Men and Osteoporosis - Part 2

The rate of bone turnover can be increased by excess production of thyroid hormones and this can make the development of osteoporosis more likely, although treatment to maintain the normal range of thyroid hormone concentrations is straightforward. Five percent of men who suffer from this condition do so because of consumption of excessive alcohol and they have three times the risk of suffering a hip fracture compared to people who do not drink. The activity of bone producing cells called osteoblasts is suppressed by alcohol, with other side effects such as the reduced absorption of nutrients and calcium, all contributing to bone loss and the tendency to fall.

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.

If the scan shows lowered bone density, there has been a fracture from a trivial event or specific risk factors then a rheumatological specialist or a general practitioner might prescribe treatment. When a scan is performed the outcome falls within one of three main areas, normal, osteoporotic or osteopoenic (a reduced level of bone density above osteoporosis). Male bone density can be reduced by many medical conditions and these will be investigated and managed initially as this can improve bone density. Hormone replacement of testosterone can be given as implants, patches, injections or tablets, with medical discussion important about risks.

Bisphosphonates are a class of drugs which slow down the actions of the osteoclasts, the bone cells which break down bone, allowing the bone building cells (osteoblasts) to work with less opposition and so increase the density of the bone. Examples of these drugs are risedronate, alendronate and etidronate. Calcitonin also interferes with the bone breakdown cells and is particularly used to relieve the acute pain of recent spinal fractures. Anabolic steroids can be used in some cases, especially where their muscle building effect is required. It is not clear exactly what role calcium and vitamin D supplements have in managing osteoporosis in men, but a good diet and some sunlight exposure outside are useful for this.

Maintaining a healthy bone density can be part of our individual responsibility and diet and exercise are two important factors. Even though much of our bone density is determined by genetic factors, we can alter it by our behaviour. A well balanced diet is typically recommended by choosing from four different groups of foods: cereals and breads; fruit and vegetables; milk and other dairy products; eggs, pulses, nuts, meat and fish. A sufficient calcium intake is vital with dairy products such as milk and cheese particularly high in this mineral.

As our bones are a living and dynamic tissue, if we do not use them then they will lose strength as they are not being used. Regular impact activities in weight bearing exercise stimulate bone to become denser to resist the stresses. Useful exercise types are running, fast walking, aerobics, tennis, weight training and skipping, all activities with impacts. There is much less or no impact in cycling and swimming and so they are less therapeutic. Three times a week exercise for a continuous twenty minute period is a common recommendation. Exercise and drug therapies are continually being innovated.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Rugby. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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