Osteoporosis in Men ” Part Two

Thyroid hormones can speed up the bone turnover rate if they are at abnormally high levels which make the incidence of osteoporosis more likely although it is relatively simple to medically treat the person to maintain normal thyroid hormone levels. Men with osteoporosis who are given to high levels of alcohol consumption are about 5 percent of all male osteoporosis sufferers and their chance of developing a hip fracture is three times that of someone who does not consume alcohol. Alcohol suppresses the activity of cells which produce bone substance and also inhibits the absorption of calcium and other nutrients, all fitting together with the tendency to be unsteady to add up to significant bone loss plus a risk of falling over.

Disease of the gastrointestinal tract and operations on the stomach can increase our risk of developing osteoporosis, but the exact mechanism is not clear. Coeliac disease, an intolerance to gluten in the diet, results in inflammation of the lining of the intestine, causing poor absorption of vitamins and minerals. Half of patients suffering with coeliac disease were shown in a study to be exhibiting low bone density even on the correct diet.

If the risk to an individual of developing osteoporosis is higher than a certain level then a measurement of bone density may be requested. Bone density has to drop by 30% at least before the results show up on an x-ray so this is not a good way of estimating bone loss or monitoring it over time. DEXA scanning (Dual Energy X-ray Absorptiometry) is a much more reliable and sensitive method of calculating bone loss and following the changes which might occur with treatment. The level of bone density on DEXA scanning correlates well with the risk of fracturing and it is a very easy, safe and convenient technique due to the low radiation levels used and lack of undressing.

Treatment may be prescribed by a rheumatological specialist or a general practitioner on the basis of a risk factor, fracture incidence or on the results of a scan. The results of a scan are checked against typical average results and overall fall into the osteoporotic, osteopoenic or normal ranges. Since many individual conditions can alter bone density in men these will be diagnosed, investigated and treated as they can have large effects in improving bone stock. Replacement therapy for testosterone can be as patches, injections, implants or tablets but this treatment is not risk free and discussion with a medical adviser is recommended.

Bone breakdown cells or osteoclasts are responsible for bone removal and their actions are slowed down by a class of drugs known as bisphosphonates. This permits the osteoblasts or bone building cells to work with so much opposition and increase the bone mass. Common drugs are called alendronate, etidronate and risedronate. In very acute spinal fractures there is very severe pain and calcitonin is used which again interferes with osteoclasts and gives pain relief. If a muscle developing effect is required then anabolic steroids can be used to boost both that and bone density. Calcium and supplementation with vitamin D is used in men but the specific role in not clear but is covered by having an appropriate diet and some exposure to sunlight.

We are responsible to some extent for keeping our bone density up to normal levels, with exercise and dietary intake being relevant factors. Genetic variation accounts for significant amounts of variation in our bone densities but our behaviour can also change it. Typical recommendations are to take a well-balanced diet and choices are suggested from four varied food groups: fruit and vegetables; pulses, eggs, nuts, fish and meat; milk and other dairy; breads and cereals. Milk and cheese foods are high in calcium and their consumption is important.

Immobility or lack of use leads to the skeleton, a dynamically changing tissue, to suffer loss of bone as it adjusts to the reduced stresses put upon it. Bone increases its density is response to repeated impact stresses and examples of this are skipping, weight training, tennis, aerobics, fast walking and running. These activities all involve jarring and since this is absent to a great extent from cycling and swimming these sports are much less effective. To maintain fitness it is recommended to take a twenty minute exercise session three times a week. New research continues into exercise and drugs treatments.