Hormones A Hidden Factor In Men’s Bone Health

While post-menopausal women are more prone to osteoporosis and increased risk of fracture, older men are not immune to a weakening of their bones due to hormonal changes.

Every adult experiences a slow decline in bone density after they reach their peak bone mass, usually beginning in their third decade of life, said Samuel Worsham, DO, a Franciscan Physician Network endocrinologist in Lafayette, Indiana.

In men, the aromatase enzyme converts testosterone to estrogen, which helps protect bone mass. A loss of testosterone can impact that process and lead to bone density loss.

“Factors that increase the risk of developing osteoporosis could be hypogonadism (a condition in which the body doesn’t produce enough testosterone), hormone suppression from prostate cancer treatment, long-term steroid use, tobacco use and alcohol abuse,” Dr. Worsham said.

As men age, bone density decreases, making fractures more likely. The National Institutes of Health reports that incidents involving fractures are 10 to 15 times more likely to occur in adults aged 60 or older. Arthritis and lower back problems also increase with age.

Bone Density Screenings For Men

A bone density screening is recommended in all men over 70 and if a patient under 50 has been diagnosed with low testosterone.

A fracture risk assessment, determining a FRAX score using a patient’s age and weight along with health history, can help identify risk factors associated with increased risk of fracture.

Men’s Fracture Risk

Most people will experience joint or bone issues, particularly as they age. However, due to physical and hormonal differences, men have an injury risk distinct from that of women.

James Hartson, MD, an orthopedic surgeon at Franciscan Health Michigan City, says men tend to have orthopedic injuries that are less common in women. These injuries include trauma such as hand and wrist fractures.

“Men tend to do more manual labor, weekend home repairs and physical hobbies that leads to hand and wrist fractures,” Dr. Hartson said. “Also, younger men who participate in contact sports and extreme sports are more common to fracture their upper extremities.”

Physical activities or labor can also lead to soft-tissue injuries such as torn knee meniscus, distal biceps rupture (a tear of the tendon from the forearm bone) and rotator cuff issues in the shoulder. Tears of the Achilles tendon, which connects the calf muscle to the heel bone, are much more common in men.

Preventing Fractures

What can men do to prevent injuries? Dr. Hartson believes that most injuries can be prevented by following overall wellness guidelines, including a well-balanced diet and a routine exercise program that includes cardiovascular exercises and light weight training with dumbbells or machines.

“As we age, flexibility becomes increasingly important. The less flexible the muscles and tendons, the increased risk of strains, tears and ruptures. Therefore, I would recommend a good flexibility class or yoga,” he said.

While research continues to improve injury treatment, Dr. Hartson says older techniques are still effective, including massage, ultrasound, electrical stimulation, medications and surgery. Newer techniques include platelet-rich plasma injections for muscle, tendon and joint injuries.