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, 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:
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.
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.
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.
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.
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.
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