Some Men Have Risk Factors for Osteoporosis
Everyone knows that women need to fend off osteoporosis as they age. But what is less well-known is that 30 percent of elderly men who suffer a hip fracture will die within a year of that fracture - double the rate for older female patients.
But despite this increased risk, experts say many men view brittle bones as a "woman's problem."
One recent US study, reported in the journal Osteoporosis International, "validated what we thought - that men who have fractures are woefully undertreated.
"Just one in every six men who had a spine or hip fracture was treated with osteoporosis medications" to strengthen ailing bones, says Dr. Thomas J. Weber, an assistant professor of medicine at Duke University Medical Center.
According to the same study, just 1.1 percent of men brought to the hospital for a serious fracture received a bone density test to evaluate their overall risk.
A bone density test is used to measure the bone mineral content and density. This measurement can indicate decreased bone mass, a condition in which bones are more brittle and more prone to break or fracture easily.
"Now, doctors wouldn't hesitate to do that for a woman, but it seems we just don't think of it in terms of men," Dr. Weber says.
It is true that men start out with denser, healthier bones than women.
"Women have less bone to begin with, and then they get a big hit at menopause," says Dr. Joseph Lane, chief of the metabolic bone disease service at the Weill Cornell Medical College's Hospital for Special Surgery in New York City.
"The overall rate of bone loss for men and women is the same, but because men start higher they don't get into trouble as quickly - osteoporosis is not an issue for men until 70 and beyond," he says.
But when a fracture occurs in the elderly, brittle bones can quickly become a life-or-death concern.
"There are a number of reasons people can die after fracture," Dr. Weber explains. "They may have underlying cardiovascular disease that leads to congestive heart failure. They may develop infection and there's a suggestion, based on some evidence that perhaps in 25 percent of male patients death is related to the consequences of the hip fracture itself."
While menopause is a major cause of bone deterioration in women, factors such as smoking, alcohol consumption, and the use of certain medicines increase fracture risks for men, Dr. Lane notes.
The gradual age-related decline in circulating testosterone is another factor.
"A young guy has a testosterone value of about 1,000 and older men are down to about 300," he says.
All of these risk factors are preventable, either through quitting smoking and heavy drinking, or with the help of medications, says Dr. Lane, who is also a spokesman for the American Academy of Orthopaedic Surgeons.
And there is diet and exercise.
"In general, men over the age of 50 should be getting 1,200 mg of calcium a day from diet, or diet and supplements combined," Dr. Weber says.
Dr. Lane advises men to use calcium citrate - not bicarbonate - supplements, because the bicarbonate formulation raises risks for kidney stones.
The current recommended daily allowance for another bone-strengthener, vitamin D, is 400 International Units (IU) per day for older men, but Dr. Weber says that level is currently under review and will no doubt be revised.
"I think maybe upwards of 800 to 1,000 IU can be safely recommended for men," he says. Many foods, including milk, come fortified with vitamin D (check the label) and cod liver oil capsules are particularly high in the nutrient.
Skin also manufactures vitamin D under strong sunlight. "It has to do with the sun's angle, though, so go out there between 10 a.m. and 2 p.m. rather than taking a walk in the early morning," Dr. Weber says.
As for exercise, its benefits are more about balance than bones, according to Dr. Weber.
"Exercise's effects on the skeleton tend to be fairly modest," he explains. "When we prescribe exercise for older people we're doing it not only to help bone density but to increase strength and reduce their risk of falls."
Dr. Lane agrees. "You need two things for a fracture: bad bones and a fall. There's an easy way to tell if you're at high risk for falling: try standing on one leg for 12 seconds. If you can't do that, then by definition you're an unsteady individual who needs fall protection" such as sturdy shoes, a cane, or walker, he says.
But failing balance can be restored, and one of the world's oldest interventions remains among the most effective.
"The most successful method is Tai Chi," Dr. Lane says. "All of the YMCAs in New York now teach Tai Chi, and we send all the people who fail the one-leg test to the Y to learn it."
Always consult your physician for more information.
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The US Food and Drug Administration (FDA) recently ordered updated labeling for the impotence drugs Viagra®, Cialis®, and Levitra® to reflect a small number of reports of sudden vision loss among users.
The agency is advising consumers to stop taking these medications and call a physician immediately if they experience sudden or decreased vision loss in one or both eyes.
This condition is known as NAION (nonarteritic ischemic optic neuropathy) and occurs when blood flow is blocked to the optic nerve.
Anyone taking or considering taking one of these erectile dysfunction medications should also tell their healthcare provider if they have ever had severe loss of vision, which might reflect a prior episode of NAION.
Such patients are at an increased risk of developing NAION again, the FDA says in a statement.
The agency states it had not yet been able to determine if the medications were the cause of the loss of eyesight or whether the problem was related to other factors such as high blood pressure or diabetes, or to a combination of these problems.
The move followed an announcement by the FDA that it had received 43 reports of varying degrees of vision loss - including blindness - among 38 users of Viagra, four users of Cialis, and one user of Levitra.
But, health experts caution, this type of vision loss also is linked to the same illnesses - such as heart disease and diabetes - that can lead to impotence or erectile dysfunction.
FDA spokeswoman Susan Cruzan says the labeling change was "based on adverse event reports, a total of 43 for all three drugs. But we have not established that this is a cause-and-effect relationship.
"We're not sure we can establish it as the cause, because this is a population with other problems. If and when we get other reports, based on media interest, we will continue to evaluate and monitor the report," she says. "That's what we do for every drug."
An estimated 23 million American men take these impotence medications.
The FDA states that the vision problems are attributed to NAION, which is considered one of the most common causes of sudden vision loss in older Americans. Estimates suggest there are anywhere from 1,000 to 6,000 cases a year.
Risk factors for NAION include diabetes and heart disease - two of the leading causes of impotence. For that reason, it may be impossible for the FDA to determine whether the impotence medications contribute to vision loss.
Dr. Robert Cykiert, an ophthalmologist at New York University Medical Center, says "these drugs are known to have effects on the blood vessels in various parts of the body."
Viagra can cause blood pressure to drop, which may cause insufficient blood flow to the optic nerve, resulting in vision loss, he explains.
"Probably, patients need to be careful about using this drug," Dr. Cykiert says. "If somebody has bad vascular disease, then they are at an increased risk of developing vision problems. The risk is low, but it is a possible risk factor."
Always consult your physician for more information.
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