Bones grow in length and density during a person's younger
years. Bone density relates to the mineral content of the tissue. People reach their
maximum height during their teens, but bone density continues to increase until
about age 30. After that point, bones slowly start to lose density and
strength. Throughout life, bone density is affected by heredity, sex hormones,
physical activity, diet, lifestyle choices, and the use of certain medications.
In their 50s, men do not experience the rapid loss of bone
mass that women have in the years following menopause. "But some men do
have a hormonal drop-off in testosterone, with skeletal consequences that are
similar to those seen in women following reduction of estrogen," explains
Bruce Schneider, a medical officer in the FDA's Division of Metabolic and
Endocrine Drug Products. Testosterone may diminish as a result of hypogonadism,
a condition marked by decreased function of the testicles. Testosterone levels
also may decrease naturally as a man ages. This loss of sex hormone eventually
can result in accelerated bone loss. Whether bone loss at this point translates
into osteoporosis, however, depends on how much bone a man has when the loss
begins, and how quickly he loses it.
By age 65 or 70, men and women lose bone mass at similar
rates, and the absorption of calcium, an essential nutrient for bone health
throughout life, decreases in both sexes.
Osteoporosis
Osteoporosis, which means "porous bone", is a
disease characterized by progressive bone thinning. The deterioration of bone
tissue can lead to bone fragility and fracture, especially of the:
- hip
- spine
- wrist
Osteoporosis gradually weakens bones and can lead to painful
and debilitating fractures. It is characterized by low bone density (how solid
bones are) and structural deterioration of bone tissue. Often called the
"silent disease," osteoporosis usually progresses without symptoms
until it is diagnosed following a fracture.
Osteoporosis is seen less often in men than in women because
men generally have larger, stronger bones, and because men don't usually
experience the abrupt and substantial hormonal changes, associated with
andropause, that women do following menopause. Also, bone loss begins later and
advances more slowly in men than in women. However, the National Institutes of
Health says that the problem of osteoporosis in men recently has been
recognized as an important public health issue, especially in light of
estimates that the number of men above age 70 will double between 1993 and
2050.
Today, more than 2 million American men have osteoporosis,
and another 3 million are at risk for the disease, according to the National
Osteoporosis Foundation (NOF). Each year, men suffer one-third of all hip
fractures, and one-third of these men will not survive more than one year. In
addition to hip fractures, men most often experience fractures of the spine and
wrist due to osteoporosis.
Osteoporosis Types
In men, there are two main types of osteoporosis: primary
and secondary. In primary osteoporosis, there may be no identifiable cause
(idiopathic) or it may be the result of age-related bone loss. Often, these two
conditions overlap, and distinguishing between them is arbitrary. Secondary
osteoporosis in men can be due to a variety of causes. Low testosterone
(hypogonadism), medications such as prednisone that can lead to steroid excess,
and alcoholism are among the important causes of secondary osteoporosis in men.
Once bone is lost, it cannot be completely replaced using
currently available therapies. Therefore, it is essential that men be evaluated
and treated before significant bone loss has occurred. Building strong bones
during childhood and adolescence can be the best defense against developing
osteoporosis later.
Risk Factors
Aging and andropause
effects represent the significant risk factor for men. In addition, the
following lifestyle features are considered as substantial supplementary risk
factors:
- Excessive alcohol consumption and cigarette smoking. Smoking and alcohol are on the list of risk factors. Smoking has been associated with lower bone density. Because of the negative impact smoking has on health, it is recommended people avoid smoking. High levels of alcohol intake (over 50 units per week in men or 35 units in women) are associated with osteoporosis too, therefore it should be avoided or limited.
- Inactive lifestyle. Building strong bones, especially before age 30, can be the best defense against developing osteoporosis. Exercise is imperative to good bone health. Weight-bearing exercise, such as walking, dancing, jogging, stair-climbing, racquetball, tennis, and hiking are recognized as the best type of exercise to promote good bone health. If you have been sedentary for most of your adult life, the NOF recommends you ask your doctor before starting an exercise program.
- Not balanced diet, low in calcium. Calcium is needed for the heart, muscles, and nerves to properly function, for blood to clot, and is needed to grow and maintain healthy bones. The NOF emphasizes the importance of getting the daily recommended amount of calcium (between 1000 and 1300 mg/day) and vitamin D (between 400 and 800 IU/day), if not from your diet, then by taking supplements. Vitamin D is needed for the body to absorb calcium.
- Use of corticosteroid medications
- Use of anticonvulsant drugs
- Excessive use of caffeine and soda. The link between osteoporosis and caffeinated sodas is not clear, but caffeine and phosphoric acid in the drinks may interfere with calcium absorption. Caffeine, also found in coffee and tea, is also a diuretic, which may increase mineral loss.
Warning Signs
There are many warning signs that you may be at risk for
premature osteoporosis and bone deterioration. These warning signs, although
rather obvious, are commonly overlooked.
Did you know that an abnormally foul taste in your mouth may
be a sign of deteriorating bone health? Because bone health requires, to some
extent, a pH balance within the body, the noticeable bad breath you may be
experiencing, could be the first indication that your body's pH balance is in a
state of flux. In fact, for individuals who participate in diets such as the
Aitkin's diet, the state of acidosis commonly leads to bad breath, thus an
indication the body's pH is not in balance, a risk factor for deteriorating
bone health.
Because protein is important to bone health, it is also
important to monitor the outward signs of obvious protein insufficiencies. The
most common place to find evidence of protein deficiency is in the hair and
nails. Because these are nourished by blood flow, any deficiency of protein
will, in many cases, show up in the hair and nails with hair turning dry,
brittle and weak and nails easily peeling off in layers.
Another aspect of deteriorating bone health lies in the
abnormal change in behavior. Again, because there is an imbalance in the body,
many women who experience premature osteoporosis find they may have suffered
from a greater incidence of insomnia and restlessness in the months and years
before their deteriorating bone health was diagnosed. Stress may play a key
factor into the development of premature osteoporosis as well.
And, finally, your gums and teeth are a clear indication of
potential bone deterioration. While the research is still out on the
connections of bone health to the teeth and gums, some researchers have
suggested the deterioration of gums and teeth, by eating foods right in acid,
may lead to bone deterioration as seen through the damage to the gums and
teeth. Because the teeth are also made of bone like material, and the gums are
a direct pathway to the circulatory system, consuming foods right in acid,
ultimately leading to a breakdown of tooth enamel and gum disease, may be a
risk factor for increased bone deterioration overall.
Detection of Osteoporosis
Early detection of osteoporosis is very important. There are
tests which can detect bone density problems:
- Low level x-ray on a finger or wrist
- Ultrasound of the heel
- CT scan of the spine
- Bone density scan / DEXA (Dual Energy X-Ray Absorption Test)
Standard x-rays do not detect osteoporosis until one-quarter
of bone mass is already lost. By then susceptibility to fracture already
exists. DEXA is an early detection tool and can detect as little as one percent
of bone loss.
DEXA uses a low level of radiation, focuses on the hip and
spine which are common sites of fracture, and is considered safe and
comfortable for the patient. However, DEXA which has been called the "gold
standard" of bone density tests may not be covered by some insurance
plans. People at risk for osteoporosis should get one of the less expensive
screenings done first. If there is evidence of bone loss the insurance company
will likely pay for a DEXA test since it is then indicated.
Osteoporosis
Treatment
Although it cannot be cured, osteoporosis can be slowed
down, and steps can be taken to help prevent the disease. In 2001, the FDA
approved Fosamax (alendronate) to increase bone mass in men with osteoporosis.
Fosamax works by reducing the activity of the cells that cause bone loss. The
drug was already approved to prevent and treat postmenopausal osteoporosis in
women based on studies that indicated it not only increased BMD, but also
reduced fractures related to a loss of bone mass. The study in men was designed
only to examine the effect on BMD, not on fracture risk. However, it is
believed that ultimate fracture benefits are likely to occur in men who
experience increases in BMD with treatment, although the relationship between
BMD increases and fracture benefits may differ between the genders.
More recently, a novel approach to treating osteoporosis in
postmenopausal women and in men with primary or hypogonadal osteoporosis is being
investigated. The active portion of human parathyroid hormone (PTH), which
regulates normal calcium and phosphate metabolism in bones, has been
administered by daily injections and shown to stimulate new bone formation,
leading to increased bone mineral density. Post-menopausal women treated with
this agent showed a reduction in the incidence of osteoporotic fractures
relative to those treated with calcium and vitamin D alone. Like Fosamax, the
trial of parathyroid hormone in men was not designed to test the effect of
treatment on the risk of fractures. However, based on the study in women, some
beneficial effect on fracture risk reduction is likely.
Until Fosamax was approved for men with osteoporosis, the
FDA had approved medications only for the prevention and treatment of
osteoporosis in postmenopausal women and steroid-induced osteoporosis in both
men and women. Steroids, a class of compounds that includes prednisone and
cortisone, are powerful anti-inflammatory substances that are used to treat
many diseases, including rheumatoid arthritis and asthma. Steroids can cause
bone to be removed faster than it is formed, and loss of bone density can
occur, increasing the risk for osteoporosis and related fractures. Fosamax and
Actonel (risedronate) are approved for use by men and women with
steroid-induced osteoporosis.
Tailored to the particular reason for bone loss, the
treatment plan for men with osteoporosis will include proper nutrition,
exercise, and lifestyle modifications for preventing bone loss and, if needed,
one of the FDA-approved osteoporosis medications. Doctors may want to monitor
bone density and testosterone levels, recommending testosterone replacement as
necessary, and may suggest changes to the current steroid dosage if they feel
bone loss is due to steroid use. Finally, maintenance of adequate calcium and
vitamin D intake is very important in the treatment and prevention of
osteoporosis.
Sources and Additional
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