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Ask the Pharmacist
by Ron & Marla Chapleau

December 28, 2016
www.saugeentimes.com
www.kincardinetimes.com

Health

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Q) I slipped on the ice yesterday, fell, and wound up surprisingly with a broken bone. Can males have osteoporosis too?

A) Osteoporosis has long been thought of as a “female’s disease” and is therefore often ignored in males until things take a dramatic turn for the worse.

 The facts are that while women are predominantly affected, the disease is very common in both sexes with an estimated incidence in the general population of those aged 40 or above at 10%. This equates to approximately 1.5 million Canadians aged 40 or above who are at risk of a life altering fracture due to the fragility of their bones.

Females are four times more likely to report osteoporosis than males, but these numbers may be heavily skewed by the fact that so few males bother to get their bone densities checked and are therefore potentially walking around at risk and undiagnosed.

As well, the numbers may be starting to balance out a little as men are now living longer and their life expectancy is increasing faster than females meaning that men will be living long enough to fracture. Experts currently estimate that one in five men over the age of 50 will experience an osteoporotic fracture during their lifetime and at present almost 30% of hip fractures occur in males.

There’s also evidence that men deal less well with fractures than their female counterparts do. While males experience about half as many fractures as females do they are more likely to be permanently disabled by a hip fracture and more than twice as likely to die within a year. Some specialists now recommend that any man over 70 should have a bone density test, and if they have other risk factors for osteoporosis, they should be checked perhaps as soon as the age of 50.

 Common risk factors for a fracture are similar for both sexes. These include advanced age (over 60 for women and over 70 for men); being thin or underweight; being a smoker; consuming more than 3 alcoholic beverages a day; a family history of osteoporosis; or having suffered a previous fracture already.

As well there are a bunch of health conditions that can increase either sex’s risk of suffering from osteoporosis including rheumatoid arthritis; mobility disorders such as Parkinson’s; multiple sclerosis; a history of stroke; celiac disease and COPD.

Some medications can also thin one’s bones when used long-term including glucocorticoids such as prednisone; drugs for prostate cancer; drugs used to reduce stomach acid; antidepressants; some anti- seizure drugs; a number of cancer treatments; and immunosuppressants such as cyclosporine.

Of the many groups noted above, those on prolonged glucocorticoids (such as those taking prednisone at a dose of 7.5mg per day or more for 3 months or longer) or those who were treated for prostate cancer with androgen deprivation therapy are at especially high risk and there are strong feelings that they should be put on osteoporosis drugs as a preventative measure.

One alarming stat shows that by five years of antiandrogen prostate treatment almost 20% of white males (& 15% of African-Americans) will suffer an osteoporotic fracture.

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Like risk factors, treatment is similar for both males and females. Lifestyle choice that can help include regular weight bearing and resistance exercises, adequate consumption of calcium (1200mg a day for men over 70) preferably through diet (as supplements may contain some degree of cardiovascular risk especially when taken in large amounts) and ensuring you get enough vitamin D (800-2000 IU a day, more than likely through pills as natural sources are few and far between, especially in the winter).

Drug treatment options include the tablets known as the biphosphonates (alendronate/ Fosamax, risedronate/ Actonel...) which are generally taken for a period of five years , followed by a 1-2 year break at which point the bones are rechecked to see if continued treatment is warranted. As well, the twice yearly monoclonal antibody known as Prolia can be given as an injection and seems to work at least as well the biphosphonates and might be more useful than those in men who are at risk due to prostate cancer treatments.

Another drug that doesn’t seem to be used as much as the others but may be very effective is Forteo which is a man-made form of our parathyroid hormone. Forteo is the only osteoporotic med that stimulates bone growth (all of the others slow down bone loss) and might be of particular use to those who suffered a fracture while already taking a bisphosphonate or who’s osteoporosis is related to glucocorticoid therapy.

A last option that can be looked at is testosterone replacement therapy. This should only be considered in those whose blood levels have been proven to be low and also have other associated symptoms (such as a low libido) and only in combination with one of the other previously mentioned therapies. This is because while testosterone does increase bone density, there is no evidence to support that it reduces the risk of a fracture.

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For more information about this or any other health related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination.


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Wednesday, December 28, 2016