While women are more likely than men to develop osteoporosis, one in five men will still sustain an osteoporosis related fracture in their lifetime, according to Osteoporosis Canada. They also say 80 percent of all fractures in people 50 years of age or older are caused by osteoporosis.
Healthy bone looks like a honeycomb under a microscope, but as bone begins to lose density the holes and spaces in the honeycomb become larger. This can weaken the bone and cause it to break more easily.
During your lifetime, your body is constantly breaking down old bone (through a process called resorption) and building up new bone. Bone loss occurs when old bone is broken down faster than new bone is made, and can lead to low bone density.
The older you are, the more likely you are to have low bone density, sometimes called osteopenia. It may also increase your chance of getting osteoporosis – a disease which causes bones to lose density and can lead to fractures, pain, and deformities.
Women and men begin to lose bone in their mid-30s. Women are more likely than men to develop osteoporosis, because they generally have smaller, thinner bones than men. Plus, women lose bone tissue rapidly in the first four to eight years after menopause because of the sharp decline in estrogen.
However, proportionately more men than women die as a result of a hip fracture – 37 percent of men who suffer a hip fracture will die within the year following that fractured hip. Men are also more likely than women to require care in a long-term facility after a hip fracture.
Yet despite this, men are less likely to be assessed for osteoporosis or to receive treatment for osteoporosis after they break a bone. Some of this can be accounted for by the fact that men are less likely to seek medical care.
The most accurate way to determine the density of the bones is to have a bone mineral densitometry (BMD) exam, also known as dual-energy X-ray absorptiometry or DEXA scan. This exam sends a finely collimated (parallel), low-dose X-ray beam with two distinct energy peaks through the spine, hip, or forearm. One peak is absorbed mainly by soft tissue and the other by bone. Special computer software can subtract the soft tissue information and display the bone density measurements (in grams per centimetres squared, the bone mineral content divided by the area). Generally, the higher the mineral content, the denser the bone is, and the denser the bones are, the less likely they are to fracture.
During your BMD exam, you will need to avoid wearing clothes with buttons, metal buckles, and zippers near your spine and hip as they may interfere with the X-ray. You will also be weighed and measured, then positioned on the table by the technologist. You will be asked to hold very still while the scanner moves over the area being examined. You may be scanned more than once.
Measurements must be very precise. A first (baseline) BMD exam is often taken at around age 50 and then subsequent exams may be recommended every two years. Since measurements can vary between machines, repeat tests must be taken on the same machine, or a new baseline will be needed.
Low bone density and osteoporosis rarely have symptoms, which mean you may not discover you have one of them until you sustain a painful fracture. This is why early detection is important, as well as being aware of risk factors.
The effects of low bone density can be mitigated with a balanced diet rich in calcium and vitamin D, a healthy lifestyle without smoking or excessive alcohol intake, and physical activity that includes weight-bearing exercises. Medication may also be prescribed to improve bone health.
Regular bone density testing is also recommended to monitor bone loss. A BMD exam is not usually required until you are 50 years of age or older, unless you fall into a high risk category. To determine if bone density testing is right for you, you will need to discuss your risk factors and family history with a health care practitioner.
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Harvard Medical School (2019) “Mars vs. Venus: The gender gap in health.” Harvard Health Publishing.
Statistics Canada (2019) “Changes in life expectancy by selected causes of death, 2017.” www150.statcan.gc.ca. Accessed December 20, 2019.