Paula Span
Ronald Klein was biking round his neighborhood in North Wales, Pennsylvania, in 2006 and tried to leap a curb. “But I was going too slow — I didn’t have enough momentum,” he recalled.
As the bike toppled, he thrust out his left arm to interrupt the autumn. It didn’t appear to be a severe accident, but “I couldn’t get up,” he mentioned.
At the emergency room, X-rays confirmed that he had fractured each his hip, which required surgical restore, and his shoulder. Klein, a dentist, went again to work in three weeks, utilizing a cane. After about six months and loads of bodily remedy, he felt advantageous.
But he puzzled in regards to the harm the autumn had triggered. “A 52-year-old is not supposed to break a hip and a shoulder,” he mentioned. At a follow-up go to along with his orthopedist, “I said, ‘Maybe I should have a bone density scan.’”
As Klein suspected, the check confirmed he had developed osteoporosis, a progressive situation, rising sharply with age, that thins and weakens bones and may result in severe fractures. Klein instantly started a drug routine and, now 70, stays on one.
Osteoporosis happens a lot extra generally in girls, for whom medical pointers advocate universal screening after age 65, {that a} man who was not a well being care skilled may not have considered getting a scan. The orthopedist didn’t elevate the prospect.
But about 1 in 5 men over age 50 will undergo an osteoporotic fracture of their remaining years, and amongst older adults, about a quarter of hip fractures occur in men.
When they do, “men have worse outcomes,” mentioned Cathleen Colón-Emeric, a geriatrician on the Durham VA Health Care System and Duke University and the lead creator of a latest research of osteoporosis remedy in male veterans.
“Men don’t do as well in recovery as women,” she mentioned, with higher rates of death (25% to 30% inside a 12 months), incapacity and institutionalization. “A 50-year-old man is more likely to die from the complications of a major osteoporotic fracture than from prostate cancer,” she mentioned.
(What’s “major”? Fractures of the wrist, hip, femur, humerus, pelvis or vertebra.)
In her study of 3,000 veterans ages 65 to 85, performed at Veterans Affairs well being facilities in North Carolina and Virginia, solely 2% of these assigned to the management group had undergone bone-density screening.
“Shockingly low,” mentioned Douglas Bauer, a medical epidemiologist and osteoporosis researcher on the University of California-San Francisco, who printed an accompanying commentary in JAMA Internal Medicine. “Abysmal. And that’s at the VA, where it’s paid for by the government.”
But establishing a bone well being service — overseen by a nurse who entered orders, despatched frequent appointment reminders and defined outcomes — led to dramatic modifications within the intervention group, who had a minimum of one threat issue for the situation.
Forty-nine p.c of them mentioned sure to a scan. Half of these examined had osteoporosis or a forerunner situation, osteopenia. Where acceptable, most of them started medicines to protect or rebuild their bones.
“We were pleasantly surprised that so many agreed to be screened and were willing to initiate treatment,” Colón-Emeric mentioned.
After 18 months, bone density had elevated modestly for these within the intervention group, who have been extra more likely to follow their drug regimens than osteoporosis sufferers of both intercourse in real-world circumstances.
The research didn’t proceed lengthy sufficient to find out whether or not bone density elevated additional or fractures declined, however the researchers plan a secondary evaluation to trace that.
The outcomes revive a longtime query: Given how life-altering, even lethal, such fractures may be, and the supply of efficient medication to sluggish or reverse bone loss, ought to older males be screened for osteoporosis, as girls are? If so, which males and when?
Such points mattered much less when life spans have been shorter, Bauer defined. Men have larger and thicker bones and have a tendency to develop osteoporosis 5 to 10 years later than girls do. “Until recently, those men died of heart disease and smoking” earlier than osteoporosis might hurt them, he mentioned.
“Now, men routinely live into their 70s and 80s, so they have fractures,” he added. By then, they’ve additionally accrued different persistent circumstances that impair their means to get better.
With osteoporosis testing and remedy, “a man could see a clear-cut improvement in mortality and, more importantly, his quality of life,” Bauer mentioned.
Both sufferers and plenty of docs nonetheless have a tendency to treat osteoporosis as a girls’s illness, nonetheless. “There’s a bit of a Superman idea,” mentioned Eric Orwoll, an endocrinologist and osteoporosis researcher at Oregon Health & Science University.
“Men would like to believe they’re indestructible, so a fracture doesn’t have the implication that it should,” he added.
One affected person, for instance, for years resisted entreaties from his spouse, a nurse, to “see someone” about his visibly rounded higher again.
Bob Grossman, 74, a retired public college trainer in Portland, blamed poor posture as an alternative and informed himself to straighten up. “I thought, ‘It can’t be osteoporosis — I’m a guy,’” he mentioned. But it was.
Another impediment to screening: “Clinical practice guidelines are all over the place,” Colón-Emeric mentioned.
Professional associations just like the Endocrine Society and the American Society for Bone and Mineral Research advocate that males 50 and older who’ve a threat issue, and all males over 70, should seek screening.
But the American College of Physicians and the U.S. Preventive Services Task Force have deemed the proof for screening of males “insufficient.” Clinical trials have discovered that osteoporosis drugs increase bone density in men, as in girls, however most male research have been too small or lacked sufficient follow-up to point out whether or not fractures additionally declined.
The activity drive’s place signifies that Medicare and plenty of personal insurers usually received’t cowl screening for males who haven’t had a fracture, although they may cowl look after males recognized with osteoporosis.
“Things have been stalled for decades,” Orwoll mentioned.
So it might fall to older males themselves to ask their docs a few DXA (pronounced DECKS-ah) scan, broadly accessible at $100 to $300 out-of-pocket. Otherwise, as a result of osteoporosis is usually asymptomatic, males (and ladies, who’re additionally undertested and undertreated) don’t know their bones have deteriorated till one breaks.
“If you had a fracture after age 50, you should have a bone scan — that’s one of the key indicators,” Orwoll suggested.
Other threat components: falls, a household historical past of hip fractures, and a reasonably lengthy listing of different well being circumstances together with rheumatoid arthritis, hyperthyroidism and Parkinson’s illness. Smoking and extreme alcohol use improve the chances of osteoporosis as effectively.
“A number of medications also do a number on your bone density,” Colón-Emeric added, notably steroids and prostate most cancers medication.
When a scan reveals osteoporosis, relying on its severity, docs could prescribe oral medicines like Fosamax or Actonel, intravenous formulations like Reclast, day by day self-injections of Forteo or Tymlos, or twice-annual injections of Prolia.
Lifestyle modifications like exercising, taking calcium and vitamin D dietary supplements, stopping smoking, and ingesting solely reasonably will assist however aren’t ample to cease or reverse bone loss, Colón-Emeric mentioned.
Although pointers don’t universally advocate it, a minimum of not but, she wish to see all males age 70 and up be screened, as a result of the chances of incapacity after hip fractures are so excessive — two-thirds of older folks is not going to regain their prior mobility, she famous — and the medicines that deal with it are efficient and infrequently cheap.
But informing patients and health care professionals that osteoporosis threatens males, too, has progressed “at a snail’s pace,” Orwoll mentioned.
Klein remembers attending a seminar to instruct sufferers like him in utilizing the drug Forteo. “I was the only male there,” he mentioned.
The New Old Age is produced by means of a partnership with The New York Times.
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