When we think of osteoporosis, it's often mistakenly viewed as a condition that primarily affects older women. However, osteoporosis is a growing concern among men too and the statistics are alarming.
According to the National Osteoporosis Foundation South Africa (NOFSA), 1 in 5 men in South Africa is at risk of developing a fracture due to osteoporosis, compared to 1 in 3 women.
While the numbers are higher for women, this does not diminish the significant risk that men face, particularly as they age.
In light of these statistics, Yolandé Venter, a clinical dietitian, chose to focus her master's thesis on the diet and lifestyle risks of men with low bone density.
Together with Dr Jaco du Plessis, a radiologist at SCP Radiology, they explore the often-overlooked issue of osteoporosis in men, how bone mineral density is measured, and what treatment and prevention strategies are available.
What is osteoporosis?
Osteoporosis is a disease that weakens bones, making them fragile and more likely to break. Under a microscope, healthy bone looks like a honeycomb. In osteoporosis, the holes and spaces in this honeycomb become larger, reducing bone strength and density.
Osteoporosis often progresses silently, without any symptoms, until a fracture occurs. These fractures, commonly in the hip, spine or wrist, can be triggered by even minor incidents such as a small stumble or a sneeze.
This is why osteoporosis is often referred to as a "silent disease".
Osteoporosis in men
While osteoporosis is more commonly associated with women, men are not immune to its effects.
According to Venter, “Even though fewer men seem to be at risk of developing osteoporosis, it is still a problematic percentage.”
With 15 years of experience as a clinical dietitian, she emphasises the importance of maintaining a healthy body weight to prevent osteoporosis.
If you are underweight, it increases the risk of osteoporosis. If you are overweight, your vitamin D levels may be reduced, which can cause or worsen osteoporosis.”
Men often face unique risks when it comes to osteoporosis. Factors such as ageing, lifestyle habits, and hormonal changes — especially the male equivalent of menopause, known as andropause — play a significant role in bone health.
During andropause, men experience a decline in testosterone, which can lead to accelerated bone loss, particularly in the spine.
Diagnosing osteoporosis
To diagnose osteoporosis, radiologists measure bone mineral density (BMD) using various imaging techniques.
One of the most common methods is the Dual-Energy X-ray Absorptiometry (DEXA) scan, which is widely available in clinics and hospitals. A DEXA scan uses a low dose of radiation to generate a 2D image of your bones and measures their density.
Alternatively, a Computed Tomography (CT) scan can provide a more detailed 3D image of the bones, offering insights into bone quality and microarchitecture.
Although CT scans are more precise, they involve higher radiation exposure compared to DEXA scans.
“The amount of radiation in a DEXA scan is minimal,” says Du Plessis. "It’s equivalent to one or two days of background radiation at sea level."
Osteopenia v osteoporosis: What's the difference?
Both osteopenia and osteoporosis reflect decreased bone density, but they differ in severity. Osteopenia is a condition where bone density is lower than normal but not low enough to be classified as osteoporosis.
Diagnosing osteopenia early can serve as a warning sign, giving individuals time to take preventative measures before osteoporosis develops.
Du Plessis explains, "We measure your BMD by comparing it to that of a healthy, young adult. The result is a T-score, which tells us how much lower (or higher) your bone mass is."
This score helps predict the risk of fractures over the next 10 years, particularly for major fractures such as those of the hip. Preventing fractures later in life is crucial, as they are a leading cause of morbidity and mortality in elderly populations.
Risk factors
There are several risk factors for osteoporosis, some of which are beyond your control, such as age, genetics, and certain medical conditions.
However, many risk factors are lifestyle-related and can be managed. These include:
- Tobacco use and alcohol abuse.
- High caffeine intake.
- Sedentary lifestyle.
- Poor dietary habits, including low calcium and vitamin D intake.
- Low body weight and low muscle mass.
High levels of the stress hormone cortisol can deplete calcium and vitamin D in the body, leading to weakened bones.
Men undergoing treatment for prostate cancer are also at higher risk due to the effects of certain medications on bone density.
Du Plessis advises that men in this category should discuss regular bone health screenings with their healthcare provider.
Taking proactive steps
The path to treating low bone density involves a balanced approach of medication and lifestyle adjustments.
Bisphosphonates, hormone-related therapy, and other bone-building medications often feature in treatment plans.
Boosting calcium and vitamin D intake, engaging in weight-bearing exercises, quitting smoking and limiting alcohol are integral lifestyle changes that can fortify bone health.