Osteoporosis In Men

Male Osteoporosis

Introduction:

Osteoporosis is a devastating disease that causes deterioration of bone tissue and an increased risk of bone fractures. It is a major public health problem, affecting millions of elderly over age sixty-five. The disease is one of the most costly costing fourteen billion dollars a year in U.S. health expenditures. Osteoporosis is primarily thought of as a woman's disease, it affects over two million men annually. While there are less fragile fractures in men, if they do fracture, men are more likely to die from it. Today the lack of awareness for male osteoporosis is where it was for women fifty years ago. This is a frightening fact as the lifetime risk for osteoporosis is higher than that of prostate cancer. With such a risk, one would think the medical community would eager to prevent osteoporosis from even occurring.

In some ways they are, as there are many clinical studies and trials directed towards osteoporosis as whole, and specifically osteoporosis in men. Even so, there are less approved treatments for men, and they must rely on the programs available. Many of these programs are excellent, and span across the local, state, and national level. They offer both prevention and treatments methods for the at-risk and currently afflicted populations. These include the Gaylord Hospital, Lawrence and Memorial Hospital, UCONN Center for Osteoporosis, the Growing Stronger Exercise Program, and Medicare Bone Mass Measurement Initiative. No program is perfect, however, and all would benefit from changes as well as a gender-specific overhaul. Male Osteoporosis is a major health issue, but it is one that can be conquered.

Literature Review:

According to the Tuft's Health and Nutrition Journal, Volume 19, Issue 7, "a man over age 50 has a greater chance suffering a fracture as a result of osteoporosis than being diagnosed with prostate cancer." They also claim twenty percent of all men will suffer a hip fracture by age 90, with a third of them dying from complications. Despite these facts, there is a natural tendency for doctors to view osteoporosis as a women's disease. "It's a disconcerting problem [that] as doctors, we often don't talk to male patients about their bones." Even more alarming is the fact that even when the symptoms are recognized, many doctors choose not even consider osteoporosis as a possible cause for men. For that reason, Tufts encourages men to know the red flags of the disease, which include "loss of height, changes in posture, and sudden back pain." Luckily, despite the lack of publicity, men's treatments are expanding. The drugs Fosamax and Actenol have been approved for male osteoporosis by the FDA. There is also hope in prevention, where avoiding smoking and drinking, good diet, and exercise can all help men conquer their risk of disease.

In understanding osteoporosis in older men, one needs to understand where their health beliefs are coming from. In Volume 19, Issue 3 of Orthopedic Nursing there was a study on how men's knowledge of osteoporosis affected their health beliefs. The study started with the idea that there was in fact "a gender biased in osteoporosis research." It was important to provide a medical definition for osteoporosis as a control which is the "the demineralization of bone". It occurs when the breakdown of bone is greater than the buildup of bone. Calcium deficiencies, medical conditions, and medications are all risk factors for men. The article listed some well known prevention methods, especially emphasizing lifestyle change. The study determined that when men are analyzed for their health behaviors, they see susceptibility, seriousness of the disease, benefits in prevention behavior, barriers in prevention behavior, and motivation in health maintenance as the primary factors for whether or not to be concerned for a particular disease. In the case of osteoporosis, the gender bias in research and literature has detrimental effect. If men's knowledge base could influence their behavior in a positive manner, osteoporosis would be a decreased risk to men.

The above articles describe the current situation for men, as well as how their own beliefs can help or hinder them in dealing with osteoporosis. It is important that physicians understand their role as well. The American Family Physician, Volume 67, Issue 7, offers the epidemiology and treatments methods most effective in men. Men have naturally bigger and longer bones, and therefore have greater total bone mass. This is why, that up until recently, osteoporosis did not seem like a threat to men, but this is a very wrong assumption. "About 4 to 6 percent of men older than 50 have osteoporosis, and 33 to 47 percent have osteopenia (diminished bone loss no meeting the diagnostic criteria for osteoporosis)." Because of their big bones, men have a greater risk for fracture once they get older, and "once hip fractures occur men have higher rates of morbidity and mortality than women." Once again medications, tobacco and alcohol use, and other lifestyle behaviors are the highest risk factors for men. Laboratory evaluation for men is currently limited, but as physicians see osteoporosis in men as a diagnosis this will improve. Currently blood cell counts, nutrient levels, kidney and liver function tests, testosterone levels, and urinalysis are the primary methods of testing men. Fosamax and Alendronate are the medications the journal is recommending to physicians for the disease. Hormone therapy is also being considered, and there is also strong emphasis on fall prevention.

Program Overview:

Gaylord Hospital is a long-term care hospital in Wallingford that specializes in the care and treatment of medically difficult patients and rehabilitation (Gaylord 2004). It offers over fifty programs specific to various conditions, including Arthritis Rehabilitation, Medical Nutrition Therapy, Occupational Therapy, Osteoporosis Therapy, Physical Therapy, and Therapeutic Recreation. For issues with bone health, the Gaylord programs follow a certain defined pattern. There is initial evaluation and interview with a bone health expert, such as a rheumatologist. Blood tests and x-rays are also routinely conducted to help determine the correct therapy and proper medication (Gaylord 2004). Typically, an osteoporosis program includes half-hour outpatient settings in which the patient in instructed in an individualized exercise program. These programs often include flexibility and strengthening workouts, aqua therapy, energy conservation analyses, counseling and coping skills, and may include learning to work with assistive devices (Gaylord 2004).