Can men get osteoporosis?

DEAR DOCTOR K:

My doctor says I need to worry about osteoporosis. I’m a man in my 60s. Doesn’t osteoporosis affect mostly women?

DEAR READER:

Osteoporosis is a disease that weakens bones. You’re correct that women are more likely than men to develop osteoporosis, but that doesn’t mean men don’t have to worry about it. In fact, about 2 million men in the United States have osteoporosis.

There are two main reasons men are less vulnerable than women to bone loss. First, men start out with bigger bones and greater bone density. Second, men generally have high levels of androgens, hormones that increase bone density.

When men under age 75 develop osteoporosis, it’s often because of treatment with certain drugs that cause osteoporosis as a side effect, or because they have other medical conditions that weaken bone. When osteoporosis is caused by a treatment or another underlying condition, it is called secondary osteoporosis. For example:

MEDICATIONS: Glucocorticoid use is one of the most common causes of secondary osteoporosis. Glucocorticoids are steroids used to reduce inflammation caused by asthma, arthritis and a variety of other conditions. Anticonvulsants (medicines used to control seizures) and certain cancer treatments also increase risk.

UNDERLYING MEDICAL CONDITIONS: Abnormally low sex hormone levels can increase the risk of osteoporosis in men (and women). Men and women produce both estrogen (the “female” sex hormone) and testosterone (the “male” sex hormone. Of course, women make a lot more estrogen than men, and men make a lot more androgen than women. Both estrogen and androgen build bone. Levels of both of these hormones decline as people age, and this can cause bone loss. When men have very low androgen levels (or a rare condition in which men’s tissues don’t respond to androgens normally) it is called hypogonadism.

In addition to hypogonadism, other disorders can also damage bone health: Type 1 diabetes, epilepsy, hyperthyroidism, multiple sclerosis and many others.

(I’ve put a more complete list of medical conditions and medications that increase the risk of secondary osteoporosis, below.)

Other risk factors that are particularly relevant to men include:

  • HEAVY ALCOHOL USE. Heavy drinking can damage bone health by reducing bone mass.
  • SMOKING. Many years of smoking encourage the thinning of bones.
  • INACTIVITY. Our bones respond to being challenged by becoming denser and stronger. The bones of the legs, hips and spine are strengthened by weight-bearing activities, and by exercises like walking or running.
  • GASTRECTOMY. This operation, in which part or all of the stomach is removed, can reduce the amount of calcium the body absorbs. That, in turn, causes some thinning of the bones.

Some men (like some women) are more vulnerable to getting osteoporosis, but we don’t understand all of the genetics involved. Also, people of Caucasian or Asian ethnicity are at higher risk than those of African background.

The National Osteoporosis Foundation recommends bone mineral density testing for men starting at age 70. If you’re younger but have any of the risk factors I’ve discussed, get tested earlier.

Possible causes of secondary osteoporosis

Underlying medical conditions
  • Acromegaly
  • Alcoholism
  • Anorexia
  • Amyloidosis
  • Androgen insensitivity
  • Ankylosing spondylitis
  • Athletic amenorrhea
  • Bulimia
  • Calcium deficiency
  • Celiac disease
  • Chronic metabolic acidosis
  • Cushing’s syndrome
  • Cystic fibrosis
  • Diabetes (type 1)
  • Depression
  • Ehlers-Danlos syndrome
  • Emphysema
  • End-stage renal disease
  • Epilepsy
  • Gaucher’s disease
  • Gastric bypass
  • Gastrointestinal surgery
  • Glycogen storage diseases
  • Heart failure
  • Hemochromatosis
  • Hemophilia
  • Homocystinuria
  • Hypercalciuria
  • Hyperparathyroidism
  • Hyperprolactinemia
  • Hyperthyroidism
  • Hypogonadism
  • Hypophosphatasia
  • Liver disease
  • Idiopathic scoliosis
  • Inflammatory bowel disease
  • Leukemia and lymphoma
  • Lupus
  • Malabsorptive disorders
  • Marfan’s syndrome
  • Multiple myeloma
  • Multiple sclerosis
  • Muscular dystrophy
  • Osteogenesis imperfecta
  • Pancreatic disease
  • Panhypopituitarism
  • Porphyria
  • Post-transplant bone disease
  • Premature ovarian failure
  • Primary biliary cirrhosis
  • Renal tubular acidosis
  • Rheumatoid arthritis
  • Sarcoidosis
  • Sickle cell disease
  • Systemic mastocytosis
  • Thalassemia
  • Thyrotoxicosis
  • Turner’s and Klinefelter’s syndromes
Drugs
  • Androgen deprivation therapy (hormone therapy for prostate cancer)
  • Anticonvulsants
  • Aromatase inhibitors
  • Barbiturates
  • Cyclosporine and tacrolimus
  • Depo-medroxyprogesterone
  • Glucocorticoids
  • Gonadotropin-releasing hormone agonists
  • Heparin therapy (long-term)
  • Lithium
  • Methotrexate
  • Thyroid hormone (in excessive doses)

(This column is an update of one that ran originally in October 2012.)