Men & Osteoporosis
by Linda Weber
Lifestyle changes and regular medical care can help prevent osteoporosis in men.
Despite the public perception that osteoporosis is a disease that primarily targets women, 2 million American men have the illness and millions more are at risk. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, among men over 50, 6 percent experience a hip fracture and 5 percent suffer a fracture of the vertebrae. Osteoporosis is a painless, asymptomatic disease that progresses by stealth. By the time an unexpected fracture appears, the bones have already deteriorated.
The Life Cycle of Bones
Bones shed old cells and replace them with new ones. During childhood, we produce more bone than we eliminate, so bones grow and grow stronger. Bone mass usually peaks during your 30s. From that point on, the process reverses itself and the skeleton sheds old bone faster than it replaces it, so bone mass decreases. Men don't lose bone mass in their 50s as women do after menopause. But by ages 65 or 70, men catch up. They start losing bone at the same rate as women. That's when weakened bones can fracture at the wrist, hip or spine, with serious long-term consequences. Hip fractures are especially dangerous: More men than women die from complications of hip injuries.
Primary and Secondary Osteoporosis
Primary osteoporosis refers to bone deterioration attributed to aging or an unknown cause. Secondary osteoporosis is bone loss precipitated by behaviors, diseases or medications.
1) Diseases of the stomach and intestines block the absorption of amino acids, calcium, magnesium, phosphorous, and vitamins D and K, which are necessary for healthy bones.
2) Hypercalciuria causes the body to eliminate too much calcium, which is vital for strong bones. Other diseases, including chronic obstructive pulmonary disease, cystic fibrosis and ankylosing spondylitis can also contribute to bone loss.
3) Glucocorticoid medications prescribed for the treatment of diseases such as rheumatoid arthritis and asthma cause bone loss, although it's unclear whether these steroid drugs affect bones directly or whether they reduce calcium absorption or decrease testosterone levels, which in turn affects bones.
4) Undiagnosed low testosterone levels, hypogonadism, causes osteoporosis in men. This may happen spontaneously or be precipitated by medications, cancer treatments or other factors. New research suggests that estrogen deficiency may also cause male osteoporosis.
5) Men who suffer from alcohol abuse often have low bone mass, and those who smoke experience rapid rates of bone loss and a higher incidence of hip fractures and fractures of the vertebrae.
6) Immobilization is an important contributing factor. Bone loss can intensify after prolonged bed rest or immobilization of a body part (following a fracture or an illness).
7) Age matters. The older you are, the more you are at risk.
8) Men of all races develop the disease, but Caucasian men have a higher risk.
A complete medical history, X-rays and urine and blood tests are necessary to diagnose osteoporosis. But you'll also need a bone mineral density test (BMD), such as a dual-energy X-ray absorptiometry test (DXA), which can assess whether you have the disease, find out your risk for broken bones, measure bone density and determine your response to treatment.
Your doctor may prescribe one of several FDA-approved medications. If bone loss is due to glucocorticoids, you may need to take a drug that prevents or treats glucocorticoid-induced osteoporosis. Your physician will monitor levels of testosterone and bone density and suggest the minimum dose of glucocorticoids to take. And you may receive recommendations for nutrition, exercise and lifestyle as well as for calcium and vitamin D supplements.
Avoid smoking, decrease alcohol intake and increase physical activity. Take a daily calcium supplement, and if you don't get at least 10 minutes of sunlight a day, supplement with 200 to 600 IU of vitamin D per day. Do regular weight-bearing exercises such as walking, jogging, climbing stairs, weight training and resistance machine workouts. If you've already been diagnosed with osteoporosis, make sure your doctor approves of your exercise program.