Ronald Klein was riding his bike through his neighborhood in North Wales, Pennsylvania, in 2006 when he tried to jump over a ditch. “But I was too slow, I didn’t have enough momentum,” he recalled.
As the bike fell, he extended his left hand to break the fall. It didn't seem like a serious accident, but “I couldn't get up.”
At the emergency room, an X-ray revealed that he had a broken hip and shoulder, requiring surgery. Klein, a dentist, returned to work after three weeks using a cane. After about six months and a lot of physical therapy, he was doing well.
But he had to think about the damage caused by the fall. “A 52-year-old shouldn’t break his hip and shoulder,” he said. On a subsequent visit to the orthopedic surgeon, he said, “Maybe I should do a bone densitometry.”
As expected, the test showed that she had developed osteoporosis, a progressive disease that worsens with age, weakens bones and can lead to serious fractures. Klein immediately began drug treatment and, now 70, continues to do so.
Osteoporosis is much more common in women, for whom medical guidelines recommend universal screening after 65 yearstherefore, a non-medical professional might not consider densitometry. The traumatologist did not mention this possibility.
But approximately one in five Men over 50 years of age suffer from fractures associated with osteoporosis, and among older people approximately quarter Hip fractures occur in men.
And when that does happen, “men have a worse prognosis,” said Dr. Kathleen Colon-Emerick, a geriatrician at the Durham Veterans Health Care System and Duke University and lead author of a recent study on treating osteoporosis in male veterans.
“Men do not recover as well as women,” he said, with higher rates of death (25% to 30% per year), disability and hospitalization. “A 50-year-old man is more likely to die from complications of a major osteoporotic fracture than from prostate cancer,” he added.
(What is considered “major”? Fractures of the wrist, hip, femur, humerus, pelvis or vertebra).
in your learn from 3,000 veterans In a study conducted at Department of Veterans Affairs medical centers in North Carolina and Virginia between the ages of 65 and 85 years, only 2% of those in the control group underwent bone densitometry.
“It’s surprisingly low,” said Douglas Bauer, a clinical epidemiologist and osteoporosis researcher at the University of California, San Francisco, who published the study. additional comment in JAMA Internal Medicine. “Terrible. And this is at the Department of Veterans Affairs, where it is funded by the government.” But the creation of a bone health service, overseen by a nurse who wrote down orders, sent frequent appointment reminders and explained results, led to dramatic changes in the intervention group, which had at least one risk factor for developing the disease.
49% of them agreed to have an ultrasound scan. Half of those examined had osteoporosis or a pre-existing condition called osteopenia. When necessary, most of them began taking medications to preserve or restore bones.
“We were pleasantly surprised that so many people agreed to get tested and begin treatment,” Colon-Emerick said.
After 18 months, bone density increased slightly in the intervention group that continued to improve drug treatment, compared with osteoporosis patients of both sexes in a real-world setting.
The study did not last long enough to determine whether bone density increased further or whether the number of fractures decreased, but the researchers plan to conduct a secondary analysis for follow-up.
The results revive a long-standing question: Given how important and even fatal these fractures can be, and the availability of effective medications to slow or reverse bone loss, should older men be screened for osteoporosis in the same way as women? If so, which men and when?
These issues became less important when life expectancy was shorter, Bauer explained. Men have larger, thicker bones and are more likely to develop osteoporosis five to ten years later than women. “Until recently, these men were dying from heart disease and smoking” before osteoporosis could harm them, he said.
“Men now typically live into their 70s and 80s, so they do have fractures,” he said. By then, they have also accumulated other chronic diseases that affect their ability to recover.
By testing and treating osteoporosis, “a man could see a clear improvement in mortality and, more importantly, quality of life,” Bauer said.
However, both patients and many doctors still tend to consider osteoporosis a woman's disease. “It's kind of a Superman idea,” said Eric Orwall, an endocrinologist and osteoporosis researcher at Oregon Health & Science University.
“Men like to believe that they are indestructible, so the bill is not given the importance it should be,” he added.
One patient, for example, resisted for years the requests of his wife, a nurse, to “visit someone” because of his noticeably hunched back.
Bob Grossman, 74, a retired Portland public school teacher, decided to correct his posture and ordered himself to stand up straight. “I thought, ‘This can’t be osteoporosis, I’m a man,’” he said. But that's how it was.
Another barrier to screening: “Clinical practice guidelines are very varied,” Dr. Colon-Emerick said.
Professional associations such as the Endocrine Society and the American Society for Bone and Mineral Research recommend that men over 50 with a risk factor and all men over 70 screening tests are carried out.
However American College of Physicians And Preventive Services Task Force The US found the evidence for screening men to be “insufficient”.
Clinical trials show that drugs for osteoporosis increase bone density in men as well as women, but most studies in men were too small or did not have sufficient follow-up to show whether fracture rates were reduced.
The task force's position means that Medicare and many private insurers generally do not cover screening tests for men who have not had a fracture, although they do cover treatment for men diagnosed with osteoporosis.
“The situation has been stagnant for decades,” Orwall said.
Thus, older male patients may want to ask their doctors about bone densitometry, which is widely available for $100 to $300. Otherwise, because osteoporosis is often asymptomatic, men (and women, who also receive little testing and treatment) don't know their bones have deteriorated until they break.
“If you have a fracture after age 50, you should have bone densitometry; that’s one of the key indicators,” Orwall said.
Other risk factors include falls, a family history of hip fractures and a long list of other diseases, including rheumatoid arthritis, hyperthyroidism and Parkinson's disease. Smoking and excessive alcohol consumption also increase the likelihood of developing osteoporosis.
“Certain medications also affect bone density,” Colon-Emerick explained, especially steroids and prostate cancer medications. When an ultrasound reveals osteoporosis, depending on its severity, doctors may prescribe oral medications such as Fosamax or Actonel, intravenous medications such as Reclast, daily self-injections of Forteo or Tymlos, or semiannual injections of Prolia.
Lifestyle changes such as exercise, taking calcium and vitamin D supplements, quitting smoking and drinking alcohol in moderation will help, but they are not enough to stop or reverse bone loss, says Colon-Emerick.
While guidelines don't universally recommend it, at least not yet, he would like all men over 70 to be screened because the chances of disability after a hip fracture are very high (two-thirds of older people won't regain their previous mobility, he said) and the drugs that treat the injury are effective and often inexpensive.
However, education among patients and health care providers that osteoporosis also affects men has advanced Paso turtle,” said Orvoll.
Klein remembers attending a seminar to teach patients like him how to use Forteo. “I was the only man,” he said.
The New Old Age is produced in collaboration with New York Times.
