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Q
Bone Scans for Men?

I heard recently that men as well as women should have bone density tests as they get older. Is this true? What would put a man at risk for osteoporosis?

A
Answer (Published 9/27/2012)

You heard correctly. The Endocrine Society, a professional organization of physicians and researchers, has issued a new set of guidelines recommending bone density screening for all men age 70 and older and for those aged 50 to 69 who have risk factors for osteoporosis. The guidelines were published in the June 2012 issue of the Journal of Clinical Endocrinology and Metabolism. This collaboration of medical professionals isn’t the first group to recommend bone density testing for men. The American College of Preventive Medicine (ACPM) and the National Osteoporosis Foundation (NOF) also recommend screening of men 70 and older.

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In announcing the guidelines, the Endocrine Society emphasized that men as well as women suffer from osteoporosis, and that although the bone disorder is more common in women, men actually account for disproportionately more fractures due to the condition than women and face a higher risk of dying as a result. The Endocrine Society task force that wrote the guidelines noted that an estimated 20 percent of the 44 million Americans who have osteoporosis and osteopenia are men 70 and older. According to the NOF, up to one in four men over 50 will suffer a fracture due to weakened bones and each year about 80,000 men will break a hip. The NOF reports that approximately two million American men have osteoporosis, that 12 million more are at risk and that men over 50 are more likely to break a bone due to osteoporosis than they are to develop prostate cancer.

The risk factors for osteoporosis in men include a family history of the disorder, a sedentary lifestyle, smoking, drinking alcohol to excess, and low testosterone levels. Certain health problems can also increase a man’s risk, including chronic kidney or gastrointestinal disease, prostate cancer, and autoimmune disorders such as rheumatoid arthritis. Additional risks include a history of fracture after age 50, chronic obstructive pulmonary disease, and taking steroid drugs like prednisone used to treat diseases such as asthma and rheumatoid arthritis. (Bone loss is a common side effect of these drugs.)

Women begin losing bone mass rapidly after they reach menopause. This sudden change doesn’t occur in men, but by age 65 or 70, both men and women are losing bone mass at the same rate. Absorption of calcium also declines in both men and women in this age range. Men - and their physicians - don’t focus on thinning bones to the extent that women do. As a result, men may not know that they’re at risk until they break a bone, develop back pain, or notice that they’ve lost some height or that their posture has changed.

If you think you’re at risk of osteoporosis, it’s worth a discussion with your physician. A bone density test may be in order. You can find my recommendations for osteoporosis prevention and treatment here.

Andrew Weil, M.D.

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