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Osteoporosis in Men " Part Two

Thyroid hormones can speed up the bone turnover rate if they are at abnormally high levels which make the incidence of osteoporosis more likely although it is relatively simple to medically treat the person to maintain normal thyroid hormone levels. Men with osteoporosis who are given to high levels of alcohol consumption are about 5 percent of all male osteoporosis sufferers and their chance of developing a hip fracture is three times that of someone who does not consume alcohol. Alcohol suppresses the activity of cells which produce bone substance and also inhibits the absorption of calcium and other nutrients, all fitting together with the tendency to be unsteady to add up to significant bone loss plus a risk of falling over.

Stomach surgery and gastrointestinal tract diseases make the likelihood of developing osteoporosis more likely but the precise reason for this is not certain. Being intolerant to gluten in the diet, known as coeliac disease, initiates intestinal lining inflammation and this leads to the absorption of vitamins and minerals being poor. In a study of patients with coeliac disease, half were found to have low bone density despite following the correct diet.

Testing for bone density is usually recommended for anyone with a higher than average risk of developing osteoporosis. Osteoporosis can show up on a spinal x-ray as can an osteoporotic fracture, but it takes a loss of 30 percent of bone mass before it shows on an x-ray. This is not an accurate or sensitive way of measuring bone density which is now done by DEXA scanning or Dual Energy X-ray Absorptiometry. It is a reliable and accurate account of your bone density and thereby the risk of fracturing a bone. DEXA scans use very low doses of radiation and there is no undressing or discomfort involved in the scan.

Treatment may be prescribed by a rheumatological specialist or a general practitioner on the basis of a risk factor, fracture incidence or on the results of a scan. The results of a scan are checked against typical average results and overall fall into the osteoporotic, osteopoenic or normal ranges. Since many individual conditions can alter bone density in men these will be diagnosed, investigated and treated as they can have large effects in improving bone stock. Replacement therapy for testosterone can be as patches, injections, implants or tablets but this treatment is not risk free and discussion with a medical adviser is recommended.

Bone breakdown cells or osteoclasts are responsible for bone removal and their actions are slowed down by a class of drugs known as bisphosphonates. This permits the osteoblasts or bone building cells to work with so much opposition and increase the bone mass. Common drugs are called alendronate, etidronate and risedronate. In very acute spinal fractures there is very severe pain and calcitonin is used which again interferes with osteoclasts and gives pain relief. If a muscle developing effect is required then anabolic steroids can be used to boost both that and bone density. Calcium and supplementation with vitamin D is used in men but the specific role in not clear but is covered by having an appropriate diet and some exposure to sunlight.

We are responsible to some extent for keeping our bone density up to normal levels, with exercise and dietary intake being relevant factors. Genetic variation accounts for significant amounts of variation in our bone densities but our behaviour can also change it. Typical recommendations are to take a well-balanced diet and choices are suggested from four varied food groups: fruit and vegetables; pulses, eggs, nuts, fish and meat; milk and other dairy; breads and cereals. Milk and cheese foods are high in calcium and their consumption is important.

Being an active tissue, bones respond to not being used by losing some of the strength which does not seem to be necessary. Weight bearing exercise causes regular impacts onto the bone, stimulating it to maintain itself or get denser. Examples of useful exercise are fast walking, running, weight training, aerobics, tennis and skipping, all impact activities. Swimming and cycling do not give this impact effect so are less useful. A typical recommendation is to perform suitable exercise for 20 minutes continuously three times a week for best results. New treatments are continually being developed for drugs and exercise therapy.


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