Dave, age 52, a physically active man, recently went to his doctor for a checkup. Like most men his age his concerns were his blood pressure, cholesterol reading, and the health of his colon and prostate. But he also told his doctor, "I know I carry my stress in my upper back, neck, and shoulders, but the pain I've had there lately is pretty intense." The doctor referred him for x-rays. When the results came back Dave was stunned to learn he had compression fractures in his upper back. He was told, "You have osteoporosis."

"It's impossible," Dave said. "I run three or four miles every day."

Running is a very good fitness routine. It can prevent the heart, colon, and prostate diseases that concerned Dave, but it doesn't do much to strengthen the upper back.

Like most people we meet, Dave thought osteoporosis was a woman's disease. He'd seen a few stooped older men, but attributed their stature to aging. He never realized a man his age had to worry about his bones.

It is true that osteoporosis is diagnosed less often in men than in women, but the statistics for its occurrence are not something to sneeze about. The lifetime risk for low trauma, osteoporotic fractures in men is 25 percent. This means one in four men over age fifty will have an osteoporosis-related fracture in their lifetime. The risk is highest in men who smoke or if they have more than two alcohol-based drinks a day.

Men have larger and stronger skeletons than women, so they have a slight edge when it comes to the bone loss that accompanies aging. In fact, most men don't get fragile bones, or the osteoporosis diagnosis, until much later in life than their women friends. That diagnosis usually occurs when, like Dave, they go to a doctor for back pain or have an unexpected fracture and the doctor, who suspects osteoporosis, does a bone scan that reveals the disease.

Men also don't have the abrupt drop in estrogen production that women experience at menopause, but they do have estrogen and that estrogen level does decline with age. Testosterone gives men bigger muscles, which indirectly results in a higher bone density. Additionally, some of that testosterone gets converted to estrogen, which prevents the excessive cell activity that breaks down bone-especially in men who don't have a calcium rich diet or aren't physically active.

Dave received a prescription to treat his pain and was sent to a physical therapist who agreed to help him design an upper body weight training program once his pain diminished. Dave began taking a calcium and vitamin D supplement-twice a day and joined one of the drug trials that is studying the use of parathyroid hormone to treat osteoporosis. His prognosis is good.

Osteoporosis can be diagnosed with a low dose xray called a DEXA scan. It's mandatory for men who have decreased sexual function due to low testosterone levels, if they have a low trauma fracture, take one of the medications that causes bone loss (ask your doctor or write to smartcoach@aol.com) or have a disease known to affect bone. If they have a family history of osteoporosis, the sooner they have this scan the better. It could save a life-maybe your life or the life of someone you love. Act now.