Osteoporosis in Older Men: Feelings of Masculinity and a 'Women's Disease'

Osteoporosis is a metabolic bone disorder characterized by low bone density and associated with atraumatic fractures, pain, disability, long-term-care placement, and premature mortality. The condition is an important public health issue for all older adults, but the construction of osteoporosis as a "women's disease," and men's behavior in response, may limit the efficacy of current screening and treatment options for men. Though men are indeed at risk for osteoporosis, it does occur primarily among postmenopausal women, with the therapeutic interventions, educational outreach, and screening programs thus aimed primarily at women. The positive trends seen among at-risk womenimproved healthcare utilization and health outcomes for osteoporosis-are not evident among at-risk men. Men themselves rarely recognize their risk of osteoporosis, and behaviors associated with masculine gender identity may constrain them when it comes to preventive behavior to avoid osteoporosis and to recognize the disease if it does appear. Attention to men as a risk group and to the behaviors associated with masculine gender identity must inform research and practice related to osteoporosis. EFFECTS ON QUALITY OF LIFE We know that osteoporosis has negative consequences for interpersonal relationships and overall quality of life among older female sufferers (Gold, 1996, 2001, 2003). Women with the disease have difficulty performing recreational and home-keeping activities from which they derive identity, and they often experience feelings of role loss and of premature aging, as well as shame or embarrassment, stress, anxiety, and depression (Gold, 1996,1999; Gold and Roberto, 2000; Penrod, 2000; Roberto and Gold, 1997,2002; Roberto, Gold, and Yorgasen, 2004; Roberto and Reynolds, 2001). But we do not know the ways and extent to which osteoporosis similarly affects the quality of life for men. The gendered nature of social roles and activities in later life would suggest a qualitative difference in how men feel about and adapt to osteoporosis. Although literature on the epidemiology and treatment of male osteoporosis is thin, recent study of men's knowledge about osteoporosis and feelings of self-efficacy in relation to it, as well as studies of the relationship between gender performance and health behavior, illustrate how men's experience of osteoporosis most likely will differ from that of women and identify areas for future qualitative and intervention research. MEN'S VULNERABILITY TO A WOMEN'S DISEASE' Several studies have demonstrated that men have little knowledge of risk factors for osteoporosis, have inadequate calcium consumption, and engage in alow levd of weight-bearing exercise (Ailinger et al., 2005; Sedlak, 2000; Tung and Lee, 2006). In addition, the incidence of osteoporosis and related fractures in men is increasing because more men now live past the seventh decade of life, and the prevalence may continue to grow with the proportion of our population that is over the age of 70 (Nguyen et al., 1996, p. 259; Fande and Francis, 2001). But men's own health and illness behavior is not the only reason that men are vulnerable to osteoporosis. Even in the presence of fractures, osteoporosis in men is underdiagnosed and infrequently treated. In a study of male HMO members over 65 years of age, treatment for osteoporosis was infrequent (Feldstein et al., 2005). Among those who were treated for fractures, less than 2 percent had their bone density measured, and almost 70 percent of men with vertebral fractures received no osteoporosis-relatcd treatment (Feldstein et al., 2005). These data reveal a missed opportunity to decrease the vulnerability of men to subsequent fractures, disability, and premature death. In comparison to women, men with osteoporosis experience vertebral body and hip fractures more often; have higher post-fracture mortality, higher rates of disability and institutionalization; and are diagnosed later in the disease, after a fracture has occurred (Campion and Mariac, 2003; Pande and Francis, 2001; Vondracek and Hansen, 2004). …