Make no bones about it...

  • Joanne McCarthy

As many as one in five people with osteoporosis are men, despite osteoporosis being widely portrayed as a woman’s disease. More men than ever before are now developing the disease as a result of reduced sex hormone levels caused by increasingly high stress levels, smoking, excessive alcohol consumption and physical inactivity. 

In spite of this, osteoporosis in men continues to be under-diagnosed and under-treated. Because weak bones are usually associated with women, men who suffer fractures are sometimes not encouraged to go for osteoporosis screening. A recent report by the International Osteoporosis Foundation (IOF) maintained that the lack of awareness of osteoporosis in men is similar to the lack of awareness in women 50 years ago.

Osteoporosis occurs when the density of bones is reduced, meaning that bones become fragile and liable to break easily. Men lose the same amount of bone mass as women, with both losing almost half of the bone mass achieved during growth over the course of a lifetime. However, men compensate better for the loss of bone mass by naturally laying down more bone on the outer surface of the bone. They have larger skeletons, their bone loss starts later and progresses more slowly, and they have no period of rapid hormonal change as women do.

The new bone on the outer surface does not entirely compensate for the loss of bone, however, and so about one in every five men suffer osteoporotic fractures. This number is on the rise, with some estimating that by 2025, the number of fractures in men will be similar to the number in women.

Key risk factors for men include race (with Caucasian men being at greatest risk), family history, late onset of puberty, and insufficient calcium and vitamin D in the diet. Smoking, excess alcohol consumption and lack of exercise also increase the risk. High levels of stress are increasingly being linked to osteoporosis in men. 

Like many men, Philip Byrne, a 48-year-old bricklayer from Carlow, was shocked to discover that he had osteoporosis when he was diagnosed at the age of 45.

“I injured my back, I thought maybe I had pulled a muscle or something. It went on for a long period of time and it got worse rather than better. It wouldn’t be uncommon for me to injure myself at work and still carry on. It tends to come right after a week or so. But this injury never went away, it got worse.

“I eventually went for an x-ray. I didn’t have any broken bones, but it was suggested that I should go for a DEXA scan, as my bone looked thin. That’s how they discovered I have osteoporosis,” he said.

Like many men his age, Philip knew very little about osteoporosis. At first, it was a relief to get a diagnosis, but that relief quickly turned to shock when he was told that he would never work again.

“It was a huge shock to me when I sat in front of the doctor and he said what he said, which was that I would never work again. In five minutes everything had changed, from me thinking I was just going to go into the chemist and get this sorted, to basically being told I was never going to work again. My whole world was upside down,” he said.

Thankfully, Philip was able to prove that verdict entirely wrong. After speaking with the Osteoporosis Society, he received the treatment he needed and made a number of lifestyle changes.

“I was out of work for a full eight months. I’m back working now, but the way the industry is at the moment I’m in and out of work and to a degree that suits me, because I’m not up to full speed yet. I have to take something for pain on occasion when I am working.

“If I wasn’t involved in the construction industry, I believe things would be fine, but my job is very physical. I’m picking up a lot of weight every day and you tend to be bent a lot. That’s where I’m having the most problems, with pain,” he explained.

When he was diagnosed, Philip says he was ‘unfit to walk, let along work’. However, after responding well to his medication, changing his diet and starting regular weight-bearing exercise, he saw major changes.

“I’m very cautious about what I’m doing as regards being physical. I watch what I’m eating, I make sure that I look after myself a little bit better than I was a couple of years ago. I thought I was looking after myself, but it’s a lot higher up on the list now. It’s number one on the list really, just to eat properly and be more active as far as exercise is concerned.

“Before, I used never eat in the mornings, I’d be up and out the door, always last minute. Now I eat a lot better. If I’m late, I’m late, and it doesn’t bother me too much any more,” he said.

Philip is now very optimistic about the future, and plans to stay working for a long time. He is currently completing a course in Carlow IT on Building and Energy Rating, and is hoping to get into that field, where he can use his building expertise but not have a physically demanding job.

Philip attributes his disease to stress, and says he has had to make ‘quite a few changes’ to the stressful lifestyle he was living before his diagnosis. He now recognises that he was taking on too much.

“There was many a year that I would feel that I was doing too much, but then again I was over the top. You wouldn’t want to work with me, let’s put it that way! I’ve calmed down a lot now. I’m mindful that there are more important things than upsetting yourself over something you really might have no control over,” he said.

Professor Moira O’Brien, president of the Irish Osteoporosis Society, believes that the increased incidence of osteoporosis in men is caused by stress. Ten years ago, just one in 20 men had osteoporosis; now, one in five men get the disease.

“Stress means that men have less sex hormones. If you have less sex hormones, you don’t absorb calcium and vitamin D. You lose calcium from your bones, and then you run into trouble. This applies to both men and women, but because men are not considered liable to get it, they’re often not investigated,” she explained.

Prof O’Brien recommends that men who have low sex hormones, or who have had chemotherapy or radiation should be tested to see whether they’re at risk. Furthermore, if they are experiencing one or more of the traditional risk factors associated with osteoporosis, they should be examined.

Increased awareness of the disease in men will amount to a rise in the number of men getting tested, and a rise in the number getting tested earlier. Osteoporosis is treatable, and the earlier it is detected, the higher the chance of success.

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