Osteoporosis is a man's illness too

Roger Wilkins didn’t know men could have osteoporosis until he was diagnosed with the disease after falling and breaking his right hip five years ago.

“It was a surprise that I had osteoporosis, mostly because prior to that I don’t think I’d ever had a broken bone,” he says. “I don’t think I’d been aware of men having osteoporosis.”

When he was younger, Roger, 83, was involved in sports and outdoor activities — rugby, biking, skiing, hiking — but he developed arthritis in his knees, which ultimately led to the fall that fractured his hip. After having surgeries to replace his right knee and hip, he was referred to the Osteoporosis Clinic at the Grey Nuns Community Hospital for treatment. With medication, vitamin D supplements and regular exercise, he’s now feeling stronger and getting around better.

“These are the things I feel I need to do to make things better for myself,” Roger says.

Roger’s osteoporosis diagnosis is not unusual. About one in eight adult men has the disease, compared with one in four women, but significantly fewer men than women get diagnosed, says Dr. Brian Wirzba, medical director at the Grey Nuns Osteoporosis Clinic.

In Canada, only about 10 per cent of men who’ve had a "fragility fracture" from a fall or some other low-impact injury are diagnosed or get treatment. And though osteoporosis is not as common in men, it has a significantly worse outcome. About 37 per cent of men who have a hip fracture die within one year, compared with 28 per cent of women. Men also have a higher rate of needing nursing home care or other forms of institutionalization, along with loss of independence.

Brian defines osteoporosis as a loss — with age — of both bone quantity (i.e., density) and bone quality that increases the risk of fracture through a fall or other injury. Contrary to popular belief, the focus of osteoporosis therapy is not treating low bone density but reducing the risk of fracture, and preventing fractures is key.

“There are absolutely no symptoms of osteoporosis until you break a bone,” says Brian.

It could be an obvious fracture in the hip, wrist, shoulder or arm, or it could be a fracture that goes unrecognized. For example, two-thirds of fractures in the middle and lower spine are painless, so men may not notice them but go to their doctor complaining of height loss, breathing issues or trouble with bowel function.

“Far too often we see men who’ve had multiple fractures and they just attribute it to the activity they've been doing rather than to a condition. If you don’t make the diagnosis, you can’t really intervene to reduce bad outcomes,” says Brian.

Once diagnosed, male patients with a high risk of fracture should get therapy, Brian says. Medications like alendronate, risedronate, zoledronate and denosumab can reduce the risk of fracture by at least 50 per cent in the first three years of use. And zoledronate and denosumab, which are taken by injection, can reduce the risk of multiple fractures by upwards of 70 to 80 per cent. These results translate into greater ability to perform daily tasks, less pain and better quality of life.

When it comes to preventing osteoporosis, Brian has the same advice for men as for women: keep active, watch your posture and exercise regularly to strengthen your bones and reduce the chance of falls. He also suggests people take vitamin D supplements (1,000 to 2,000 units per day), eat a healthy diet and avoid habits like drinking too much and smoking. The same advice goes for living safely with the disease.

“The more active you are in your late 60s, the less likely you are to fall in your 70s. The more active you are in your 70s, the less likely you are to be frail and fall in your 80s,” Brian says.

Though Roger can’t go skiing or mountain biking anymore, he’s staying active by working out for up to 45 minutes every day on the treadmill in his basement.

“It makes me more confident in the way I walk,” says Roger. “I think it has also strengthened my legs, and that’s why I try to do it on a regular basis.”

He also takes care to avoid falling by using a cane when he feels unsteady on his legs, taking a walker with him when he goes out on errands and holding on to the handrail when he goes up and down stairs.

“Even just less than 10 years ago, I used to go up and down stairs often without even thinking about using the railing, but now I know that if I don’t use it, the consequences are pretty serious,” he says.

And Roger has his own advice for other men who have osteoporosis: be proactive and seek out things that can be helpful, such as balance testing and exercise programs.

“Keep an open mind and do whatever you can benefit from," Roger says. "You can only benefit or experience things if you’re prepared to try them."

More advice for men

• Keep an eye on your height. If you’re losing centimetres, ask for an X-ray of your entire back to check for compression fractures.

• If you’re over 65, get a bone density test to assess your risk for fractures.

• Use the Fracture Risk Assessment (FRAX) tool on the Osteoporosis Canada website to get an estimate of your risk over the next 10 years. If your risk is over 20 per cent, talk to your doctor about therapy.

• If you’re diagnosed with osteoporosis, educate yourself by attending a workshop at the Grey Nuns Community Hospital or visiting the websites of organizations such as Osteoporosis Canada to get information about nutrition as well as programs and resources for living with the disease.

• Follow Osteoporosis Canada’s Too Fit to Fracture exercise program — a free download available from the website — or take advantage of exercise programs offered by seniors' and geriatric groups in your community.