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Osteoporosis, Breast Cancer, and Eating Disorders: Not Just for Women

 Seymour, 70, noticed a patch of what looked like blood on his pajama top three years ago and thought he had cut himself, but he was not scratched. His doctor tested the discharge and told the New Jersey man he had breast cancer .
Dan, also 70, a retired Michigan engineer, was pulling weeds three years ago. For no apparent reason, he fractured two vertebrae. He had osteoporosis .
As a teenager, Gary was obsessed with having a trim, athletic body. The Wisconsin resident shunned food and exercised excessively. Sometimes he would do sit-ups and push-ups for three hours before school. He ate little and shrank from 160 pounds (73 kilograms) to an unhealthy 104 pounds (47 kilograms). Over a six-year period, he was hospitalized four times. Now 26, Gary 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 may fail to recognize symptoms. Likewise, doctors and families often do not 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

Osteoporosis is a disorder in which bones become weakened. It is sometimes known as a silent disease because it has no symptoms until the first fracture occurs. Osteoporosis most often results in fractures of the hip , wrist , and spine . Scientists are still piecing together just how osteoporosis develops, but it is well known that a key factor is low levels of the mineral calcium .
Bone is continually being broken down and rebuilt throughout our lifetime. Calcium is an important factor in rebuilding. Low calcium in the body may impair the rebuilding process. In addition, when there is not enough calcium in the diet, the body will take calcium out of the bones to make sure there is enough in the bloodstream. Both these factors can make the breakdown process exceed the rebuild process make the bones less dense, weaker, and vulnerable to fractures. Loss of sex hormones can also accelerate bone loss. Testosterone may diminish as a result of hypogonadism, a condition marked by decreased function of the testicles. Testosterone levels may also naturally become lower as a man ages.
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. Getting adequate calcium and vitamin D is the first line treatment for both men and women with bone loss.

Osteoporosis Prevention

The Endocrine Society recommends screening in men starting at age 70. Younger men (aged 50-69 years) should be screened if there are other factors present, such as certain medications or other chronic diseases. Screening is done by checking bone density. In men at higher risk for osteoporosis, a test called a dual-energy x-ray absorptiometry, may be used to measure the spine and hip.
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 with adequate calcium and vitamin D .
  • Ask your doctor if you should take a calcium supplement. A study reported that taking 1,200 mg (milligram) a day of calcium helped to increase bone mineral density in men.
  • Exercise regularly , emphasizing weight-bearing activities. Be sure to use proper form when lifting weights. If you have osteoporosis, you may need to change certain movements to protect your spine. You may also need to avoid activities that involve a lot of twisting motions, like golf or tennis.
  • If you smoke, quit.
  • If you drink alcohol, do so in moderation.
Talk to you doctor about factors that can increase your risk. Some include long-term use of certain medications, such as steroids or aluminum-based antacids. Also, increasing age, undiagnosed low levels of testosterone, and chronic lung or kidney disease can raise your risk.

Osteoporosis Treatment

Alendronate and other drugs that prevents or slow the weakening of bones are a treatment for osteoporosis in men. Another drug, calcitoninis a drug that has been shown to slow bone breakdown and reduce pain associated with fractures attributed to osteoporosis. If doctors see a benefit, some will prescribe this drug for men. Additional options include: parathyroid hormone and a nasal spray version of calcitonin.
Men who have low testosterone levels may respond to testosterone supplementation.

Breast Cancer

Breast tumors may be present and go undiscovered in men because breast cancer is so rare in men. Men may also not be aware of new small lumps in their chest tissue and doctors do not ordinarily examine men for breast cancer during physicals. The lump is also often painless. It may not draw attention until it causes more abnormal symptoms like nipple retraction, crusting, or a discharge.

Breast Cancer Screening

Though medical professionals typically do not recommend detection exams for the general male population, doctors may advise men at high risk to perform periodic breast self-examinations and to have mammograms.
According to the American Cancer Society (ACS), risk factors for male breast cancer include:
  • Age—Average is 59 years.
  • Family history of breast cancer
  • Prior radiation exposure to the chest—This is usually from treatment of another cancer.
  • Liver disease—This can lead to higher estrogen levels and gynecomastia .
  • Gynecomastia (enlargement of the male breast)
  • Hyperestrogenism, estrogen treatment (e.g., for prostate cancer ) or abnormal secretion of the hormone estrogen
  • Klinefelter's syndrome —This is a male disorder characterized by reduced or absent sperm production, small testicles, and enlarged breasts
  • Heavy alcohol consumption
  • Obesity

Breast Cancer Treatment

The approach to treatment is geared to the stage, or extent, of the disease at diagnosis. Since there are so few cases of breast cancer in men, the data on effectiveness of treatment comes from clinical trials in women. If the cancer is found in an early stage before it spreads to surrounding tissue or to the lymph nodes, surgical removal of the breast and lymph nodes may completely remove the cancer. However, often some additional therapy (adjuvant) is recommended to kill any undetected cancer cells that may have been left behind after surgery. Depending on the type of cells in the tumor, and a person’s general health, hormone, radiation , or chemotherapy may be used. Later stages of breast cancer may be treated with multiple adjuvant therapies. If the breast cancer has spread to other organs, a regimen of hormonal or chemotherapy is tailored to each patient. Once hormonal or chemotherapy is no longer effective, there are still options for immunotherapy as well as other treatments to relieve symptoms.
Possible complications after surgery or radiation include decreased shoulder function, fluid retention in the arm, and pain or stiffness in the operated or radiated area. The ACS emphasizes that, besides tending to the physical consequences of breast cancer therapy, attention should be paid to the psychological after-effects.
Patients also need follow-up monitoring, which may include regular exams, blood chemistry, imaging (such as MRI ), and bone scans, to discover any recurring tumors quickly.

Eating Disorders

Two common eating disorders include anorexia nervosa and bulimia nervosa. With anorexia nervosa , the person limits food intake to the point of starvation. With bulimia nervosa , people alternate between eating large amounts of food and ridding the body of it through vomiting or laxative use.
Anorexia and bulimia are most commonly seen in people who have a fear of getting fat, or in people who have body image problems that are heavily influenced by weight and shape. Other aspects of eating disorders include psychological factors centering around control, attention, mood, or even family environment. Many times disorders include depression or anxiety .
These eating disorders may appear more frequently in adolescents, but can happen at any age. These illnesses can lead to lifelong medical and psychological complications as well as death. Most people find it difficult to halt the behavior without professional assistance. Though some men ultimately seek help, many continue untreated with the disorders, often for years, and sometimes for a decade or more.

Delayed Diagnosis

Diagnosis is complicated by a reluctance some men have to seek medical help for disorders that are still primarily related to women. Many men may be ashamed to have an illness of this type and thus, suffer in silence. Another problem is that a great number of doctors and healthcare professionals are not trained to identify or treat male eating disorders, especially anorexia. Families, too, often fail to see the diseases' symptoms. The illnesses then can progress to a more advanced stage where they are harder to treat.

Treatment for Eating Disorders

Treatment for eating disorder has several components. The first and most important aspect is to stabilize any medical condition brought on by the disorder. Sometimes this may require hospitalization. Proper diet, nutrition, and weight gain are addressed, but that alone may not fix the original problem. Counseling, in a group or alone, is often a part of the healing process. During this time, medications for treatment of depression may also be prescribed. Antidepressants and even tricyclic drugs have been used to effectively treat eating disorders. Only your doctor can guide your treatment.

Future Knowledge

Men in support groups for eating disorders, as well as those for breast cancer and osteoporosis, say the public gradually is becoming more aware that these disorders can occur in men. They also say there is a long way to go. Some think doctors need to be enlightened, others bemoan the lack of research. Most seem to agree that men should be educated about these serious health problems and how to prevent or detect them.

RESOURCES

National Association of Anorexia Nervosa and Associated Disorders http://anad.org/

National Cancer Institute http://www.cancer.gov/

National Osteoporosis Foundation http://www.nof.org/

CANADIAN RESOURCES

Bulimia Anorexia Nervosa Association http://www.bana.ca/

Canadian Cancer Society http://www.cancer.ca

Osteoporosis Canada http://www.osteoporosis.ca

References

Anorexia Nervosa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 7, 2012. Accessed December 13. 2012.

Breast Cancer in Men. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003091-pdf.pdf . Accessed December 13, 2012.

Breast Cancer in Men. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 1, 2012. Accessed December 13. 2012.

Bulemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 17, 2012. Accessed December 13. 2012.

General Information. National Association of Anorexia Nervosa and Associated Disorders website. Available at: http://www.anad.org/get-information/about-eating-disorders/general-information/ . Accessed December 13, 2012.

Osteoporosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 5, 2012. Accessed December 13. 2012.

The Man's Guide to Osteoporosis. National Osteoporosis website. Available at: http://www.nof.org/files/nof/public/content/file/252/upload/85.pdf . Accessed December 13, 2012.

11/19/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Reid IR, Ames R, Mason B, et al. Randomized controlled trial of calcium supplementation in healthy, nonosteoporotic, older men. Arch Intern Med . 2008;168:2276-2282.

11/5/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Watts NB, Adler RA, Bilezikian JP, et at. Osteoporosis in Men: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab . 2012;97(6):1802-1822.

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