Ask the Pharmacist

Q: I slipped on the ice yesterday, fell, and wound up, surprisingly, with a broken bone. Can men have osteoporosis too?

A: Osteoporosis has long been thought of as a “female disease” and is, therefore, often ignored in males until things take a dramatic turn for the worse.

The fact is while women are predominantly affected, the disease is very common in both sexes with an estimated incidence of 10 per cent in the general population of those aged 40 or above. This equates to approximately 1.5-million Canadians aged 40 and over who are at risk of a life-altering fracture due to the fragility of their bones.

Females are four times more likely to report osteoporosis than males, but these numbers may be heavily skewed by the fact that so few men bother to get their bone densities checked and are, therefore, potentially walking around at risk and undiagnosed. As well, the numbers may be starting to balance out a little as men are now living longer and their life expectancy is increasing faster than women, meaning that men will be living long enough to fracture.

Experts currently estimate that one in five men over the age of 50, will experience an osteoporotic fracture during their lifetime and, at present, almost 30 per cent of hip fracture occur in males. There’s also evidence that men deal less well with fractures than their female counterparts do. While men experience about half as many fractures as women do, they are more likely to be permanently disabled by a hip fracture and more than twice as likely to die within a year.

Some specialists now recommend that any man over the age of 70, have a bone density test, and if they have other risk factors for osteoporosis, they should be checked perhaps as soon as the age of 50.

Common risk factors for a fracture are similar for both sexes. These include: advanced age (over 60 for women and over 70 for men); being thin or underweight; being a smoker; consuming more than three alcoholic beverages per day; a family history of osteoporosis; or having suffered a previous fracture. As well, there are a bunch of health conditions that can increase either sex’s risk of suffering from osteoporosis, including rheumatoid arthritis; mobility disorders such as Parkinson’s; multiple sclerosis; a history of stroke; celiac disease and COPD.

Some medications can also thin one’s bones when used long-term, including glucocorticoids such as prednisone; drugs for prostate cancer; drugs used to reduce stomach acid; antidepressants; some anti-seizure drugs; a number of cancer treatments; and immunosuppressants such as cyclosporine.

At especially high risk, are people on prolonged glucocorticoids (such as those taking prednisone at a dose of 7.5 milligrams per day or more for three months or longer) or those who were treated for prostate cancer with androgen deprivation therapy, and there are strong feelings that they should be put on osteoporosis drugs as a preventative measure.

One alarming statistic shows that by five years of antiandrogen prostate treatment, almost 20 per cent of white males (and 15 per cent of African-Americans) will suffer an osteoporotic fracture. Like risk factors, treatment is similar for both males and females.

Lifestyle choices that can help, include regular weight-bearing and resistance exercises, adequate consumption of calcium (1,200 milligrams per day for men over age 70, preferably through diet as supplements may contain some degree of cardiovascular risk especially when taken in large amounts) and adequate Vitamin D (800-2,000 International Units or IU per day, more than likely through pills as natural sources are few and far between, especially in the winter).

Drug treatment options include the tablets known as the biphosphonates (alendronate/Fosamax, risedronate/Actonel) which are generally taken for a period of five years , followed by a one- to two-year break at which point the bones are rechecked to see if continued treatment is warranted. As well, the twice yearly monoclonal antibody known as Prolia can be given as an injection and seems to work at least as well as the biphosphonates and might be more useful than those in men who are at risk due to prostate cancer treatments.

Another drug that doesn’t seem to be used as much as the others but may be very effective, is Forteo which is a manmade form of the parathyroid hormone. Forteo is the only osteoporotic medication that stimulates bone growth (all of the others slow down bone loss) and might be of particular use to those who suffered a fracture while already taking a bisphosphonate or whose osteoporosis is related to glucocorticoid therapy.

A final option to look at, is testosterone replacement therapy. This should only be considered in those whose blood levels have been proven to be low and also have other associated symptoms (such as a low libido), and only in combination with one of the other previously-mentioned therapies. This is because while testosterone does increase bone density, there is no evidence to support that it reduces the risk of a fracture.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts