The silent disease affecting Idaho men
When a 70-year-old man broke his wrist last winter, an emergency room doctor told him he might have osteoporosis. He never followed up. The scenario, described in a recent health column published by East Idaho News, reflects a pattern doctors say is common across eastern Idaho and the nation.
Osteoporosis affects men as they age, and like women, men often don't realize they have it until a bone breaks. The condition is often termed the "silent disease," as it typically is asymptomatic until a fracture occurs.
About 2 million men are estimated to have osteoporosis and an additional 16 million men have low bone mass, known as osteopenia. Men face higher risks of subsequent fractures, morbidity, and mortality following an initial fracture.
The disease weakens bones over time, making them thin, brittle and more likely to break. The bones most often affected are the hip, spine and wrist.
Why men are less likely to be tested
One of the biggest problems is that men are less likely to be tested than women. Men also are less likely to get osteoporosis treatment. Osteoporosis in men remains underdiagnosed and inadequately managed.
Most men found to have osteoporosis are diagnosed only after a hip or spine fracture has already occurred. Even after a fracture, many never get a bone density scan. Doctors sometimes overlook it in men, and men themselves may not realize they're at risk.
Medicare provides coverage for bone mass measurement using dual energy X-ray absorptiometry scans for postmenopausal women because estrogen deficiency results in an increased risk for osteoporosis. Despite the clear association of male hypogonadism with low bone density and osteoporosis, Medicare does not provide coverage for bone mineral densitometry testing in these individuals.
Men age 70 and older are covered for bone density testing. Tests must be ordered by a physician as medically necessary, ensuring that even men can be covered under certain circumstances.
Risk factors for Idaho men
In women, menopause speeds up bone loss. In men, it usually happens more gradually, but age is still a major factor. Men suffer osteoporotic fractures about 10 years later in life than women.
Risk rises for men over age 70, those who are thin or underweight, smokers, heavy drinkers, men with a parent with osteoporosis, or those who have already broken a bone.
Certain medical conditions can also increase risk, including rheumatoid arthritis, celiac disease, low testosterone, overactive thyroid, COPD and kidney or liver disease. Neurological conditions such as Parkinson's disease, multiple sclerosis or a past stroke can raise the risk because they affect balance and mobility.
Long-term use of corticosteroids, some prostate cancer treatments, acid reflux drugs, antidepressants, and anti-seizure medications can weaken bones too. Up to 60% of male cases are associated with secondary conditions, including hypogonadism, alcohol abuse, corticosteroid use, and systemic diseases such as diabetes.
Hip fractures carry higher mortality for men
Hip fractures in men result in a 31 percent mortality rate at one year after fracture versus a rate of 17 percent in women. Men have about twice the 1-year fatality rate after hip fracture, compared to women.
Hip fractures in particular can lead to serious complications and long recoveries. Most hip fractures in older adults require surgery to restore mobility and to manage pain, putting patients at risk for a range of post-surgical complications, including infection, blood clots in the lungs or legs, bedsores, urinary tract infection and pneumonia.
About 30 percent of hip fractures occur in men, and one in eight men older than 50 years will have an osteoporotic fracture.
Testing and Medicare coverage
All men should undergo dual energy X-ray absorptiometry at 70 years of age, according to the 2012 Endocrine Society published guidelines for osteoporosis in men. Under that age, measurement of bone mineral density has to be done for all the men with risk factors.
Men over 50 who've had a fracture or have other risk factors should get tested. The scan is simple, painless and takes only a few minutes.
Medicare Part B pays the full cost of a bone density scan every 24 months. You pay nothing for this test if the doctor or other health care provider accepts assignment. Coverage is once every 24 months, or more often if medically necessary, if you meet certain conditions.
Medicare covers bone density scans for men when an individual has been previously diagnosed with osteoporosis, primary hyperparathyroidism, vertebral bone fracture, or osteopenia of the spine, or in certain other situations.
When it comes to protecting bones, the basics matter. Get enough calcium from foods like low-fat milk, yogurt and cheese, leafy green vegetables, beans, almonds and canned salmon or sardines. Men under 70 need about 1,000 milligrams a day; those 71 and older need 1,200 milligrams.
Vitamin D is important because it helps the body absorb calcium. Most adults over 50 need 800 to 1,000 international units daily, through sunlight, food or a supplement if needed.
Regular weight-bearing exercise, such as walking, along with strength training two or three times a week helps build and maintain bone. It also improves balance, which can prevent falls. Men should also avoid smoking and limit alcohol and caffeine intake.
Treatment options
If testing shows significant bone loss, medications such as Fosamax, Actonel, Reclast, Prolia, Forteo or Tymlos may be prescribed. Doctors can explain the benefits and possible side effects and help patients decide what is appropriate.
By raising awareness of the importance of screening with dual energy X-ray absorptiometry scans, advocating for healthy lifestyle changes, and treatment options like Reclast injections, providers can empower individuals to change their bone health and reduce fracture risk.
For men who have already had a fracture, a simple test and a plan now could help avoid a more serious break down the road.