Osteoporosis in Men

Bone is constantly changing - that is, old bone is removed and replaced with new bone. During childhood, more bone is produced than removed, so the skeleton grows in both size and strength. For most people, bone mass peaks during the third decade of life. At this age, men usually have accumulated more bone mass than women. After this point, the amount of bone on bone usually begins to decline slowly as removal of old bone exceeds formation of new bone.

Men in their 50s do not experience rapid loss of bone mass that women do in the years following menopause. At the age of 65 or 70, however, men and women who lose bone mass at the same level, and the absorption of calcium, an essential nutrient for bone health throughout life, the decline in both sexes. Excessive bone loss causes bones to become fragile and more likely to fracture.

Fracture due to osteoporosis most often occurs in the hip, spine, and wrist, and can be permanently disabling. Hip fractures are very dangerous. Perhaps because these fractures tend to occur at older ages in men than in women, men who sustain a hip fracture is more likely than women die from complications.

There are 2 main types of osteoporosis: primary and secondary. In the case of primary osteoporosis, whether the condition is caused by bone loss associated with age (sometimes called senile osteoporosis) or the cause is unknown (idiopathic osteoporosis). The term idiopathic osteoporosis is used only for men less than 70 years; in older men, bone loss associated with age is assumed to cause.

The majority of men with osteoporosis have at least one (sometimes more than one) secondary causes. In the case of secondary osteoporosis, loss of bone mass caused by certain lifestyle behaviors, diseases, or drugs. The most common causes of secondary osteoporosis in men include exposure to glucocorticoid drugs, hypogonadism (low testosterone), alcohol abuse, smoking, gastrointestinal disease, hypercalciuria, and immobilization.

Causes of Secondary Osteoporosis in Men:

• glucocorticoid medicines
• other immunosuppressive drugs
• hypogonadism (low testosterone levels)
• Excessive alcohol consumption
• smoking
• chronic obstructive pulmonary disease and asthma
• cystic fibrosis
• Digestive Disease
• hypercalciuria
• anticonvulsant drugs
• thyrotoxicosis
• hyperparathyroidism
• immobilization
• osteogenesis imperfecta
• homocystinuria
• neoplastic disease
• ankylosing spondylitis and
• rheumatoid arthritis
• Systemic mastocytosis

glucocorticoid drugs: Glucocorticoids are steroid drugs used to treat diseases such as asthma and rheumatoid arthritis. Bone loss is a very common side effect of this drug. This drug causes bone loss may be due to their direct effects on bone, muscle weakness or immobility, reduces the intestinal absorption of calcium, decreased testosterone levels, or, most likely, a combination of these factors.

When the drug is used continuously glucocorticoids, bone mass often decreases rapidly and continuously, with most of the bone in ribs and spine. Therefore, people taking these medications should talk with their doctor about having a bone mineral density (BMD) test. Men also should be tested to monitor testosterone levels, as glucocorticoids often reduce testosterone in the blood.

A treatment plan to minimize bone loss during long-term glucocorticoid therapy may include using the minimum effective dose, and discontinue the drug or administration through the skin, if possible. sufficient calcium and vitamin D intake is important, because these nutrients help reduce the impact of glucocorticoids on bone. Other possible treatments include testosterone replacement and treatment of osteoporosis. Alendronate and risedronate are the two bisphosphonate drugs approved by the Food and Drug Administration (FDA) for use by men and women with glucocorticoid-induced osteoporosis.

Hypogonadism: Hypogonadism refers to the normal low levels of sex hormones. It is well known that the loss of estrogen causes osteoporosis in women. In men, reduced sex hormone levels can also cause osteoporosis.

While it's natural for testosterone levels decline with age, there should be no sudden decrease in the hormone estrogen decline comparable to that experienced by menopausal women. However, drugs such as glucocorticoids (discussed above), cancer treatment (particularly for prostate cancer), and many other factors can affect testosterone levels. Testosterone replacement therapy may be helpful in preventing or slowing bone loss. Success will depend on factors such as age and how long have decreased testosterone levels. Also, not clear how long the beneficial effects of testosterone replacement will last. Therefore, doctors usually treat osteoporosis directly, using a drug approved for this purpose.

Recent research suggests that estrogen deficiency can also cause osteoporosis in men. For example, low estrogen levels in men with hypogonadism and may play a part in bone loss. Osteoporosis has been found in some men who have a rare disorder that involves estrogen. Therefore, the role of estrogen in men is being actively investigated.

Alcohol abuse: There is ample evidence that alcohol abuse can decrease bone density and cause an increase in fractures. Low bone mass is common in men who seek medical help for alcohol abuse.

In cases where bone loss associated with alcohol abuse, the first goal of treatment is to help patients stop - or at least reduce - his consumption of alcohol. Research is needed to determine whether bone loss alcohol abuse will build once again stop drinking, or even whether any further damage can be prevented. It is clear, though, that alcohol abuse causes other health and social problems, so the stop is ideal. A treatment plan also may include a balanced diet with plenty of foods rich in calcium and vitamin D, a program of physical exercise, and quitting smoking.

Smoking: Bone loss is more rapid, and the level of hip and vertebral fractures is higher, among men who smoked, although further research is needed to determine exactly how smoking damages the bone. Tobacco, nicotine, and other chemicals found in cigarettes can be directly toxic to bone, or they can inhibit the absorption of calcium and other nutrients needed for bone health. Stop is the ideal approach, such as smoking is harmful in many ways. Like alcohol, it is not known whether stopping smoking causes a decrease in the level of bone loss or gain in bone mass.

Gastrointestinal disorders: Some nutrients - including amino acids, calcium, magnesium, phosphorus, and vitamins D and K - essential for bone health. Diseases of the stomach and intestines can cause bone disease when they interfere with absorption of nutrients. In such cases, treatment of bone loss may include taking nutritional supplements to add.

Hypercalciuria: hypercalciuria is a disorder that causes too much calcium to be lost through the urine, which makes the calcium unavailable for bone building. Patients with hypercalciuria should talk with their doctor about having a BMD test and, if low bone density, to discuss treatment options.

Immobilization: Weight-bearing exercise is important for maintaining bone health. Without it, bone density will decrease rapidly. Long break (fracture following, surgery, spinal injury, or illness) or immobilization of some parts of the body often result in significant bone loss. It is important to continue with body weight exercises (like walking, jogging, dancing, and lifting weights) as soon as possible after a prolonged period of rest. If this is not possible, you should work with your doctor to minimize other risk factors for osteoporosis.

Diagnosis in Men

Osteoporosis can be treated if detected before significant bone loss has occurred. A medical examination to diagnose osteoporosis will include a complete medical history, x rays, and urine and blood tests. The doctor may also order a BMD (bone mineral density) test. These tests can identify osteoporosis, determine risk for fractures (broken bones), and measure your response to osteoporosis treatment. Bone mineral density tests are the best known is called dualenergy x-ray absorptiometry or DXA test. It is painless: a bit like having an x-ray, but with less exposure to radiation. It can measure bone density in the hip and spine.

It is increasingly common for women to be diagnosed with osteoporosis or low bone mass using a BMD test, often in middle age when doctors began to see signs of bone loss. In men, however, diagnosis is often not made ​​until a fracture occurs or a man complaining of back pain and see his doctor. This makes it very important for men to inform their doctors about risk factors for osteoporosis, loss of height or posture changes, fracture, or sudden back pain.

Risk Factors for Men?

Several risk factors have been associated with osteoporosis in men:

• Chronic illness that affects the kidneys, lungs, stomach, and intestines or alter hormone levels
• Regular use of certain medications, such as glucocorticoids
• undiagnosed low levels of sex hormone testosterone
• Healthy lifestyle habits: smoking, excessive alcohol use, low calcium intake, and inadequate physical exercise
• Age. The older you are, the greater your risk.
• Race. Caucasian men in particular seem risky, but all people can develop this disease.

Some doctors may be unsure how to interpret the test results of BMD in men, because it is not known whether the World Health Organization guidelines used to diagnose osteoporosis or low bone mass in women is also suitable for men. Although controversial, the International Society for Clinical Densitometry recommends using separate guidelines when interpreting the results of BMD testing in men.