Osteoporosis in Men

What is osteoporosis?

Osteoporosis is a disease that thins and weakens bones to the point where they may break easily. This disease often affects bones in the hip, spine, and wrist. Though it is most often thought of as a woman's disease, men also get osteoporosis.

How does it occur?

Studies indicate that bones keep their strength by being used, supporting the body’s weight. Bone-forming cells called osteoblasts make new bone all the time. Bone-absorbing cells called osteoclasts dissolve away older bone, making room for new bone. This goes on all the time – the bones are always being remodeled. For unknown reasons, the balance of formation and reabsorption of bones tips slightly in favor of reabsorption as people get older. Too much bone reabsorption leads to osteoporosis.

In healthy adults bones continue to grow, reaching their greatest strength around age 20 to 35. After that, a slow decline in bone strength over many years occurs.

The bones of young boys and teenagers who are not physically active and don't get enough calcium in their diet are probably not as strong as they would otherwise be. If bones do not become as strong as possible, there is less bone reserve, leaving you more likely to develop osteoporosis as you get older. In the US today, less than half of school-aged boys and male high schoolers get enough calcium in their diets.

In addition to aging, other causes of osteoporosis are:

• lifestyle habits such as
  • smoking
  • having more than 1 drink of alcohol a day
  • too little calcium in the diet
  • not enough weight-bearing exercise such as walking, dancing, or lifting weights
• long-term use of some medicines, such as steroids used to treat asthma or arthritis, anticonvulsants, aluminum-containing antacids, and cancer treatments
• chronic disease that affects the kidneys, lungs, stomach, intestines, or liver, or changes hormone levels (examples of such diseases are diabetes, hyperthyroidism, and congestive heart failure
• low levels of the male hormone testosterone
• long periods of bed rest during serious illness (Medical scientists think this comes from not having enough weight on the bones of the body. For example, astronauts in space a long time show signs of osteoporosis.)
• eating disorders or too much dieting.

You have a higher risk of osteoporosis if you have a family history of the disease.

What are the symptoms?

Usually, there are no symptoms until a bone breaks. Broken bones are the most common problem for people with osteoporosis. Often it's the spine, hip, arm, or wrist that breaks. You may break a bone in your spine just by coughing or sneezing. A simple slip and fall may fracture a wrist or hip.

Often, as bones of the spine (vertebrae) thin over time, the vertebrae collapse on themselves. This can cause a loss of height, back pain, and a stooping posture (dowager's hump).

How is it diagnosed?

Your healthcare provider will review your medical history, ask about symptoms, and examine you.

The main test used to look for osteoporosis is a bone mineral density test, such as a DEXA scan. This test is a special X-ray exam of the spine, hip, and/or wrist. Sometimes, osteoporosis can be measured using ultrasound scans.

How is it treated?

Treatment can slow down the loss of bone and rebuild some bone. It does not restore bone strength all the way back to normal.

The 3 essentials of basic treatment for osteoporosis are:

• Weight-bearing exercise. Weight-bearing exercise, such as walking or stair climbing, helps keep your bones strong. Doing this kind of physical activity every day may help keep your bones from getting weaker.
• Plenty of calcium in the diet. Men 19 to 70 years old should have 1000 milligrams (mg) of calcium a day. Men over 70 need at least 1200 mg a day. Calcium is found naturally in foods such as milk, yogurt, and cheese. It can also be taken as a supplement.
• Good levels of vitamin D in the blood. If your blood levels of vitamin D aren’t high enough, you may need to take supplements. Vitamin D helps your body absorb and use calcium. The current US recommendations for vitamin D are 800 international units (IU) a day if you over 70 years old. You should get 600 IU a day if you are 70 or younger.

Some medicines such as alendronate (Fosamax) and risedronate (Actonel) may be used to prevent and treat osteoporosis. You may be given testosterone if tests show your hormone level is low.

Other medicines and therapies have been or are being developed. Check with your healthcare provider about your current choices for treatment.

How long will the effects last?

The risk of a broken bone resulting from osteoporosis gets higher as you get older. Compression fractures in the spine are the most common type of fracture caused by osteoporosis. Treatment can help reduce your risk of broken bones, especially compression fractures and broken hips. However, no treatment has eliminated the risk of these types of fractures.

How can I take care of myself?

Follow the treatment recommended by your healthcare provider. In addition, you can:

• Stop smoking. Smokers may absorb less calcium from their diet.
• Drink no more than 2 ounces of hard liquor, two 12-oz servings of beer, or two 4-oz glasses of wine a day.
• Get regular weight-bearing exercise. Walking is especially good. Be sure to exercise your upper body also. Weight-bearing exercise helps prevent bone loss and strengthens muscles, which can help prevent falls. Ask your healthcare provider if there are any limits on your exercising.
• Eat a healthy diet that includes dairy products and plenty of fruits and vegetables.
• Take a daily calcium supplement and vitamin D supplement if your healthcare provider recommends it. You can get vitamin D by drinking milk, taking supplements, or spending time in sunlight.

You can reduce the risk of injury and broken bones if you:

• Avoid lifting heavy objects.
• Avoid unusually vigorous physical activity. Build your activity level gradually. Take exercise classes that fit your age, strength, and fitness.
• Avoid antacids that contain aluminum hydroxide, such as Amphojel, Gaviscon, or Mylanta.
• Wear shoes that provide good support (such as running or walking shoes).
• Use support for walking, such as a cane, if you need it.
• Keep areas where you will be walking well lit and uncluttered. When you walk outside, avoid graveled areas or other uneven surfaces that could cause a fall.
• Avoid putting throw rugs on your floors at home.
• Be cautious about going outdoors when roads and sidewalks are icy.

If you are taking medicine to treat your osteoporosis, be sure to take it as prescribed by your healthcare provider. For example, alendronate must usually be taken with a full glass of water in the morning on an empty stomach. You must remain upright for at least a half hour after taking it.

How can I help prevent osteoporosis?

• If you are over age 55, be sure to keep getting regular weight-bearing exercise.
• Get enough calcium and vitamin D daily from foods you eat or dietary supplements.
• Don't smoke.
• Avoid drinking too much alcohol.