Osteoporosis in Men Causes, Symptoms, and Treatment Options

Many people believe that osteoporosis is only a female disease. But that’s not true: 20 to 30 per cent of those affected with osteoporotic fractures are men. Scientists assume that the frequency of osteoporosis in men will continue to rise in the future due to increasing life expectancy and lifestyle changes. Find out here what you should know about osteoporosis in men.

Where does osteoporosis in men come from?

The factors that can lead to osteoporosis in men hardly differ from those that trigger osteoporosis in women.

Osteoporosis is a chronic bone disease in which the balance between the constantly occurring bone formation and breakdown processes is disturbed. As a result, the density of the bones decreases – they become brittle and porous, and the risk of fractures increases.

A distinction can be made between two different forms of osteoporosis, which can occur in both men and women.

 

Primary osteoporosis in men

Primary osteoporosis, including senile osteoporosis, often occurs in old age. On the one hand, the probability of an imbalance in the formation and breakdown of bone mass increases in this phase of life. On the other hand, hormone levels decrease with age. However, estrogen and testosterone are of central importance for calcium absorption into the bones and, thus, for their stabilization. Since hormone levels in women often fall more sharply during menopause than in men at an older age, they are much more likely to be affected by primary osteoporosis.

Around 80 to 90 per cent of all women with osteoporosis have a primary form. For men, it is only 40 per cent. Sixty per cent of men are affected by what is known as secondary osteoporosis.

Secondary osteoporosis in men

Secondary osteoporosis can arise due to existing previous illnesses or the long-term use of medication. Conditions commonly associated with osteoporosis include:

• chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
• chronic kidney disease
• Overactive parathyroid gland
• Parkinson

In addition, therapies with drugs such as cortisone and antiepileptic drugs or chemotherapy can be causes of osteoporosis.

Other risk factors that favour osteoporosis in men and women are:

• Underweight (body mass index less than 19) or unintentional loss of more than 10 per cent of the original body weight
• Disorders of food absorption in the digestive tract (malabsorption syndrome: past gastric removal, sprue )
• alcoholism
• Overactive parathyroid or thyroid
• family predisposition (relatives with osteoporosis, hunchback, forearm, vertebral body or femoral neck fracture)
• inflammatory rheumatic diseases
• Calcium or vitamin D deficiency, for example, due to increased calcium excretion (hypercalciuria)
• heavy smoking (more than 20 cigarettes daily)
• Lack of exercise, especially if you are bedridden or have a physical disability

Symptoms of Osteoporosis

Since osteoporosis is still increasingly viewed as a “women’s disease”, it is often diagnosed late in men. However, early diagnosis of the disease is crucial to counteract long-term consequences as far as possible.

The following symptoms can indicate an existing osteoporosis:

• Frequent falling or falls (two or more times within six months).
• Past or current bone fractures that occurred for minor reasons
• Suspicion of a vertebral fracture, for example, due to acute, persistent severe back pain or a height loss of more than 4 cm and the formation of a hunchback (“widow’s hump”)
• loose or falling teeth

hormone deficiency in men

The hormone testosterone plays a unique role in the development of osteoporosis in men. It promotes the natural development of muscles and bones and helps keep the skeletal system resilient. If the man lacks enough testosterone, bone loss (osteoporosis) occurs within a few weeks.

Unlike women, men do not experience menopause. Nevertheless, even in men from the age of about 40, there can be a lower production of sex hormones and, thus, a lack of testosterone.

This hormone is produced in the testicles. In addition to age, damage to the testicles, such as can occur after viral diseases ( e.g. mumps ), is a cause in men. A testosterone deficiency also occurs when the testicles have had to be removed due to a disease such as prostate cancer. In addition, a malfunction in the pituitary gland, which controls hormone production in the body, can trigger a testosterone deficiency.

A hormone deficiency in men manifests itself, for example, through the following symptoms:

• Erectile dysfunction or fewer nocturnal erections
• weaker sexual desire
• Decreasing body hair, less beard growth
• decreased sperm production
• Insomnia, listlessness, mood swings
• decreasing muscle mass and increasing belly fat

Diagnosis: Osteoporosis evaluation in men

As with women, a careful risk assessment and cause clarification must be carried out in men if osteoporosis is suspected. In addition to a physical examination, in which mobility and body size are determined, this also includes an anamnesis interview. With this, the doctor asks about the use of certain medications or the occurrence of osteoporosis in the family.

A bone density measurement (osteodensitometry) is usually carried out if osteoporosis is suspected. With this, the bone mineral content is determined and compared with the values ​​of a healthy person.

If necessary, the testosterone level in the blood is also determined in men. A bone sample (biopsy) is also valuable for men in rare cases. However, this is mainly carried out in the case of an atypical course of osteoporosis, for example, in the event of a lack of therapeutic success or the case of osteoporosis in young men.

 

Osteoporosis in men: Therapy

As a “basic therapy” for osteoporosis, the adequate administration of calcium and vitamin D, muscle-building training, fall prevention, and hormone-replacing or bone-stabilizing drugs are indispensable.

In contrast to postmenopausal osteoporosis (i.e. osteoporosis in women caused by menopause), for which a large number of drugs are approved, only the highly effective, bone-stabilizing bisphosphonates alendronate, risedronate, and zoledronate are available for the treatment of osteoporosis in men.

Therapy with painkillers and physiotherapy or physical therapy (including massage and heat treatment) can also be used.

Fix testosterone deficiency – treat osteoporosis.

If testosterone deficiency is involved in the development of osteoporosis, (additional) sex hormone replacement therapy can be considered. Treatment with drugs that increase testosterone must be discussed in detail by the doctor with the person concerned and, if necessary, with their partner.

A US study from 2017 convincingly showed that the bone density of older men increased significantly after one year of treatment with a gel containing testosterone. However, study participants were not affected by osteoporosis. Whether this effect also occurs in the case of existing osteoporosis has not yet been sufficiently proven.

However, scientific studies have shown that the bisphosphonate alendronate is also effective in men in whom a testosterone deficiency was involved in the development of osteoporosis. For alendronate, the duration of treatment is usually two to three years.