BONE HEALTH

Australian Health Today - - Contents -

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.

Pre­ven­tion

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

Treat­ment

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.

Nor­mal bone

Bone with Os­teo­poro­sis Turn to page 62 for some re­sis­tance ex­er­cise ideas

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