Breast cancer, osteoporosis... Conditions Men Get, Too

by Food and Drug Administration (FDA)

Seymour Kramer noticed a patch of what looked like blood on his pajama top three years ago and thought he had cut himself. But he wasn't scratched. His doctor tested the discharge and told the New Jersey man he had breast cancer.

Dan, 70, a retired Michigan engineer who asked that his last name not be used, was pulling weeds three years ago. For no apparent reason, he fractured two vertebrae. Doctors told him his bones were wasting away. He has osteoporosis.

As a teenager, Gary Grahl was obsessed with having a trim, "athletic" body. The Wisconsin resident shunned food and exercised excessively. Sometimes he'd do situps and pushups for three hours before school. He ate little and shrank from 160 to an unhealthy 104 pounds. Over a six-year period, he was hospitalized four times. Now 26, Grahl says he is "completely recovered" from his eating disorder.

What do these men have in common? They all suffer from illnesses typically thought of as "women's diseases." Breast cancer, osteoporosis, and eating disorders all occur in men, too, though their prevalence is much greater in the female population. As a result, many men, unaware that the diseases affect both sexes, may fail to recognize symptoms. Likewise, doctors and families often don't suspect these illnesses. This can delay therapy and make disorders difficult to treat.

Medical experts say men may shy away from seeking medical treatment for disorders they feel are unmasculine. In support groups, men use terms like "very scared" and "ashamed" to describe initial feelings about their illnesses. Others express frustration at the difficulty in finding information and therapy.

Osteoporosis

High on the list of such conditions is osteoporosis. Though women are four times more likely to acquire it, about 5 million men in this country have osteoporosis, according to the National Osteoporosis Foundation. A disorder in which bones become weakened, osteoporosis is sometimes called the "silent disease" because it has no symptoms. It often manifests itself in fractures of the hip, wrist, spine, and other bones. Among both sexes, it is responsible for 1.5 million fractures a year. Scientists are still piecing together just how osteoporosis develops, but it is well known that a key factor is deficiency of the mineral calcium. Leo Lutwak, M.D., Ph.D., a medical officer in FDA's Center for Drug Evaluation and Research, emphasizes that calcium intake over a person's lifetime is crucial to preventing bone loss. Ideally, he says, a diet adequate in calcium starting in childhood "can maximize peak bone mass," helping to ensure strong bones and make osteoporosis less likely. The revised food label that went into effect in 1994 can help consumers pinpoint calcium-rich foods (see the May 1993 issue of FDA Consumer).

About 99 percent of the body's calcium is stored in bones and teeth. Bone is continually being broken down and rebuilt. If the amount of calcium absorbed equals the amount lost, a state of balance occurs. When calcium absorption is greater than losses, the body accrues a "positive balance" that it can use for bone growth and repair. But when dietary intake of calcium can't meet the body's needs, the body draws the mineral from bones to allow a constant bloodstream supply. Ultimately, the breakdown process can exceed deposits, causing a possible reduction in bone mass and density.

Osteoporosis is seen less often in men than in women for several reasons. Men generally have greater bone mass than women, and in males, bone loss begins later and advances more slowly. But men do have a hormonal drop-off in testosterone similar to women's reduction of estrogen after menopause. Testosterone may diminish as a result of hypogonadism, a condition marked by decreased function of the testicles. Testosterone levels may naturally become lower as a man ages.

"Loss of sex hormone results in accelerated bone loss in whomever it occurs, whenever it occurs, for whatever reason," says Michael Kleerekoper, M.D., deputy associate chairman of internal medicine at Wayne State University. "Whether that translates to osteoporosis depends on how much bone you have when the loss begins and how quickly you lose it." Women find relief from osteoporosis with estrogen therapy, and some men respond to testosterone injections. But successes with hormone therapy come most often from "seeing young men in the early stages" of the condition, Kleerekoper says.

Another therapy shown to slow bone breakdown and reduce pain associated with fractures attributed to osteoporosis is the drug calcitonin, marketed as Miacalcin or Calcimar. FDA has not approved these drugs specifically for men, though some doctors prescribe them to males if they feel the patient will benefit. Currently under study for osteoporosis treatment are sodium fluoride, which some researchers think may help increase bone mass; vitamin D, which helps the body absorb calcium; and a nasal spray version of calcitonin.

Dan, the Michigan osteoporosis patient, receives biweekly testosterone injections and takes daily supplements of 1,500 milligrams of calcium with vitamin D. He also exercises in a swimming pool, where water provides a beneficial resistance to movement. He says his two fractured vertebrae three years ago made him realize that osteoporosis gives no warnings.

Factors that raise the risk of osteoporosis include cigarette smoking, alcohol consumption in excess of two drinks a day, advanced age, and an inactive lifestyle.

Eric, 45, says years of inactivity helped bring on his osteoporosis. In his early 20s, the New York resident (who asked that his last name not be used) had several sports accidents that seriously impaired his mobility. An eating disorder in college also encouraged development of the condition, he suspects. Now, his bone loss is so severe that "anytime I have an x-ray, the doctors go into shock," he says. He risks injury by simply taking a walk and cannot stand barefoot on a hard floor without excruciating pain. He is taking calcitonin, which he hopes will stabilize his bone loss and allow him to do more walking.

Though osteoporosis cannot be cured, it can be slowed down and steps can be taken to prevent it. The National Osteoporosis Foundation suggests these preventive measures:

• Eat a balanced diet rich in calcium.
• Exercise regularly, especially in weight-bearing activities.
• Don't smoke.
• If you drink alcohol, do so in moderation.

Breast Cancer

Primarily associated with women, breast cancer also occurs in men, although rarely. According to the American Cancer Society (ACS), men will make up 1,400 of the 183,400 new cases of breast cancer expected in 1995.

Men typically do not perform breast self-examinations to detect tumors, and doctors do not ordinarily examine men for breast cancer during physicals. Unlike women, men do not get routine mammograms. Consequently, a tumor may be present and go undiscovered.

About the Author

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