Larry Curson was a strapping 6-foot-1-inch farmer growing 200 acres of corn and raising some 550 head of cattle and hogs in Marshalltown, Iowa. Then, at age 38, he was hospitalized for a blood clot in his left leg, and doctors discovered that his bones were breaking.
Now, 25 years later, Curson walks on crutches. Because of the broken vertebrae in his back, he stands just 5-foot-5. He fills his days carving wooden caricatures for friends, having given up farming 23 years ago. "When I was told I had osteoporosis, I asked the doctor: 'What is this? I've never heard of it.' Whenever you pick up something about osteoporosis, it's always about women and menopause." Today, he says, "I can't really take a deep breath because my torso's so packed together. I was not aware how serious it was going to be."
Curson is one of 2 million American men who have what many think of as a woman's disease. While more than three times as many women have this problem, a man is more likely to get osteoporosis than prostate cancer. One in four men over age 50 will suffer an osteoporosis-related fracture. And a man who breaks a hip -- though half as likely as a woman to do so -- is twice as likely to die within a year. "Most men aren't aware that they can get this disease until they get a fracture," says Dr. Sundeep Khosla, professor of medicine at Mayo Clinic College of Medicine and a leading researcher in the field. Men who learn of their affliction are sometimes embarrassed to own up to it. For example, a 57-year-old professor with osteoporosis was willing to talk to BusinessWeek about it but not to have his name used.
Only in recent years have doctors come to understand that osteoporosis threatens men, says Dr. Laura Tosi, who is on the board of directors of the American Academy of Orthopaedic Surgeons. Even 10 years ago, a man who displayed signs of osteoporosis might have puzzled his family physician. In 1994, when an X-ray for a sprained ankle turned up the professor's osteoporosis, the family doctor who spotted it nonchalantly told him to take a little calcium. He had to beg another family doctor to do additional testing to determine the severity of his problem.
Unlike with women -- who often develop osteoporosis after menopause, when estrogen levels plummet -- there is no abrupt life change that causes a man to get the disease. Age is a factor (as it is with women). Bones reach peak density around age 30, then begin a (hopefully) slow decline. The propensity for normal bone loss to escalate into osteoporosis is often genetic for either sex.
Many times male osteoporosis arises from an underlying condition: smoking or excessive drinking; low testosterone levels; glucocorticoid steroids (often prescribed to treat ailments such as asthma); hormone agonists to cut testosterone output during prostate-cancer treatment. In Curson's case, an overactive thyroid may have contributed to his development of osteoporosis at such a young age. Hyperparathyroidism, or overactivity of the small parathyroid glands behind the thyroid, is also a risk factor.
A CLOSER LOOK
A man with such conditions should ask his physician for a DEXA (Dual Energy X-Ray Absorptiometry) scan, which uses low-dose X-rays to measure bone density. It costs around $250 and is often covered by insurance. While the National Osteoporosis Foundation advises women age 65 and older to take the test, as well as younger women considered at risk, there is no age standard for men. The sexes lose bone at the same rate once they reach 65, but men are less likely to suffer breaks because they start out with bigger bones.
Men who want to reduce their chances of getting this crippling disease should quit smoking and drink only moderately (no more than two drinks per day), since chemicals in these substances can be toxic to the cells that make bone. Weight-bearing exercise such as walking, running, and, of course, weight-lifting help strengthen bones, says orthopedic surgeon Dr. Kimberly Templeton.
Adequate calcium, magnesium, and Vitamin D (which comes from sunlight) are needed to build bone. Adults should have 1,000 milligrams of calcium per day, and 1,200 after age 50. Since a glass of milk or fortified orange juice provides only 300 milligrams of calcium, supplements are the best option for many people, says Dr. Tosi. If you're taking antacids for calcium, check the label. Avoid those containing aluminum, which prevents new cells from adhering to bone. For people who work indoors, getting enough Vitamin D can also be difficult. Adults need at least 400 to 800 IU (international units) to fully absorb the recommended calcium. Ten to 15 minutes of daily sunshine can meet the requirement. Otherwise, a multivitamin may be in order.
Researchers are still looking for reasons why some men develop osteoporosis and others don't, and studying which drugs used for women also work for men. Part of the solution for men is to realize they need to be watchful -- and, if necessary, proactive -- to prevent a serious problem. When it comes to bones, anyone's can break.
By Carol Marie Cropper