Discover the bone disease Osteoporosis: Causes, Effects and the Role of Gender Medicine

When thin is not beautiful!

Christoph Bartl & Reiner Bartl
Osteoporosis Centre Munich

In today’s blog post, we take an in-depth look at the bone disease osteoporosis. But what exactly is osteoporosis? How does it develop and what role does gender medicine play in this context? We will examine these questions in detail below and provide you with answers.

Osteoporosis is a Women’s Disease?

‘Osteoporosis in men is underdiagnosed and undertreated!’ — Christoph Bartl & Reiner Bartl

What is Osteoporosis?

Osteoporosis implies low bone mass and deterioration in bone quality. ”Osteoporotic fractures” occur when the bone structure has deteriorated. They occur in the event of trauma (injury), although the force applied is not normally sufficient to break a healthy bone.[1]

How does Osteoporosis develop?

A person’s bone density depends on the following five parameters:

• Genetics
• Hormones
• Physical activity
• Diet
• Lifestyle

After the age of 40, there is a steady increase in bone loss – due to genetic and hormonal factors (”degradation phase”) [1].

The reason for the increasing fracture risk in old age is the decrease in sex hormones. Both oestrogen and testosterone are responsible for the absorption of calcium into the bones. If the level of sex hormones falls, the bones lose their stability [2].

In 80 % to 90 % of cases, primary osteoporosis occurs in female patients due to the natural breakdown of the hormone oestrogen with the onset of the menopause. The rate of bone loss in women during the menopausal phase of life is 1 % per year. Up to 40 % of all women develop osteoporosis after the menopause [1].

40% of osteoporosis cases in men are caused by a testosterone deficiency. Testosterone deficiency in men is not equivalent to oestrogen deficiency in women. With testosterone deficiency, in addition to increased bone loss (as with oestrogen deficiency), reduced bone formation is also observed. This causes particularly rapid bone loss. However, studies show that both oestrogen deficiency and testosterone levels are decisive in the development of osteoporosis in men. Around 60% of male cases are caused by secondary osteoporosis. [1]

Risk factors or causes of secondary osteoporosis in men are as follows

• Alcohol
• Smoking
• Other diseases (e.g. hyperthyroidism, liver disease, malignant diseases, etc.)
• Medication such as cortisone

Osteoporosis manifests itself symptomatically through:

• Reduction in height
• Curvature of the spine
• Back pain
• Bone fractures

How many Cases of Osteoporosis occur in Men and how many in Women?

Bone loss in women begins abruptly due to the drop in oestrogen after the menopause. The risk of fractures also increases in men with a one-decade delay [1]. The delayed bone decay in men is due to the fact that men do not experience a menopause in which the sex hormones drop rapidly. Rather, male osteoporosis patients suffer a gradual process [1].

One in four women is affected over the age of 50 and 80% of osteoporosis patients are female. However, men can also suffer from bone loss. One in 17 men over the age of 50 is affected. This means that 20% of all diagnosed cases of osteoporosis are male patients.

From the age of 70, just as many men as women develop osteoporosis [2]. (Sievers, 2023, p. 196) A hip fracture has a serious impact on men. Men over the age of 74 have a 34% chance of dying from a hip fracture within a year [1] (Bartl, 2021, p. 321).

What are the Risks for Male Osteoporosis Patients?

Secondary osteoporosis begins in men between the ages of 40 and 50, slightly earlier than primary osteoporosis in women. However, osteoporosis screening is only recommended for men from the age of 70. Also problematic are the limit values for bone density measurements, which may be set too low, resulting in an increased risk of bone fractures. As a result, men often get help too late when it comes to treating osteoporosis! [2]

A retrospective study in the USA analysed 1,171 men with osteoporotic fractures. Of these, only 7.1 % of patients received medication for osteoporosis and only 1.1 % received a bone density measurement [1](Bartl, 2021, p. 321).

These reasons shows that the disease is fatal to male patients due to a lack of awareness.

How can the Prevention of Osteoporosis be promoted?

The development of osteoporosis depends on differentiated parameters (see above). This means that various preventive measures can be taken to protect against it, such as

• Being physically active
• Healthy diet: sufficient calcium
• Getting enough vitamin D: go outside
• Have a check-up in good time (especially if you experience back pain)

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Takeaway Points:

• Osteoporosis: not only women are affected
  • Men are often under-diagnosed and under-treated
  • Osteoporosis can occur in both sexes
• What is Osteoporosis?
  • Low bone mass & poor bone quality
  • Fractures from minor injuries
• Causes and Symptoms
  • Hormonal changes: Oestrogen deficiency and testosterone deficiency
  • Symptoms: loss of height, curvature of the spine, back pain, bone fractures
• Gender Distribution
  • Women: onset after menopause (primary osteoporosis)
  • Men: onset later, but increasing risk with age (primary osteoporosis)
  • Men have a higher risk of dying from hip fractures
• Challenges for Men
  • Earlier onset of secondary osteoporosis
  • Less treatment and diagnosis in men
• Prevention
  • Exercise, healthy diet, vitamin D, regular check-ups

For more Information

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