I was recently asked to see a male patient, in his early 80s, who four months before fell in his bathroom and broke his hip. Two days later, hip surgery was performed. After the operation he became agitated and confused, was unable to urinate and required a catheter. He spent three months in a recuperative care unit in a nursing home. When I first saw him he was wheelchair bound, markedly underweight and required help with bathing, feeding and grooming. Two weeks later he developed an upper respiratory infection that led to a severe pneumonia from which he never recovered.
The hip fracture ended his life. Thirty percent of hip fractures occur in men; over 50 percent never walk again and 37 percent die within a year. In reviewing his X-rays, it was clear that he had severe osteoporosis. This finding is particularly important, as the risk of a life-threatening fracture is 80 percent more common in anyone with osteoporosis.
Osteoporosis is generally thought to be a disease of women, and yet men frequently suffer from bone loss as well. Both men and women increase bone strength until they reach early adulthood. Thereafter, bone strength remains stable until the early 50s when both men and women lose an average of 1 percent of bone annually. Many women have accelerated bone loss around menopause. Thereafter, bone loss continues at the same rate in both men and women. In general, the bone strength of an average 70-year-old woman is equal to that of an 80-year-old man. In other words, men develop osteoporosis but 10 years later.
Currently, men who have no risk factors for osteoporosis and should not be screened for the disease. However, there are many risk factors that should make a physician screen for osteoporosis in an older man. Anyone who has a long history of smoking is at greater risk. Certain drugs that can lead to osteoporosis include corticosteroids, anticonvulsants, long-term use of medications such as omeprazole (that is used to treat gastric reflux disease), some anticancer drugs and medications to lower testosterone levels. Men with low testosterone levels, long-standing kidney or liver disease and a lifetime of inadequate exercise and calcium intake are more likely to have osteoporosis. Men with a strong family history of osteoporosis and fractures should also be screened.
Far and away the most important risk factor is advancing age. In the future, I would not be surprised if all men at age 80 are advised to have a scan to look for osteoporosis.
Many experts are warning that as the baby boomer generation reaches the age of 80 and beyond, there will be an epidemic of fatal hip fracture in men with osteoporosis. For this reason, it is now recommended that more attention be given to the bone health of men. Many recommend that from age 60 onward, men be screened for low testosterone and Vitamin D deficiency, both of which contribute to a higher risk of osteoporosis.
Men must also assure adequate calcium intake. Today over 50 percent of men consume less than 50 percent of the recommended daily requirement of calcium. And the number taking calcium is decreasing because of recent reports that 1000 mg of calcium supplement daily in pill form increases the risk of heart disease. However inadequate, calcium is just as bad because of the risks of bone loss.
Ideally, calcium should be obtained exclusively from our diet. The average American diet without dairy products contains anywhere from 600 to 800 mg calcium. One serving of dairy (cup of milk or yogurt or an ounce of cheese) contains 300 mg of calcium. Thus, a healthy diet containing at least two servings of dairy will assure that you receive sufficient calcium to meet your needs. If unable to eat dairy or calcium-fortified drinks, take no more than one calcium tablet daily with meals. The tablet should contain no more than 500 mg Calcium.
And remember the importance of impact exercises such as running, walking and impact aerobics. And nothing builds muscle or bone more than exercising with weights.
Virtually every disease that afflicts us as we grow older can be minimized by living a healthy life, which includes consuming the right foods, vitamins and minerals and getting the right amount of exercise.
Dr. David Lipschitz is the director of the Dr. David Health and Wellness Center in Little Rock. To find out more about Dr. David Lipschitz, visit www.drdavidhealth.com