Back in 2006, Ronald Klein, a dentist from North Wales, Pennsylvania, had an unfortunate biking accident. He attempted to jump a curb, but without enough speed, his bike toppled.
He instinctively extended his left arm to brace himself, and while it didn’t seem like a severe crash at first, he soon realized he couldn’t get back on his feet.
Emergency room X-rays revealed more serious injuries: fractures in both his hip (requiring surgery) and his shoulder. Remarkably, Dr. Klein was back at work within three weeks, albeit with a cane. Six months of diligent physical therapy later, he felt fully recovered.
Despite his recovery, a nagging question lingered: ‘A 52-year-old isn’t supposed to break a hip and a shoulder,’ he thought. During a follow-up with his orthopedist, he proactively suggested, ‘Perhaps I should get a bone density scan.’
His hunch was correct. The scan confirmed osteoporosis, a progressive condition that severely thins and weakens bones, making them highly susceptible to fractures, especially with age. Dr. Klein promptly started a medication regimen, which he continues today at 70.
Osteoporosis is far more prevalent in women, with medical guidelines recommending universal screening for them after age 65. This common perception often leads men, even those without a healthcare background, to overlook the need for a bone density scan. Notably, his orthopedist hadn’t even suggested it.
Yet, statistics tell a different story: roughly one in five men over 50 will experience an osteoporosis-related fracture, and men account for about a quarter of all hip fractures among older adults.
Alarmingly, when men do suffer these fractures, their outcomes are often significantly worse, according to Dr. Cathleen Colon-Emeric, a geriatrician at the Durham VA Health Care System and Duke University. She led a recent study on osteoporosis treatment in male veterans.
Dr. Colon-Emeric highlighted that men typically face a tougher road to recovery than women, with higher rates of death (25-30% within a year), increased disability, and a greater likelihood of needing long-term institutional care. She starkly noted that ‘a 50-year-old man is more likely to die from the complications of a major osteoporotic fracture than from prostate cancer.’
A ‘major’ fracture includes breaks in the wrist, hip, femur, humerus, pelvis, or vertebrae.
Her study, which involved 3,000 veterans aged 65 to 85 at VA health centers in North Carolina and Virginia, uncovered a staggering statistic: only 2% of the control group had ever received a bone-density screening.
Dr. Douglas Bauer, a clinical epidemiologist and osteoporosis researcher at the University of California, San Francisco, who penned a commentary on the study in JAMA Internal Medicine, described this figure as ‘shockingly low’ and ‘abysmal,’ especially considering that screening is government-funded at the V.A.
However, the intervention group, all of whom had at least one osteoporosis risk factor, saw dramatic improvements after the implementation of a dedicated bone health service. This service, managed by a nurse, handled orders, sent regular appointment reminders, and clearly explained results.
A remarkable 49% of this group agreed to a scan. Of those tested, half were diagnosed with either osteoporosis or its precursor, osteopenia. Crucially, most of these individuals then began appropriate medications to help preserve or rebuild their bone mass.
Dr. Colon-Emeric expressed pleasant surprise, stating, ‘We were pleasantly surprised that so many agreed to be screened and were willing to initiate treatment.’
After 18 months, the intervention group showed modest increases in bone density and, notably, were more adherent to their medication regimens compared to typical osteoporosis patients.
While the study’s duration wasn’t long enough to confirm further increases in bone density or a reduction in fractures, researchers are planning a follow-up analysis to investigate these outcomes.
These findings reignite a critical, long-standing debate: Considering the potentially deadly and life-altering consequences of osteoporotic fractures, and the existence of effective treatments to combat bone loss, should older men receive routine osteoporosis screenings, similar to women? And if so, at what age and for which risk profiles?
Dr. Bauer explained that this issue was less pressing in previous generations when men had shorter life expectancies. Men naturally possess larger, thicker bones and typically develop osteoporosis 5-10 years later than women. Historically, many men succumbed to conditions like heart disease or smoking-related illnesses before osteoporosis could significantly impact them.
However, with modern medicine extending lifespans, men are now routinely living into their 70s and 80s, making them increasingly susceptible to fractures. By this age, they often contend with multiple chronic conditions that further hinder their recovery from such injuries.
Dr. Bauer emphasized that with proper osteoporosis testing and treatment, men could experience ‘a clear-cut improvement in mortality and, more importantly, his quality of life.’
Despite the growing evidence, both patients and many physicians still largely perceive osteoporosis as a ‘woman’s disease.’ Dr. Eric Orwoll, an endocrinologist and osteoporosis researcher at Oregon Health and Science University, humorously referred to this as ‘a bit of a Superman idea.’
He elaborated that ‘men would like to believe they’re indestructible, so a fracture doesn’t have the implication that it should,’ leading to a dangerous underestimation of the condition.
Take, for instance, one patient who, despite repeated urging from his wife (a nurse), resisted seeking medical attention for his noticeably rounded upper back for years.
Bob Grossman, a 74-year-old retired public-school teacher in Portland, simply attributed his posture to age and tried to ‘straighten up.’ He recalled thinking, ‘It can’t be osteoporosis — I’m a guy,’ only to discover that it was indeed osteoporosis.
Another significant hurdle to widespread screening is the inconsistency of clinical practice guidelines, noted Dr. Colon-Emeric, describing them as ‘all over the place.’
While organizations like the Endocrine Society and the American Society for Bone and Mineral Research advise that men over 50 with risk factors, and all men over 70, should undergo screening…
…other prominent bodies, including the American College of Physicians and the U.S. Preventive Services Task Force, consider the evidence for routine male screening ‘insufficient.’ Although clinical trials demonstrate that osteoporosis medications boost bone density in men, similar to women, most male-focused studies have been too limited in size or duration to conclusively prove a reduction in fractures.
This stance by the task force has practical implications: Medicare and many private insurers typically won’t cover osteoporosis screenings for men who haven’t already experienced a fracture, even though they will cover treatment once a diagnosis is made.
‘Things have been stalled for decades,’ lamented Dr. Orwoll.
Consequently, the onus often falls on older male patients to proactively ask their doctors about a DXA (pronounced DECKS-ah) scan, which typically costs $100 to $300 out-of-pocket. Without such proactive steps, and given that osteoporosis is usually asymptomatic, many men (and women, who also face undertesting and undertreatment) remain unaware of their deteriorating bone health until a fracture occurs.
Dr. Orwoll strongly advised, ‘If you had a fracture after age 50, you should have a bone scan — that’s one of the key indicators.’
Other crucial risk factors include recurrent falls, a family history of hip fractures, and a range of existing health conditions such as rheumatoid arthritis, hyperthyroidism, and Parkinson’s disease. Lifestyle choices like smoking and excessive alcohol consumption also significantly elevate the risk of developing osteoporosis.
Dr. Colon-Emeric also pointed out that ‘a number of medications can negatively impact your bone density,’ specifically mentioning steroids and certain prostate cancer drugs.
If a DXA scan confirms osteoporosis, treatment options vary depending on severity and may include oral medications such as Fosamax or Actonel, intravenous treatments like Reclast, daily self-administered injections of Forteo or Tymlos, or bi-annual injections of Prolia.
While lifestyle adjustments like regular exercise, adequate calcium and vitamin D intake, quitting smoking, and moderate alcohol consumption are beneficial, Dr. Colon-Emeric stressed that they are typically ‘not sufficient to stop or reverse bone loss’ on their own.
Despite the lack of universal guidelines, Dr. Colon-Emeric advocates for screening all men over 70. Her reasoning is clear: the severe risk of disability following hip fractures (two-thirds of older individuals never fully regain their previous mobility) combined with the effectiveness and often low cost of available treatments makes a strong case for broader screening.
However, the effort to educate both patients and healthcare professionals that men are also vulnerable to osteoporosis has advanced ‘at a snail’s pace,’ according to Dr. Orwoll.
Dr. Klein vividly recalls attending a seminar on using the drug Forteo, only to find himself the sole male in the room, underscoring the gender disparity in awareness and treatment.
This article is part of ‘The New Old Age,’ a series produced in partnership with KFF Health News.