Osteoporosis doesn’t just happen to women.

As we age, our bone tissue wears out and loses quality. In women, this loss of bone quality becomes very noticeable after menopause because levels of estrogens, sex hormones that have a protective effect on the skeleton, decrease. But even though men do not experience a sudden loss of sex hormones, they suffer from osteoporosis more often than we might realize.

Silent increase in bone fragility

Osteoporosis is characterized by a decrease in bone mass and a deterioration in microarchitectonics and bone quality. These changes increase bone fragility and lead to a greater risk of fractures, especially in certain specific areas of our skeleton, such as the hip, spine, and wrist.

It is estimated that this disease causes more than 9 million fractures per year worldwide, but the number of people affected is much higher, about 200 million. They go unnoticed because it is an often hidden, asymptomatic disease that causes our skeleton to collapse without warning until the first fracture appears.

But why do we lose bone mass? Throughout life, our skeleton undergoes cycles of bone renewal or remodeling, during which “old” or damaged bone tissue is broken down and replaced with new bone that can withstand all the tests that we put our skeleton on a daily basis. The problem is that over the years, this process of replacing old tissue becomes insufficient, and the cells responsible for bone formation are not able to compensate for the loss of the removed bone. As a result, the bone balance begins to be negative. And we lose bone quantity and quality as part of the natural and innate aging process.

The problem is not only the woman. It is true that in women the loss of bone quality is very noticeable after menopause, a stage that marks a marked decrease in the production of the female sex hormone, estrogen. These hormones have an important protective effect against bone loss, and their decline at the onset of menopause also causes a sharp decline in bone mass.

However, about 25% of osteoporotic fractures occur in men. More importantly, the complications and mortality associated with these fractures are higher in men than in women. In fact, it is estimated that each year about 80,000 men suffer a hip fracture, and one in three die within the first year, and the same number break again.

Despite these data, osteoporosis in men is underestimated, and therefore in many cases it is not treated. Sometimes medical professionals are not well aware that osteoporosis can affect men, which contributes to the delay in its diagnosis.

Men develop osteoporosis ten years later

Peak bone mass is reached during the third decade of life, between the ages of 20 and 30. And from that moment on, we begin to lose bone tissue.

However, in men, this peak is reached later, since they start puberty later and stay in it longer than women. In addition, androgens, the male sex hormones, increase bone thickness, which is a definite mechanical advantage. Another important factor is that men do not experience a sudden loss of sex hormones, as occurs in women after menopause: in men, the hormonal decline occurs gradually, starting from the fourth to fifth decade of life.

All these factors lead to the fact that men develop osteoporosis at least ten years later than women. This fact contributes to an increase in the severity and risk of mortality after a fracture, including because with age a situation of sluggish chronic inflammation also arises, which accelerates the process of bone degradation, thereby increasing the risk of fractures and making their repair more difficult. With age, the deficiency of vitamin D, the main hormone for bone mineralization and quality, also increases, as does muscle function.

In the case of hypogonadism (a condition in which a man’s testicles produce little or no sex hormones), alcohol abuse, or long-term treatment with glucocorticoids used as anti-inflammatory or immunosuppressive drugs, the process is even more accelerated.

At the moment, we must clearly understand that the quality of our bones directly affects our health, so all of us, men and women, must take care of our skeleton. Mainly by staying active, eating a varied diet rich in calcium and vitamin D, limiting alcohol intake and avoiding tobacco.

Arancha R. Gortazar, Professor of Cell Biology. Principal Investigator of the Bone Physiopathology Group, CEU San Pablo University and Juan Antonio Ardura, Professor of Cell Biology and Histology, CEU San Pablo University

This article was originally published on The Conversation. Read the original.