What is Osteoporosis? Why should I care about Osteoporosis?

We know from recent articles and studies that Testosterone can prevent Osteoporosis, but what is Osteoporosis and why is it important to prevent?

As men age, and especially around age 70, their bone density decreases. Unlike women, men do not generally go through periods or rapid hormonal change. However, men can develop osteoporosis as a result of low hormone levels in the body, especially low testosterone levels.

Osteoporosis is a quiet condition that occurs slowly over time as we all get older. It is usually not discovered until we start breaking bones from simple falls or less.

All of us are born with thin bones, and as we grow, our bones grow and thicken. So, when Mom said “eat your veggies and drink your milk to grow up big and strong,” she was telling the truth.

While osteoporosis is most commonly associated with postmenopausal women, men are also at risk. About 2 million men in the United States currently have osteoporosis, and millions more have osteopenia.

Some contributing factors are the same between genders, including diet, exercise frequency, and concurrent medical conditions. However, low and/or diminishing levels of testosterone are the most common causes of osteoporosis in men.

Osteoporosis Differences Between Men and Women

As women age and enter menopause, they experience a decline in estrogen levels. This decline leads to accelerated loss of trabecular bone, the spongy bone inside the hard cortical bone.

In men, however, osteoporotic bone loss is related to the natural decrease in the production the hormones estradiol (a type of estrogen) and testosterone with age. Instead of losing trabecular bone, men experience trabecular thinning. Because of this, men with osteoporosis experience slower bone loss with smaller decreases in bone mineral density

Other differences between men and women are thought to contribute to the gap in osteoporosis rates. Men are, on average, more consistently physically active over their lifetimes than women, which helps prevent the loss of bone mass. Women also typically live longer than men, and the chances of developing osteoporosis increases with age.

Microscopically, bones are built like steel-girder bridges or scaffolds, lots of bone girders holding up our bodies. Our bones should be their strongest by about age 30. After that, our bones gradually lose their strength, and the bone girders are taken away until we cannot support ourselves.

» Three-fourths of women will not be treated even a year after their fracture.

» One-third of women over age 50 will develop an osteoporosis fracture.

» Those with one osteoporosis fracture have a five-times higher risk of a second fracture within a year.

» Thirty-three percent of women and 50 percent of men who experience an osteoporosis hip fracture die within a year due to complications.

Many things affect our bone strength. Factors that increase bone loss include age, being underweight, Caucasian, female, sedentary, having a family history of fractures, low estrogen and testosterone levels, smoking, using steroids and excessive alcohol.

Medical conditions also can decrease bone strength, such as thyroid and other endocrine diseases, liver or kidney disease, kidney stones, malnutrition, malabsorption of nutrients, rheumatoid arthritis, lupus, seizure disorders and cancers.

Diagnosing osteoporosis is easy and painless. Your medical provider can order a DEXA scan of your low back and hip. This screening measures bone density and provides a T-score that can help identify those at risk for osteoporosis and bone fractures:

It is recommended that all women over age 65 and men over 70 should get a DEXA scan. Others who should be screened include postmenopausal women under age 65 with significant risk factors and men age 50 to 69 with risk factors. Risk factors include:

» Physical inactivity.

» Previous fractures.

Another tool is FRAX, or Fracture Risk Assessment Tool, which can be completed online in seconds and gives a 10-year risk assessment for an osteoporosis fracture. To assess your 10-year risk, search for FRAX and select the appropriate region from the website’s calculation tool menu.

People with osteoporosis should be on 1,000 mg of elemental calcium and 2,000 to 5,000 units of vitamin D per day. Depending on past fractures and risk of future fractures, medications, including oral bisphosphonates and biologic therapies, also can be used to slow bone loss and thicken bones.

Primary and secondary osteoporosis

There are two main types of osteoporosis: primary and secondary. In cases of primary osteoporosis, either the condition is caused by age-related bone loss (sometimes called senile osteoporosis) or the cause is unknown (idiopathic osteoporosis). The term idiopathic osteoporosis is typically used only for men younger than 70 years old; in older men, age-related bone loss is assumed to be the cause.

The majority of men with osteoporosis have at least one (sometimes more than one) secondary cause. In cases of secondary osteoporosis, the loss of bone mass is caused by certain lifestyle behaviors, diseases, or medications. Some of the most common causes of secondary osteoporosis in men include exposure to glucocorticoid medications, hypogonadism (low levels of testosterone), alcohol abuse, smoking, gastrointestinal disease, hypercalciuria, and immobilization.

 

Some causes of osteoporosis in men

  • Glucocorticoid medications.
  • Other immunosuppressive drugs.
  • Hypogonadism (low testosterone levels).
  • Excessive alcohol consumption.
  • Smoking.
  • Chronic obstructive pulmonary disease and asthma.
  • Cystic fibrosis.
  • Gastrointestinal disease.
  • Hypercalciuria.
  • Anticonvulsant medications.
  • Thyrotoxicosis.
  • Hyperparathyroidism.
  • Immobilization.
  • Osteogenesis imperfecta.
  • Homocystinuria.
  • Neoplastic disease.
  • Ankylosing spondylitis and rheumatoid arthritis.
  • Systemic mastocytosis.

Reduce your risk for osteoporosis fractures by stopping smoking, reducing alcohol intake and including at least 30 minutes of weight-bearing exercise in your schedule three times per week to strengthen bones and improve balance. Make sure you have your testosterone levels checked.

 

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