Male smokers have a greater risk for osteoporosis than other men and even than women smokers, a recent study finds, suggesting that U.S. screening guidelines focused on women might need to be expanded to include men.
"We expected the risk would be worse for women, but it was actually worse for men," said senior study author Dr. Elizabeth Regan, a researcher at National Jewish Health in Denver, Colorado. "The data also show that if men do have osteoporosis and get hip fractures, they do worse than the women."
Osteoporosis makes bones so weak and brittle that a fall – or even a sudden coughing fit or deep bend – can cause a fracture. It becomes more common with age. About one in 10 women over the age of 50 has the condition, compared with one in 50 men, according to the U.S. Centers for Disease Control and Prevention.
Women tend to have smaller, thinner bones than men, and they lose bone density when their production of the hormone estrogen decreases after menopause. Smoking can accelerate the loss of bone density.
Regan and colleagues examined bone density and the severity of lung disease, and looked for small fractures in the vertebra of the spine in 3,321 current and former smokers as well as a group of 63 people who never smoked.
The researchers found that male smokers had a small, but significantly greater risk of low bone density, and more vertebral fractures, than female smokers. Such signs of osteoporosis were present in 58 percent of study participants, and in 84 percent of people with a severe form of the smoking-related lung disorder known as chronic obstructive pulmonary disease (COPD).
Thirty-seven percent of the study participants had one or more vertebral fractures, and they were mostly male, older than the group average, more likely to be current smokers and had smoked for a longer time.
Study participants weren't randomly selected, the study team notes in Annals of the American Thoracic Society. They add that it's possible they chose a group of smokers with unusual degrees of bone loss.
Still, based on the results, Regan recommends that both male and female smokers be screened for osteoporosis. "Smokers already get screened for lung cancer and they could in theory use the same CT scan image to look at bone density," she said.
The U.S. Preventive Services Task Force (USPSTF), a government-backed independent organization that reviews medical evidence, last updated screening guidelines for osteoporosis in 2011. The task force concluded that women 65 and older as well as women with other risk factors would benefit from screening. These guidelines are widely used to determine whether insurance will pay for screening, and widely followed by primary care physicians.
"The evidence in 2011 was insufficient to determine the balance of benefits and harms of screening men for osteoporosis because there were few relevant treatment studies in men," said Dr. Albert Siu, a co-vice chair of the task force and a professor of geriatrics at the Icahn School of Medicine at Mount Sinai in New York City.
The current study does help quantify the osteoporosis risk in men who smoke, but it doesn't address the lack of evidence showing what preventive treatments might work in men, said Siu, who wasn't involved in the study. The USPSTF strives to revisit recommendations every five years, he said.
There haven't been large studies proving that medications such as bisphosphonates, a family of drugs commonly prescribed for osteoporosis, are as effective in men as in women, agreed Dr. Eric Orwoll, a professor of medicine at Oregon Health Sciences University. But he also criticized the task force for failing to recommend osteoporosis screening for men.
"Nobody is going to pay for those studies in men because the drugs are already approved and the science points to them being equally effective in men and women, with the same markers of bone metabolism and the same effects on fractures," said Orwoll, who wasn't involved in the study.
Men and women can take some of the same steps to reduce the risk of broken bones, Orwoll said. Regular exercise and strength training can keep bones stronger, as can a healthy diet with limited alcohol consumption. "And smokers, of course, should quit," he said.