Why brittle bones aren’t just a woman’s problem

Ronald Klein was biking around his neighbourhood in North Wales, Pennsylvania, in 2006 and tried to jump 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 break the fall. It didn’t seem like a serious accident, yet “I couldn't get up,” he said. At the emergency room, X-rays showed that he had fractured both his hip, which required surgical repair, and his shoulder. Klein, a dentist, went back to work in three weeks, using a cane. After about six months and plenty of physical therapy, he felt fine.

- Paula Span, Tribune News Service

But he wondered about the damage the fall had caused. “A 52-year-old is not supposed to break a hip and a shoulder,” he said. At a followup visit with his orthopedist, “I said, ‘Maybe I should have a bone density scan.” As Klein suspected, the test showed he had developed osteoporosis, a progressive condition, increasing sharply with age, that thins and weakens bones and can lead to serious fractures. Klein immediately began a drug regimen and, now 70, remains on one. Osteoporosis occurs so much more commonly in women, for whom medical guidelines recommend universal screening after age 65, that a man who was not a health care professional might not have thought about getting a scan. The orthopedist didn't raise the prospect.

But about I in 5 men over age 50 will suffer an osteoporotic fracture in their remaining years, and among older adults, about a quarter of hip fractures occur in men. When they do, “men have worse outcomes,” said Cathleen Colón-Emeric, a geriatrician at the Durham VA Health Care System and Duke University and the lead author of a recent study of osteoporosis treatment in male veterans. “Men don’t do as well in recovery as women,” she said, with higher rates of death (25% to 30% within a year), disability 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 said.