How many men have osteoporosis?

Though it's much more common in women, osteoporosis can strike men too, often with debilitating consequences.

Until recently, male-oriented research into the disease lagged far behind that devoted to women. But with more men living longer, and with their rates of osteoporosis climbing as a result, studies of male risk have become more common.

In research presented at the IOF World Congress on Osteoporosis in Toronto, Canada, Dr. Jane Cauley from the University of Pittsburgh, showed that rates of hip bone loss increase with age among both white and non-white men, particularly those 75 years or older. The study cohort of 5,995 individuals reflects the diversity of the male US population, Cauley says.

As with women, Cauley explained, osteoporosis in men results in part from declining levels of estrogen, which normally keep bone-depleting inflammatory compounds called cytokines in check. Without sufficient estrogen, cytokines strip away at bone layers through a process called resorption. Over time, weakening bones develop the hallmarks of osteoporosis, becoming brittle and fracture-prone. Rates of hip fracture were especially pronounced among Hispanic men, for unknown reasons, Cauley said. "The increase may be due to inadequate vitamin D, but really we don't yet know why Hispanic men are more vulnerable."

Cauley emphasized the study reinforces a basic message: namely that men over the age of 70 should consider a bone density check. "If bone density is good, you may not need to repeat the test, but if it's low, you may need to retest within a few years and maybe start thinking about treatment," she said.

In a further study, Dr. John Wong from Tufts University and his colleagues estimated the number of male fractures and associated costs from 2005 to 2025. Using a computer model that simulates costs, morbidity, and mortality for different age and racial/ethnic groups of men in the United States, Wong and colleagues predicted a 56% increase in the incidence of male osteoporotic fractures, from a total of 595,000 to 925,000.

The model also predicted a commensurate rise in related costs, from a baseline of US $4.1 billion to US $6.7 billion. The increase in male fracture incidence, Wong said, can be attributed to rising numbers of elderly people in the US population, which is steadily aging.

A large portion of the total cost of treating fragility fractures in the United States goes to treating men, a new study revealed. "People are not really aware that this disease also occurs in men as well as women, as a result, they don't really understand the economic consequences of osteoporosis in men," said Dr. Rick Adachi, professor of medicine at McMaster University, Hamilton, Ontario, Canada, and lead author on the study.

But Adachi and colleagues found that 30 percent of the total cost of treating fragility fractures goes towards treating men. "This was higher than anticipated and contradicts the view that women alone are at risk for fragility fractures and the costs and consequences associated with them," Adachi said.

Together with colleagues at St. Joseph's Hospital, Hamilton, Ontario, and Proctor and Gamble Pharmaceuticals, Mason, Ohio, Adachi examined data from approximately 45 different public and private healthcare plans. The researchers tallied medical claims for treatment of vertebral and non-vertebral fractures in men and women aged 50-89 years. Nearly two million claims were analyzed and fragility fracture rates determined for the wrist, leg, arm, hip, pelvis, shoulder and spine. In addition to the higher than anticipated costs related to treating fractures in men, the study came up with another surprising finding--over 90 percent of the cost of treating fractures in men goes towards treating non-vertebral fractures. "While vertebral fractures are important and do reflect fragility in men, the real cost in men turns out to be these non-vertebral fractures, said Adachi. These include fracture of the hip, wrist, and shoulder.

Though osteoporosis affects more women than men, about 1 in 5 men over age 50--more than will get prostate cancer--will, at sometime, suffer an osteoporotic or fragility fracture, according to previous research. In fact, estimates suggest that by 2025 the number of hip fractures in men, worldwide, will have more than doubled. Adachi's findings suggest that adjusted for inflation, the cost of treating osteoporosis in men will rise by at least that much, in real terms. "If we want to help reduce costs, then we really need to focus on new approaches for the early identification of osteoporosis in men and we need to find medications that are proven to help prevent both vertebral and non-vertebral fractures," said Adachi.