More Men Than Women Face Osteoporosis in Early Middle Age

Liam Davenport

May 29, 2019

More than a quarter of men and women in early middle age have osteopenia, placing them at risk of developing osteoporosis, the results of a new US study indicate, suggesting that bone health assessments should be more widely available.

Martha Ann Bass, PhD, associate professor of health, exercise science, and recreational management at the University of Mississippi, Oxford, and colleagues studied over 170 individuals aged 35-50 years with no known medical conditions.

Bone mineral density (BMD) scans revealed that 28% of men and 26% of women had osteopenia at the femoral neck. The findings surprised the participants and researchers, who did not expect the condition to be more prevalent in men. 

"We typically associate loss of BMD with postmenopausal women, but our findings showed elevated risk in younger men," said Bass in a press release from the American Osteopathic Association.

"Almost all participants who were found to have osteopenia were surprised, and I think this is a more prevalent issue than anyone expected," she said.

The research, published in the June issue of the Journal of the American Osteopathic Association, also shows that, despite relatively high levels of exercise in this study cohort, there was a negative correlation between exercise and BMD in the men.

Bass points out that the majority of men in the study reported cycling as their preferred exercise, whereas exercises that are more 'weight bearing' such as walking, running, and jumping are associated with maintenance of BMD.

And she added that it is possible to overestimate the value of calcium in maintaining bone health: "Calcium plays a larger role when bones are still developing. After that, the body begins to rely on weight-bearing exercise to keep bones strong."

"It really does boil down to use it or lose it," she said.

Bone Health of Those in Early Middle Age Is Understudied

Osteoporosis has become a significant public health issue, with one study estimating that an osteoporotic fracture occurs every 3 seconds, most often in the spinal vertebrae or femoral head or hip.

It is thought that the worldwide incidence of fractures will increase by 310% in men and by 240% in women by 2050.

The condition is nevertheless much more common in women than men after the age of 50, affecting approximately 8.2 million women versus 2.0 million men aged 50 years or older in 2010.

The researchers point out, however, that adults may also develop osteopenia and osteoporosis in early middle age, but the population is understudied.

So they conducted a cross-sectional study in which men and women aged 35-50 years completed a questionnaire on calcium intake, hours per week of exercise, and other factors linked to osteopenia and osteoporosis.

The participants, who had no previous known health issues and were not taking medications that can affect BMD, had their BMD measured at the femoral hip and lumbar spine on dual-energy X-ray absorptiometry.

A total of 173 individuals took part in the study, of whom 92 (53%) were women and 162 (94%) were white.

The prevalence of overweight and obesity was 48% and 23%, respectively, among men, and 28% and 22%, respectively, among women.

The questionnaires indicated that 87% of men and 86% of women consumed fewer than three servings per day of dairy, while 68% of men and 56% of women reported exercising at least 20 times per month.

This "level of exercise is not typical of the US population," the researchers point out, citing Centers for Disease Control and Prevention data from 2014, which showed only 21% of adults met the American College of Sports Medicine guidelines for sufficient exercise.

Analysis of the BMD results showed 28% of men and 26% of women had osteopenia at the femoral neck, and 6% and 2%, respectively, had osteoporosis of the lumbar spine.

There was a significant negative correlation between exercise status and BMD in the femoral neck in men (r = –0.296; P = .01).

In women, in contrast, there was a significant positive correlation between exercise status and BMD in the trochanter (r = 0.329; P = .03), intertrochanteric crest (r = 0.285; P = .01), total femur (r = 0.30; P = .01), and lumbar spine (r = 0.29; P = .01).

The results also indicate that, in men, there was a significant relationship between weight and body mass index (BMI) and BMD at the trochanter, intertrochanteric crest, total femur, and lumbar spine (P < .05).

In women, weight was significantly related to BMD at each of the same sites, although BMI was associated with BMD only at the femoral sites (P < .05).

Osteopathic Physicians Can Help With Prevention

The team writes that screening measures and preventive interventions for osteopenia and osteoporosis are needed for both men and women in middle age.

However, the general population "may not be adequately informed...or have little interest in getting scanned owing to fears about radiation exposure and cost."

"Educational interventions must be implemented to allay such misperceptions and barriers."

They continue: "Preventive interventions should aim at maintaining BMD and bone mass in early middle aged people with nutritious diets containing adequate amounts of calcium and vitamin D."

And to help with that, in the United States at least, they single out osteopaths as providing the "ideal setting" for educational and preventive interventions, thanks to the "patient-centered philosophy of osteopathic medicine and the intimate relationship between the patient and osteopathic primary care physician."

The team also believes that insurance companies could offer incentives to individuals younger than aged 50 who take action to reverse modifiable risk factors for osteoporosis.

These include smoking cessation, weight-bearing exercise, increasing calcium intake, and lowering alcohol consumption, and that insurance companies could offer to pay for BMD scans for individuals aged 35-50 years.

The researchers suggest that "by funding preventive screening and incentives, insurance companies would lessen the amount spent on osteoporotic fractures by individual consumers as well as by the insurance companies."

No funding or conflicts of interests declared.

J Am Osteopath Assoc. 2019;119:357-363. Full text

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