Bone loss in men

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Osteoporosis also affects men. Discover what the risk factors are and how to protect yourself.

Young men may feel invulnerable, but as men get older, they begin to worry about heart disease, high blood pressure, diabetes, stroke, cognitive decline, and prostate disease - all with good reason.

Faced with so many concerns, most are only too happy to cross "women's diseases" off their worry lists. But in the case of osteoporosis, it's a big mistake.

Hard facts

Although osteoporosis is more common in females than males, it's not a woman's disease. In fact, about 2 million American men have osteoporosis and another 12 million are at risk. Because osteoporosis starts later in men than women, most men with "thin bones" are over age 65.

All in all, about one in every five 50-year-old men will suffer an osteoporotic facture during his remaining years. Hip fractures are particularly common and are more serious for men than women, with a one-year mortality rate of up to 37.5%.

So, if you think osteoporosis is a woman's disease, think again. Then think about ways to prevent, recognise, and treat this important disease of men and women.

How osteoporosis develops

Healthy bones are amazingly strong. Ounce for ounce, they can support as much weight as reinforced concrete. But unlike concrete, your bones are metabolically active living tissues and have to repair themselves after injuries.

They do this by constantly remodelling. Cells called osteoblasts, which add bone, are constantly at work forming new tissue and depositing calcium to keep bones strong. At the same time, osteoclasts, which remove bone, are "resorbing" (dissolving) old bone and removing calcium. At any one time, about 7% of your body's bone calcium is on the move.

In youth, bone formation outpaces "resorption" (removal of bone) - that's how we grow. In males, bone calcium density increases rapidly when testosterone levels surge at puberty.

Bone strength peaks at about age 20 and remains stable for the next 10 to 15 years. But boys with delayed puberty, dietary deficiencies of calcium or vitamin D, or insufficient exercise levels have lower peak bone densities and are at increased risk for osteoporosis when they get older.

In both men and women, bone resorption begins to outpace bone formation at about age 35. At first, bone density declines slowly. But when women reach menopause, their oestrogen levels plummet and bone density decreases sharply. In men, testosterone levels decline more gradually, dropping just 1% a year beyond age 40. As a result, bone loss remains relatively slow - but it's steady.

Beyond age 65 or so, men and women lose bone at about the same rate. Over time, the average man will lose about 20% of his cortical bone (the dense outer layer) and 30% of his trabecular bone (the spongy inner layer). And in some men, bone loss is even more substantial, crossing the line that separates men with healthy bones from those with osteoporosis.

With osteoporosis, bones become porous because they lack enough calcium to maintain their structural integrity. In addition to having a low calcium density, osteoporotic bones develop architectural abnormalities.

In healthy bones, normal bone mineral density accounts for about 70% of bone strength, and normal architecture contributes about 30%. The combination of low calcium and poor bone quality produces weak bones that are easily fractured, with or without trauma.

Risk factors

Two of the most important determinants of a man's bone density are beyond his control. Genetic factors explain up to 80% of the variance in peak bone density in young men.

The gene that regulates vitamin D's activity appears to be the most important, which makes sense since vitamin D helps the intestines absorb calcium from the bloodstream. Genetic factors explain why osteoporosis tends to run in families and why the disease is more common in Caucasians and Asians than in African Americans.

The second major determinant of bone density in men is age. Beyond the fourth decade of life, bone density declines progressively in every man. But while men can't control their heredity or slow the tick of the clock, they can modify many of the other osteoporosis risk factors.

Medical factors account for the most severe cases of osteoporosis in men. Low testosterone heads the list, explaining about 15% of cases severe enough to cause fractures. Therapy with prednisone and related drugs is a close second at 13%.

Alcohol abuse is the most common lifestyle contributor, explaining 6% of cases. But in about half the men with osteoporosis, no specific causal abnormality can be identified. Diet and exercise are of major importance for these men diagnosed with primary osteoporosis.

Symptoms

Until it's quite advanced, osteoporosis is a very silent disease. Decreasing bone density doesn't produce any symptoms until it declines below the fracture threshold. Even then, osteoporosis is often painless until soft bones meet up with hard objects - legs can snap from a simple stumble at 70.

In men, as in women, spine fractures are the most common result of osteoporosis. A gradual loss of height may be the only evidence of compressed vertebral bones, but back pain is also common and can be very severe. In advanced cases, a characteristic stooped posture and protuberant waist testify to osteoporotic spinal fractures.

In men and women with osteoporosis, the hip and the wrist follow close behind the spine on the fracture list. Rib fractures appear to be a bit more likely in men, but osteoporosis victims of either gender can fracture any of their bones.

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