Why Brittle Bones Aren’t Just a Woman’s Problem

In 2006, Ronald Klein was biking through his neighborhood in North Wales, Pennsylvania, when he attempted to jump a curb. “But I was going too slow — I didn’t have enough momentum,” he recalled. As his bike toppled, he instinctively thrust out his left arm to break the fall. Although it didn’t seem like a serious accident at the time, he soon found himself unable to get up.

At the emergency room, X-rays revealed that he had fractured both his hip and shoulder, necessitating surgical repair. Klein, a dentist, returned to work within three weeks, using a cane for support. After six months of physical therapy, he felt back to normal but couldn’t shake the concern about the underlying damage from his fall. “A 52-year-old is not supposed to break a hip and a shoulder,” he said. During a follow-up visit with his orthopedist, he suggested, “Maybe I should have a bone density scan.”

As Klein suspected, the scan confirmed he had developed osteoporosis, a progressive condition that weakens bones and increases fracture risk, particularly as one ages. Now at 70, he remains on a medication regimen to manage his condition.

Osteoporosis is often perceived as a women’s issue, with medical guidelines recommending universal screening for women after age 65. However, about 1 in 5 men over age 50 will experience an osteoporotic fracture in their remaining years. Alarmingly, around 25% of hip fractures occur in men, and when they do, “men have worse outcomes,” according to Cathleen Colón-Emeric, a geriatrician at the Durham VA Health Care System and Duke University.

“Men don’t recover as well as women,” she noted, with higher rates of mortality (25% to 30% within a year), disability, and institutionalization. “A 50-year-old man is more likely to die from complications of a major osteoporotic fracture than from prostate cancer,” she added. Major fractures include those of the wrist, hip, femur, humerus, pelvis, or vertebra.

In a study of 3,000 veterans aged 65 to 85 conducted at Veterans Affairs health centers in North Carolina and Virginia, only 2% of those in the control group had undergone bone-density screening. “Shockingly low,” remarked Douglas Bauer, a clinical epidemiologist at the University of California-San Francisco, who published an accompanying commentary in JAMA Internal Medicine. “Abysmal. And that’s at the VA, where it’s paid for by the government.”

However, establishing a bone health service led to significant changes in the intervention group, who had at least one risk factor for osteoporosis. Forty-nine percent agreed to a scan, and half of those tested were found to have osteoporosis or its precursor, osteopenia. Most began medications to preserve or rebuild their bones.

“We were pleasantly surprised that so many agreed to be screened and were willing to initiate treatment,” Colón-Emeric said. After 18 months, bone density had increased modestly for those in the intervention group, who were more likely to adhere to their drug regimens than osteoporosis patients of either sex in real-world conditions.

The study raises an important question: Should older men be screened for osteoporosis, similar to women? While men typically have larger and denser bones and develop osteoporosis later in life, they are now living longer, often into their 70s and 80s, making them more susceptible to fractures.

“With osteoporosis testing and treatment, a man could see a clear-cut improvement in mortality and, more importantly, his quality of life,” Bauer stated. Yet, both patients and many doctors still view osteoporosis as primarily a women’s disease. “There’s a bit of a Superman idea,” said Eric Orwoll, an endocrinologist at Oregon Health & Science University. “Men would like to believe they’re indestructible, so a fracture doesn’t have the implication that it should.”

Another barrier to screening is the inconsistency in clinical practice guidelines. Professional associations recommend that men aged 50 and older with risk factors, and all men over 70, should seek screening. However, the American College of Physicians and the U.S. Preventive Services Task Force have deemed the evidence for screening men “insufficient.”

As a result, Medicare and many private insurers typically do not cover screening for men who haven’t had a fracture, although they will cover care for men diagnosed with osteoporosis. “Things have been stalled for decades,” Orwoll noted.

Older men may need to advocate for themselves by asking their doctors about a DXA (pronounced DECKS-ah) scan, which is widely available at a cost of $100 to $300 out-of-pocket. Since osteoporosis is often asymptomatic, many men (and women) remain unaware of their deteriorating bone health until a fracture occurs.

“If you had a fracture after age 50, you should have a bone scan — that’s one of the key indicators,” Orwoll advised. Other risk factors include falls, a family history of hip fractures, and various health conditions like rheumatoid arthritis and hyperthyroidism. Lifestyle factors such as smoking and excessive alcohol use also increase the risk of osteoporosis.

When osteoporosis is diagnosed, treatment options may include oral medications like Fosamax or Actonel, intravenous formulations like Reclast, or injections such as Forteo or Prolia. While lifestyle changes like exercise and proper nutrition are beneficial, they are often not enough to halt or reverse bone loss.

Although guidelines don’t universally recommend it yet, Colón-Emeric advocates for screening all men aged 70 and up due to the high risk of disability following hip fractures. “Two-thirds of older people will not regain their prior mobility,” she noted, emphasizing the effectiveness and affordability of osteoporosis medications.

Despite the slow progress in raising awareness about osteoporosis in men, Klein recalls attending a seminar for patients using the drug Forteo, where he was the only male present. “It’s clear that more needs to be done to inform both patients and healthcare professionals about the risks men face,” Orwoll concluded.

The New Old Age is produced through a partnership with The New York Times.

In 2006, Ronald Klein was biking through his neighborhood in North Wales, Pennsylvania, when he attempted to jump a curb. “But I was going too slow — I didn’t have enough momentum,” he recalled. As his bike toppled, he instinctively thrust out his left arm to break the fall. Although it didn’t seem like a serious accident at the time, he soon found himself unable to get up.

At the emergency room, X-rays revealed that he had fractured both his hip and shoulder, necessitating surgical repair. Klein, a dentist, returned to work within three weeks, using a cane for support. After six months of physical therapy, he felt back to normal but couldn’t shake the concern about the underlying damage from his fall. “A 52-year-old is not supposed to break a hip and a shoulder,” he said. During a follow-up visit with his orthopedist, he suggested, “Maybe I should have a bone density scan.”

As Klein suspected, the scan confirmed he had developed osteoporosis, a progressive condition that weakens bones and increases fracture risk, particularly as one ages. Now at 70, he remains on a medication regimen to manage his condition.

Osteoporosis is often perceived as a women’s issue, with medical guidelines recommending universal screening for women after age 65. However, about 1 in 5 men over age 50 will experience an osteoporotic fracture in their remaining years. Alarmingly, around 25% of hip fractures occur in men, and when they do, “men have worse outcomes,” according to Cathleen Colón-Emeric, a geriatrician at the Durham VA Health Care System and Duke University.

“Men don’t recover as well as women,” she noted, with higher rates of mortality (25% to 30% within a year), disability, and institutionalization. “A 50-year-old man is more likely to die from complications of a major osteoporotic fracture than from prostate cancer,” she added. Major fractures include those of the wrist, hip, femur, humerus, pelvis, or vertebra.

In a study of 3,000 veterans aged 65 to 85 conducted at Veterans Affairs health centers in North Carolina and Virginia, only 2% of those in the control group had undergone bone-density screening. “Shockingly low,” remarked Douglas Bauer, a clinical epidemiologist at the University of California-San Francisco, who published an accompanying commentary in JAMA Internal Medicine. “Abysmal. And that’s at the VA, where it’s paid for by the government.”

However, establishing a bone health service led to significant changes in the intervention group, who had at least one risk factor for osteoporosis. Forty-nine percent agreed to a scan, and half of those tested were found to have osteoporosis or its precursor, osteopenia. Most began medications to preserve or rebuild their bones.

“We were pleasantly surprised that so many agreed to be screened and were willing to initiate treatment,” Colón-Emeric said. After 18 months, bone density had increased modestly for those in the intervention group, who were more likely to adhere to their drug regimens than osteoporosis patients of either sex in real-world conditions.

The study raises an important question: Should older men be screened for osteoporosis, similar to women? While men typically have larger and denser bones and develop osteoporosis later in life, they are now living longer, often into their 70s and 80s, making them more susceptible to fractures.

“With osteoporosis testing and treatment, a man could see a clear-cut improvement in mortality and, more importantly, his quality of life,” Bauer stated. Yet, both patients and many doctors still view osteoporosis as primarily a women’s disease. “There’s a bit of a Superman idea,” said Eric Orwoll, an endocrinologist at Oregon Health & Science University. “Men would like to believe they’re indestructible, so a fracture doesn’t have the implication that it should.”

Another barrier to screening is the inconsistency in clinical practice guidelines. Professional associations recommend that men aged 50 and older with risk factors, and all men over 70, should seek screening. However, the American College of Physicians and the U.S. Preventive Services Task Force have deemed the evidence for screening men “insufficient.”

As a result, Medicare and many private insurers typically do not cover screening for men who haven’t had a fracture, although they will cover care for men diagnosed with osteoporosis. “Things have been stalled for decades,” Orwoll noted.

Older men may need to advocate for themselves by asking their doctors about a DXA (pronounced DECKS-ah) scan, which is widely available at a cost of $100 to $300 out-of-pocket. Since osteoporosis is often asymptomatic, many men (and women) remain unaware of their deteriorating bone health until a fracture occurs.

“If you had a fracture after age 50, you should have a bone scan — that’s one of the key indicators,” Orwoll advised. Other risk factors include falls, a family history of hip fractures, and various health conditions like rheumatoid arthritis and hyperthyroidism. Lifestyle factors such as smoking and excessive alcohol use also increase the risk of osteoporosis.

When osteoporosis is diagnosed, treatment options may include oral medications like Fosamax or Actonel, intravenous formulations like Reclast, or injections such as Forteo or Prolia. While lifestyle changes like exercise and proper nutrition are beneficial, they are often not enough to halt or reverse bone loss.

Although guidelines don’t universally recommend it yet, Colón-Emeric advocates for screening all men aged 70 and up due to the high risk of disability following hip fractures. “Two-thirds of older people will not regain their prior mobility,” she noted, emphasizing the effectiveness and affordability of osteoporosis medications.

Despite the slow progress in raising awareness about osteoporosis in men, Klein recalls attending a seminar for patients using the drug Forteo, where he was the only male present. “It’s clear that more needs to be done to inform both patients and healthcare professionals about the risks men face,” Orwoll concluded.

The New Old Age is produced through a partnership with The New York Times.