While osteoporosis is more prevalent in older women, an increasing number of men are falling prey to the bone disease
IT HAS been called the silent disease and it's also been called a "women's disease". The silent disease label might be extremely accurate because osteoporosis progresses without symptoms until a fracture occurs. But labelling it a women's disease couldn't be more wrong.
While osteoporosis - an ailment that causes the skeleton to weaken and the bones to break - is more prevalent in older women, an increasing number of men are succumbing to the disease.
"Osteoporosis is preventable and treatable in the majority of people but men are usually not diagnosed until it is too late," explains Prof Moira O'Brien of Trinity College Dublin, an expert on the disease and a founder of the Irish Osteoporosis Society.
"Because osteoporosis is widely considered to be a condition that only affects older women, men are disadvantaged, as it is not considered as a diagnosis in men," she says.
"As a result, they are not scanned to determine whether they have osteoporosis, despite the fact that osteoporosis will affect one in five men. It will affect one in three women over 50 and one in two women over 65 and it can affect all age groups, including children."
Osteoporosis develops less often in men than in women because men have larger skeletons, their bone loss starts later in life and progresses more slowly, and they have no period of rapid hormonal change and bone loss.
"The only difference between men and women is that women go through the menopause and, because their bones are smaller, they lose a lot more bone," says Michele O'Brien, health promotion officer with the Irish Osteoporosis Society.
"Otherwise, the majority of the risk factors for women are the same for men.
"There is a huge misconception even among a huge number of health professionals today that it is an old ladies' disease.
"The statistics for men in Ireland show that by the time they get diagnosed it's too late, which is ridiculous because it is preventable and it's treatable but we still have a huge problem with men being refused scans and children being refused scans."
One in every three women and one in every five men will develop an osteoporotic fracture during their lifetime, says Prof O'Brien.
"Up to 20 per cent of symptomatic vertebral fractures and 30 per cent of hip fractures occur in men, where they are associated with excess mortality, substantial morbidity, possibly due to co-existing conditions associated with osteoporosis rather than the fracture itself," she says.
All low-trauma fractures in both sexes should be considered osteoporosis and be treated, unless proven otherwise, according to Prof O'Brien.
"There is an increased morbidity and mortality after all major osteoporotic fractures, which is higher in men than women," she says.
"Twenty per cent of people aged 60 who fracture a hip will die within six to 12 months due to the secondary complications of osteoporosis, which are blood clots, pneumonia or infection from being bed bound.
"Fifty per cent of people aged 60 who fracture a hip will no longer be able to dress, wash or walk unassisted. Only 30 per cent of people aged 60 who fracture a hip will regain their independence."
Men, similar to women with symptomatic vertebral fractures, commonly complain of back pain, loss of height and kyphosis - a permanent curving of the spine that makes somebody look hunched over - but men have significantly less energy, poorer sleep, more emotional problems and impaired mobility than age-matched control subjects.
According to O'Brien, the most common cause of osteoporosis is hypogonadism or the lack of male hormone testosterone. This may be the result of a variety of conditions, which include abnormal chromosomes and excessive stress, either physical or psychological.
Overtraining in athletes, particularly those that have to maintain a low body weight, is associated with low levels of testosterone and high levels of cortisol - which affects bone - and low bone density.
Dietary problems, low caloric intake, inadequate calcium and vitamin D levels in the diet also play a role. Alcohol abuse, excessive caffeine intake and smoking and lack of exercise are also risk factors.
Males with a family history of osteoporosis or a close relative with a history of a low trauma hip or vertebral fracture should be referred for a DXA scan which can measure bone density, according to Prof O'Brien.
All men with osteoporosis should be given lifestyle advice on how to decrease bone loss, including an adequate caloric intake, calcium and vitamin D, 30 minutes of daily weight-bearing exercise, cessation of smoking and reduction of alcohol intake, she says.
"If there is a history of falls, attempts should be made to identify and modify underlying intrinsic and extrinsic causes, in the hope that these may be modified and the risk, therefore, of further falls and fractures decreased."
Colm Cullen (pictured in wheelchair, above) was shocked when he was told he had osteopenia, the medical diagnosis for the early signs of osteoporosis.
"When you see the little old lady bent over her shopping trolley, that's the kind of person I thought suffered from osteoporosis," he says.
It was by chance that he was actually diagnosed with the ailment.
A garda in the traffic division, Cullen was left paralysed from the chest down when he was involved in a traffic accident in 1992.
Six years ago, he was asked by the National Rehabilitation Hospital if he would take part in a study for a Trinity student's thesis on the subject of osteoporosis. On the day, it turned out that, at 48, he was too old for the case studies being conducted by the student.
But they decided to carry out the scan anyway even though he wouldn't be used in the study. It transpired he had the advance stages of the disease.
"It scared me," he says.
He was told to take calcium supplements, medication once a week and to make improvements to his diet. Two years ago, a scan showed that he had an 8 per cent improvement in his bone density.
"I would advise any middle-aged man to get a scan," he says. "If it turns out that you don't have the disease, you will be reassured and if you do have it, you can be treated. It's like prostate cancer - the earlier you get it, the more successfully it can be treated."