Osteoporosis is often referred to as a disease of women but there is significant research that shows that men also suffer from the debilitating effects of osteoporosis as James graham reports.
One of the challenges of the ageing human population is the increase in health issues associated with osteoporosis and osteoporotic fractures. Osteoporosis is an asymptomatic bone disease that affects both men and women and is often called the “silent” disease as symptoms are not regularly noticed. It is characterized by low bone mineral density (BMD) and is compounded by the destruction of the bone structure. Population studies have shown that low BMD is more common in the elderly and leads to an increased risk of fractures and breakages.
Osteoporosis is less frequent in men compared to women where approximately 30% of those affected are men. Although recent studies have shown that 1 in 8 men over 50 will suffer an osteoporotic fracture either in the spine, hip or wrist in later life. In older men it is likely that the development of osteoporosis is age-related. However, osteoporosis can manifest due to a secondary cause, such as other diseases or from taking certain medications, such as steroids which can often reduce bone loss. Regardless of the underlying cause, the test for low BMD is simple to do and usually involves a bone mineral density test, which is similar to an x-ray, at the hip and spine.
The diagnosis of osteoporosis in men is difficult due to significant under-reporting in those affected. Women who are at risk are usually identified at the onset of menopause in midlife. In men, however, diagnoses are usually only made after a fracture has occurred or if back pain has become unbearable. One of the few examples where men are tested is when men require medical help for alcohol abuse. Here, low BMD is tested due to the causal association between alcohol abuse and loss of bone mass.
Testosterone and bone health
The male hormone testosterone regulates the development of sexual virility as well as the lean muscle and fat composition in the male body. Small amounts of testosterone are converted to estrogen, which is important in the modulation of bone metabolism and the integrity of the male skeletal system. It is believed that testosterone and estrogen work together for the maintenance of bone health in men.
Although not universal, male bone loss typically starts during middle age as testosterone levels decrease—this is called hypogonadism. This is characterised by a lack of free, or bioavailable, testosterone. As men get older, bioavailable testosterone declines at a higher rate than testosterone is produced. As bioavailable testosterone levels fall, as is notable with ageing, most men will begin to experience a loss in muscle mass and strength. It has also been reported that as testosterone levels fall, there is a correlation with higher Body Mass Index (BMI) and a greater waist circumference.
Currently, there is no treatment that fully restores lost bone mass. Therefore, prevention of bone loss is the ideal solution. Pre-menopausal women, who are at risk of osteoporosis, are normally identified before menopause begins, thus allowing preventative measures to be applied in time. These include lifestyle adjustments such as quitting smoking and reducing alcohol consumption, both of which can assist in preventing osteoporosis. In addition, an adequate daily intake of calcium and vitamin D at this time can also assist in preventing osteoporosis.
Another important preventative measure is the inclusion of regular exercise, or resistance training. Resistance training involves weight lifting and has been shown to strengthen bones, thus reducing the risk of fracture. Resistance training will also improve muscle mass and strength, which will not only improves overall health but also assists in balance and coordination. Together, these benefits will reduce the chance of a fall that could cause a bone fracture. Even in aging men, resistance training increases muscle mass and strength thus reducing likelihood of fractures from falling.
A recently published study analysed the association of fruit and vegetable intake and the incidence of bone fractures in the elderly. Green vegetables and even oranges are an important source of calcium that can have higher absorption rates than that of traditional sources of calcium, such as milk. Those who consumed less than one serving of fruit and vegetables a day were likely to have a 39% increase in hip fracture risk when compared to those who had more than 3 servings per day.ß
At present, hormone replacement therapy (HRT) with estrogen is the most effective treatment of osteoporosis in women. The fracture rates in women are greatly reduced when they are administered orally, injected or skin creams of HRT. However, HRT with testosterone for men is unclear, with many conflicting results on efficacy and safety. One underlying concern is that testosterone therapy has been associated with adverse effects such as increased risk of respiratory diseases, cardiovascular disease and prostate cancer.
On a positive note, treatment with skin creams or injectable testosterone has been shown to increase fat-free mass, physical performance and grip-strength in elderly men. In another study, the mineral density of vertebrae in the lumbar spine was increased after testosterone treatment, suggesting that age-related testosterone deficiency is important when concerning the bone health status in men.
So, due to the lifestyle habits of men, lack of reporting and loss of bone mass due to decreased testosterone levels, there is an increased risk of fractures causing reduced mobility and life expectancy. Although it is natural for testosterone levels to reduce with age, low testosterone levels can increase the presence of osteoporosis in the elderly. To counteract the onset of osteoporosis, lifestyle changes such as dietary changes and the inclusion of resistance training are advised due to their advantages in assisting with enhanced bone maintenance. If in doubt, speak to a health professional for further advice.
Bone with Osteoporosis Turn to page 62 for some resistance exercise ideas