A man in his thirties shrinking? It can happen says Paul Spencer Sochaczewski, head of communications at the International Osteoporosis Foundation. The bone disease osteoporosis does not just affect older women.
Mike Nelson, from the UK, remembers that he shrunk two inches between the ages of 33 and 35. ‘The doctors told me such a height loss was 'impossible' for someone my age. They told me it was my imagination that I had had gone to 5 feet 6 inches from 5 feet 8 inches,’ Nelson recalls. ‘It wasn’t imagination, it was osteoporosis.’
In recent years, osteoporosis, a widespread chronic disease in which the bones become brittle and fracture easily, has been brought to public attention as a women's disease. But it also hits men. Quite a few men, actually. Although statistics differ, International Osteoporosis Foundation-IOF estimates that in Europe between one-in-five to one-in-eight men over 50 will suffer an osteoporosis fracture.
Osteoporosis, sometimes referred to as the silent epidemic because there are few symptoms until a fracture occurs, takes a huge toll on men and women in Europe. Consider:
- There is an osteoporosis fracture every thirty seconds in the EU, with a provisional direct cost of €25 billion per year
- The lifetime risk for women dying from hip fracture complications equals the risk of dying from breast cancer
- More women over 45 are hospitalized by osteoporotic fractures than by heart attack or breast cancer
- In men, fragility fractures cause higher morbidity and death than in women
- In the United States, a 50-year-old man has a one in 17 risk of hip fracture
- By 2025, the number of hip fractures in men will equal the current number of hip fractures in women.
If osteoporosis is so prevalent, what can be done to stop men like Mike Nelson from suffering so much? Clearly, action is needed at the individual, physician and government levels.
Individual responsibility
To reach men at risk of osteoporosis, IOF will launch, on World Osteoporosis Day 2004 (October 20 in most countries), a campaign ‘Osteoporosis in Men’, with the theme ‘Osteoporosis - It hits men too’. Men will be advised that bone development can be affected by genetics, smoking, alcohol, lack of exercise, dietary deficiency of calcium and vitamin D, delayed puberty, and steroids. Men will be encouraged to take the One Minute Risk Test (available on the IOF website in some 20 languages) and to consult their doctor if they have risk factors.
Nevertheless, IOF anticipates that many men will resist the idea that they can get a ‘woman's disease’. The campaign has to recognize that men are great deniers and are likely to use all sorts of twisted logic to avoid facing reality:
- ‘Even if I get it, it won't kill me’
- ‘And if I do get it, there's nothing I can do about it.’
- ‘If I were at risk my doctor would tell me.’
- ‘I'm a tough guy, I can handle it.’
- And the complaint heard by all physicians who treat men: ‘I'm too busy to get a checkup.’
One aspect of the campaign will be to reach men through their wives, who generally are more rational about health care.
Doctor awareness
Another challenge lies in lack of doctor awareness. ‘The doctors didn’t recognise my osteoporosis,’ says Mike Nelson. "It was only when I broke three ribs after walking into a door frame that they took notice. It took more than a year for me to convince the GP to ask the advice of a specialist. I think the doctor was as surprised as I was when the DEXA scan indicated osteoporosis.’
Physicians are likely to say ‘Osteoporosis? That's something for the gynecologists.’ Even if they recognize that it hits men, they might argue that there are fewer approved treatments available than for women and that the bone density tests have been calibrated for women, not for men. Physician education is an on-going effort with IOF, including special sessions on osteoporosis in men that are held at the bi-annual IOF World Congress on Osteoporosis (the next IOF WCO will be held in May 2004 in Rio de Janeiro, and subsequently in 2006 in Toronto) and the IOF Advanced Training Course in Lyon, France, held every January.
Specifically for osteoporosis in men, IOF hopes to encourage doctors to normalize a bone density test for men with risk factors, just as physicians regularly check a man's prostate, cholesterol, blood pressure and life style choices.
Can we develop a simplified risk assessment for use in clinical practice? The IOF-supported Thematic Network on Male Osteoporosis, led by Dr. Jean-Marc Kaufman, aims to create an algorithm for assessing the 10-year absolute fracture risk in men, based on a combination of risk factors. Participating countries currently include: Belgium, the Czech Republic, France, Germany, Italy, The Netherlands, Spain, Sweden, Switzerland and the United Kingdom. Partial funding for this project was approved by the European Commission in 2001 and the project started in 2002.
Still, men seeking a bone density test sometimes find a less-than-welcoming environment.
‘The biggest embarrassment was that in order to get a bone density scan I had to attend a “well-woman” clinic and endure some rather hostile remarks from the other clients,’ Nelson remembers. ‘This was not the first time, as I was also required to undertake a mammogram (an even more difficult and uncomfortable procedure on a man than a woman)! since my medication caused a breast enlarging lump to appear (which after a biopsy was found to be benign). All of which seemed to reinforce the myth that both osteoporosis and breast cancer are women-only problems and age-related issues.’
Changing European policy
Another problem remains the lack of government health care reimbursement for osteoporosis diagnosis and treatment before the first fracture. IOF has worked with the European Union and national health ministries to change European and national policies:
IOF endorsed and launched a 1998 European Commission report on osteoporosis in the European Community. This report included eight specific recommendations.
After seeing that little had been done to implement the eight recommendations, IOF performed an audit on osteoporosis policy in the EU. This report was launched in 2001 in conjunction with a ‘Call to Action’ issued by the European Parliament Osteoporosis Interest Group.
In 2003 the European Union Osteoporosis Consultation Panel issued an ‘Action Plan’ which provides the key steps necessary to prevent fragility fractures that result from osteoporosis. The launch was accompanied by a special showing of ‘Osteoporosis: A Photographic Vision’, a dramatic photo exhibition of men and women with osteoporosis prepared for IOF by noted Italian photographer Oliviero Toscani. Click for more information.
Through these efforts, and many other imaginative efforts by IOF member national osteoporosis societies, we hope to prevent other men from falling to the same fate as Mike Nelson.
Paul Spencer Sochaczewski is communications director of the International Osteoporosis Foundation - IOF - based in Switzerland. For more information about osteoporosis and the work of IOF see their website: www.osteofound.org
