Edward Wilwerth was lifting groceries out of the car several weeks ago when he felt a sudden, sharp pain in his back.

        He went to the doctor and found out he had cracked a vertebra. His doctor suggested a bone density test, and that's when Mr. Wilwerth learned he has osteoporosis.

Pat Callahan and his wife, Helen, at their Burlington, Ky., home. Mr. Callahan developed osteoporosis as a result of taking Predbisone after a heart transplant in 1998. (Ernest Coleman photo) | ZOOM |

        “It's embarrassing,” the 69-year-old West Price Hill man says. “I thought it was something the ladies got.”

        More and more men are learning the hard way that they can get osteoporosis too, says Dr. Nelson Watts, an endocrinologist and director of the University of Cincinnati's new Bone Health and Osteoporosis Center.

        Men and their doctors need more education about osteoporosis, its risk factors and treatments, experts say.

        Osteoporosis is less common in men — the National Osteoporosis Foundation estimates that 2 million American men have the disease, as opposed to 8 million women — but it's just as disabling.

In chronic pain

        Pat Callahan, 64, of Burlington, routinely goes to a pain management clinic to treat the discomfort of the many fractures he's suffered as a result of osteoporosis. Since he was diagnosed with it in 1999, Mr. Callahan has suffered 10 fractured vertebrae, three herniated disks and seven fractured ribs.

        “I have no idea how I broke any of them, no idea whatsoever,” he says. “I'd just bump into something or bend over to pick something up or cough or sneeze the wrong way.”

        His activities are limited — he can't drive or walk very far, and he can't play golf anymore — and he's in chronic pain.

        Mr. Callahan and his doctors are fairly certain he developed osteoporosis as a result of taking prednisone to prevent rejection of a heart transplant he received in 1998. Prednisone and other steroids can cause loss of bone mass.

        Men tend to be in their 60s and 70s when they start suffering the fractures associated with osteoporosis; women may be in their 50s when the fractures begin.

        And men don't go through the same predictable menopause women do — loss of estrogen causes loss of bone mass — but as some men age, their testosterone levels drop, and that's a risk factor for bone loss.

Risk factors

        Men and women also share several risk factors for osteoporosis:

        • Low calcium intake

        • Inadequate physical activity (weight-bearing exercise preserves bone mass)

        • Cigarette smoking

        • Excessive alcohol intake

        • Some medications, including steroids, some anticonvulsants, thyroid medications, Heparin and lithium

        • Some diseases, including inflammatory bowel disease, rheumatoid arthritis, diabetes and thyroid and parathyroid diseases

        • Previous fractures

        • Family history of osteoporosis

        Current guidelines call for women to get bone density screenings at age 65. There is no recommendation for men, Dr. Watts says, but the International Society for Clinical Densitometry is studying the issue. Members agree that it would make sense for most men to be screened at about age 70, says Dr. Watts, the president of the society.

        Once the guidelines are set, the key is getting doctors and patients to request the screenings, he says.

        “The common disease equivalent for osteoporosis is high blood pressure and high cholesterol,” Dr. Watts says. "Waiting to do a bone density test until after the first fracture occurs is like waiting to test blood cholesterol until after you've had your first heart attack. The only way to know who has these conditions is to make a measurement, and it doesn't make sense to wait until after there's a complication to make that measurement.”

Treatment

        There are several options for treating osteoporosis, including diet and exercise and medications, including Fosamax (alendronate), the only drug approved for treating osteoporosis in men. Fosamax helps slow the rate of bone loss and prompts the body to create new bone mass.
       Actonel (risedronate) is approved for preventing and treating steroid-induced osteoporosis in men, and all forms of osteoporosis in women. A spokeswoman for Procter & Gamble, which developed the drug, says further clinical trials are planned to see whether the drug can be used to treat non-steroid-induced osteoporosis in men, but details are incomplete. Actonel works by altering the cycle at which bone mass is lost and formed.

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