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Osteoporosis in Men

If our bones lose some of their structural strength they can become too porous to cope with the mechanical forces which result from activities of daily living. The cortex is the denser, outer part of the bone and provides mechanical strength and resistance to tension and compression. Cancellous bone is less dense more like a honey-comb with its spaces full of blood vessels, bone marrow and collagenous tissue. In osteoporotic change the bone spaces enlarge and the cross struts become less frequent and less dense, lowering the overall bone strength. Osteoporosis occurs throughout the skeleton but its effects are mostly felt in the wrist, hip and spine.

Bone looks static but is living and so in a constant state of change, with older bone being broken down and replaced, a process that in an adult takes about seven to ten years to replace the whole skeleton. Bone turnover is the name given to this natural and important process. Children have an altogether faster rate of bone turnover and can replace their skeleton in two years. Our bones finish growing in length from around sixteen to eighteen years of age by which time we have achieved our final size, but our bone density continues to increase for a bit longer, into our mid-twenties.

The beginning of our adult life is a stable phase during which our bony structure stays static with a balance between the rate of bone formation and bone breakdown. Once we reach middle age there is a change towards an increased breakdown of bone and we start to suffer a loss of bone density, leading to osteoporotic change in some people, particularly older, post-menopausal women. Men can get osteoporosis and precipitating factors are chronic immobility, problems with absorption of nutrients such as from ulcerative colitis, asthma management by steroid use, smoking, low bodyweight and low male hormonal levels.

Osteoporotic change occurs in one in every three women during their lifetimes and so is often viewed as being a disease of women. Men are however affected by this bone condition but at a frequency of one in twelve, with 20 percent of spinal fractures and 30 percent of hip fractures attributable to lowered bone density. The lesser frequency of osteoporosis in men may be for a couple of reasons: first they develop a higher bone density to start with so start off from a better position, and they lose bone much less significantly in middle age, especially cortical bone.

It is typical for there to be no warning signs of the development of osteoporosis and for a relatively small trauma to surprise the person with the severe pain of a spinal or wrist fracture. The thoracic spine can suffer wedge fractures which are severely painful and can produce significantly disabling pain which can be long lasting. The process of wedging and crush fractures can occur without symptoms as the person loses height or develops a spinal curve referred to as a kyphosis. A severe kyphotic curvature can cause compression of the ribcage and abdominal structures, resulting in digestive and respiratory complications.


Genetic factors may be responsible, at least partly, for the fact that no diagnostic cause can be found for 45 percent of men with osteoporosis. If someone in the close family has a history of osteoporosis then a man has a higher likelihood of developing lowered bone density and an elevated risk of spinal fractures developing. The maintenance of bone density is partly under the control of the testosterone levels in the body and osteoporosis is a risk if the levels of the hormone are low. Seventy year olds produce only fifty percent of the testosterone levels of men of thirty years of age. Testosterone replacement therapy can be prescribed if appropriate.

Corticosteroid treatment is used to counter the inflammatory effects of ulcerative colitis and asthma as well as other less well known disorders. The levels of bone loss can increase with only six months treatment with a steroid such as prednisolone so they are only prescribed when essential to combat an illness. Individuals should not change their steroid doses with consulting with their medical advisers as this could produce severe side effects.

 

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