A major new study of more than 600 Northern California men has found one-third actually have osteoporosis - but just a few had ever been screened for it or received treatment for their disease.
Indeed, up until a few years ago, there weren't even any bone-boosting medications that were government-approved for men. Osteoporosis research all but ignored men. And educational brochures on the disease tended to be directed toward postmenopausal women, focusing primarily on the importance of estrogen.
"But more men are likely to develop a hip fracture than to suffer prostate cancer. That's something a lot of people don't realize," said Lynn Chard-Petrinjak, a spokeswoman for the National Osteoporosis Foundation in Washington, D.C. "There is a misconception that it's a female disease."
An estimated 2 million men already have osteoporosis, making up 20 percent of all cases, according to the foundation. But many experts believe the true number is probably much higher, simply because most men are never screened for the disease, and few make the effort to discuss symptoms with their doctor.
"It's a rising problem and it's an under-recognized problem," said Dr. Elliott Schwartz, co-medical director of the Foundation for Osteoporosis Research & Education in Oakland.
Scientists aren't sure just why osteoporosis rates are now so high in men. In women, the course of the disease is better understood _ women tend to experience rapid bone loss after menopause, when hormone levels drop. That decline makes bones brittle, and they fracture more easily.
But men don't suffer such a quick decline in hormone levels. As for obvious risk factors that would explain why some men have osteoporosis and others don't, "so far we haven't been able to find any," Swislocki said.
Scientists hope to learn more about how testosterone levels, bone density, smoking, alcohol and other factors may predispose men to the disease from an ambitious long-term National Institutes of Health study of more than 6,000 American men.
"We don't know how men differ from women in many of these regards," said Dr. Eric Orwoll, the study's lead investigator. "But it's going to be quite a while before we know all the answers."
The two genders do have some attributes in common. By age 65 or 70, men and women do tend to lose bone mass at the same rate. The body's ability to absorb calcium, an essential nutrient for bone health, also declines for both sexes later in life.
The risk for osteoporosis among men clearly rises with advancing age, Orwoll said. But age can't be unilaterally blamed, Swislocki's team found.
"It's not necessarily a disease of old men. It's potentially a disease of middle-aged men," said Swislocki, whose team has found the disease in men in their early 50s. The patients studied are from throughout the northern part of the state, but were all originally seen at the Veterans Affairs Northern California Health Care System in Martinez for problems un-related to osteoporosis.
Women are still most affected by the disease, with half of all women over age 50 suffering an osteoporosis-related fracture at some point in their lives. But the new research suggests a new public health crisis could be emerging among men as more and more baby boomers hit middle-age.
Although women are encouraged to undergo periodic bone density exams, men usually aren't diagnosed with the disease until they have gone to their doctor complaining of back pain or bone fractures. By then, their osteoporosis is often advanced and not as likely to respond to current treatments.
"I just thought it was regular arthritis," said Margerito Perez, 76, an Antioch, Calif., resident who was diagnosed with osteoporosis four years ago. Perez, a retired fork-lift operator who participated in the new study, said his back had been hurting him for years before he went to a doctor.
Sure, he'd heard of osteoporosis before, and how older women are at high risk for the disease.
"But I've never heard men talk about it," he said.
The disease needs to be taken more seriously by men because they can suffer more serious side effects, Chard-Petrinjak said. Men have a higher mortality rate following hip fractures than women, even though women suffer more fractures.
That's news to most men, believes Jerry Donnelly, editor of an online newsletter for men with the disease. Donnelly himself was diagnosed eight years ago, at age 51.
"Several men have been point-blank told by their physicians that men don't get osteoporosis," he said. "So you generally get the reaction from men that, `Wow, I didn't know I could have this.' "