquote>\n

But the <\/span>American College of Physicians<\/span><\/a> and the <\/span>U.S. Preventive Services Task Force<\/span><\/a> have deemed the evidence for screening of men \u201cinsufficient.\u201d Clinical trials have found that osteoporosis <\/span>drugs increase bone density in men<\/a>,<\/span> as in women, but most male studies have been too small or lacked enough follow-up to show whether fractures also declined.<\/span><\/p>\n

The task force\u2019s position means that Medicare and many private insurers generally won\u2019t cover screening for men who haven\u2019t had a fracture, though they will cover care for men diagnosed with osteoporosis.<\/span><\/p>\n

\u201cThings have been stalled for decades,\u201d Orwoll said.<\/span><\/p>\n

So it may fall to older men themselves to ask their doctors about a DXA (pronounced DECKS-ah) scan, widely available at $100 to $300 out-of-pocket. Otherwise, because osteoporosis is typically asymptomatic, men (and women, who are also undertested and undertreated) don\u2019t know their bones have deteriorated until one breaks.<\/span><\/p>\n

\u201cIf you had a fracture after age 50, you should have a bone scan\u2014that\u2019s one of the key indicators,\u201d Orwoll advised.<\/span><\/p>\n

Other risk factors: falls, a family history of hip fractures, and a fairly long list of other health conditions including rheumatoid arthritis, hyperthyroidism and Parkinson\u2019s disease. Smoking and excessive alcohol use increase the odds of osteoporosis as well.<\/span><\/p>\n

\u201cA number of medications also do a number on your bone density,\u201d Col\u00f3n-Emeric added, notably steroids and prostate cancer drugs.<\/span><\/p>\n

When a scan reveals osteoporosis, depending on its severity, doctors may prescribe oral medications like Fosamax or Actonel, intravenous formulations like Reclast, daily self-injections of Forteo or Tymlos, or twice-annual injections of Prolia.<\/span><\/p>\n

Lifestyle changes like exercising, taking calcium and vitamin D supplements, stopping smoking, and drinking only moderately will help but aren\u2019t sufficient to stop or reverse bone loss, Col\u00f3n-Emeric said.<\/span><\/p>\n

Although guidelines don\u2019t universally recommend it, at least not yet, she would like to see all men age 70 and up be screened, because the odds of disability after hip fractures are so high\u2014two-thirds of older people will not regain their prior mobility, she noted\u2014and the medications that treat it are effective and often inexpensive.<\/span><\/p>\n

But <\/span>informing patients and health care professionals<\/span><\/a> that osteoporosis threatens men too has progressed \u201cat a snail\u2019s pace,\u201d Orwoll said.<\/span><\/p>\n

Klein remembers attending a seminar to instruct patients like him in using the drug Forteo. \u201cI was the only male there,\u201d he said.<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Women are more likely to develop osteoporosis than men are, but that doesn\u2019t mean men are in the clear. As journalist Pamela Span explains in this article, it does mean that they\u2019re seldom screened for the disease or treated for…<\/span><\/p>\n

Read more Why Brittle Bones Aren\u2019t Just a Woman\u2019s Problem<\/span> ›<\/span><\/a><\/div>\n

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