Doc: Men are at risk for osteoporosis, too
Dear Dr. Roach: I just read your recent article on osteopenia, and would like to know if your information also applies to males? I so often read these articles that make reference to women, but men also need guidance.
I am a 78-year-old man. I fell in 2004 while hiking and broke my right femur. The surgeon said my bones were in great shape, and repaired it with a rod and a brace. I have not had any problems with it.
My family physician had me take a bone density test in 2015, which showed a T-score in my left femur of -2.9, and the spine of -1.9. My FRAX score was a 15 percent risk of major osteoporotic fracture. He recommended alendronate, but I have side effects of bloating, pain and acid reflux. Are there separate issues for men?
Dear G.B.: Osteoporosis in men is less common than in women, and men have a lower risk of fracture at any T-score than women do, because men have a higher peak bone mass. (A T-score is a measure of bone density compared with a young person of the same sex, with negative results meaning the person being tested has less-dense bones, more likely to fracture. A T-score of -2.5 or worse is considered osteoporosis.) However, as men age, osteoporotic fractures become increasingly common. An average 60-year-old man has about a 25 percent risk of an osteoporotic fracture in his lifetime, while the average 90-year-old man has a 6 percent risk of the most dangerous fracture — a hip; compare that with an 18 percent risk for women.
It’s particularly important in younger men to look for reversible causes of osteoporosis prior to beginning therapy, especially low levels of vitamin D, testosterone, calcium and phosphorus. A wise clinician also considers causes such as celiac disease, medications and recreational drugs, and certain tumors and endocrine conditions.
Treatment in men is very similar to that in women, including regular weight-bearing exercise and adequate calcium and vitamin D. Men with low testosterone and osteoporosis should be treated with testosterone.
In your case, your femur break was suspicious for an osteoporosis fracture and you have a moderate (10 to 20 percent) FRAX risk, so I agree with your family physician that medication therapy is reasonable. For men who have gastrointestinal side effects from oral medicines like alendronate (Fosamax), I would recommend zoledronic acid (Reclast, Aclasta or Zometa), which is given intravenously once a year, and has been proven to reduce osteoporotic fractures in men. Like all bisphosphonates in men and women, it should be re-evaluated at three to five years to see whether it is still appropriate.
Dear Dr. Roach: Would you kindly weigh in on the latest in laser therapy for musculoskeletal problems? I am interested especially in its treatment of rotator cuff problems.
Dear L.W.: For rotator cuff tendinosis, I found a study that showed improvement in pain using a low-power laser combined with standard physical therapy. (That is when compared with PT alone.) However, there were no objective improvements in range of motion. Laser was found to be of benefit in adhesive capsulitis, also called “frozen shoulder.”
For back pain, the evidence is mixed. I suspect that neither the precise indications nor the proper settings for the laser are known as yet, so I can’t recommend it for use in back pain.
Email questions to ToYourGoodHealth@med.cornell.edu.