Osteoporosis means ‘porous bones’. It affects men as well as women. Up to 30 per cent of all fractures that occur in people with osteoporosis and osteopenia, occur in men. Common sites for fractures include the hip, wrist and spine.
Our bones are living tissue, which is constantly changing or ‘remodelling’. Bone remodelling is a life-long process where old bone is removed from the skeleton and new bone is added.
Childhood and early adulthood is a period of bone growth. During this time, more bone is added than is taken away. By the time we reach our mid 20s, we have reached our peak bone mass and our bones are at their strongest. From this time until sometime in our 30s, the process of bone breakdown and rebuilding is generally in balance.
After this point, our bones slowly start to lose density and strength, which makes them more susceptible to fracture. Once the bone loss reaches a certain risk level, a diagnosis of osteoporosis will be made.
Symptoms of osteoporosis in men
Osteoporosis is often called a ‘silent’ condition, as people do not notice any symptoms until a fracture occurs.
When symptoms do occur, they are generally the result of a fracture. These symptoms may include:
- loss of height
- postural changes
- back pain.
Lower risk of osteoporosis in men
Fewer men are affected by osteoporosis than women. Osteoporosis is less common in men due to several factors, including:
- The larger male skeleton offers a larger reservoir of bone tissue.
- The absence of a clearly defined menopause (drop in sex hormone levels) in men means that the onset of osteoporosis is likely to start much later in life.
- The decrease in bone mass occurs at a slower rate in male than female bones, but only until the age 65 or 70, when the rate is the same for men and women.
Risk factors for osteoporosis in men
Throughout our lives, bone density is affected by factors such as heredity, physical activity, diet, sex hormones such as testosterone, lifestyle choices and the use of certain medication.
Factors that are linked to an increased risk of osteoporosis in men include:
- a family history of osteoporosis, fractures and loss of height
- chronic diseases, such as rheumatoid arthritis, over-active thyroid or parathyroid glands, coeliac disease and other chronic gut conditions, chronic liver or kidney disease, diabetes and low testosterone levels
- regular use of certain types of medication, such as glucocorticoids, anticonvulsant medication, some anti-depressants and treatment for prostate cancer
- lifestyle factors, such as smoking, excessive alcohol use, low calcium intake, inadequate exercise, obesity, vitamin D deficiency and low body weight.
Diagnosis of osteoporosis in men
Osteoporosis may be diagnosed in men by examining their medical history, and by conducting:
- a physical examination
- DXA (dual-energy x-ray absorptiometry) scan to measure bone density
- blood tests
- urine tests.
Treatment for osteoporosis in men
Medical treatment is designed to suit the needs of the individual. Options may include:
- treatment for any underlying disease (for example, rheumatoid arthritis or celiac disease)
- lifestyle changes
- dietary changes.
Treatment for an underlying disease
When osteoporosis has been caused by an underlying condition, it is called ‘secondary osteoporosis’. It is important that the underlying condition is treated. Treatment options will depend on the particular condition. Your doctor may refer you to specialists.
The type of medication chosen by your doctor depends on factors such as your age, general health and fracture risk. Medication options may include:
- Bisphosphonates – boost bone density by interfering with the body’s natural process of breaking down bone tissue, and are the most commonly used to treat osteoporosis in men. They may be taken orally, by subcutaneous injection or by intravenous injection.
- Testosterone therapy – may be offered if testing shows low testosterone levels. Testosterone may be administered orally, or via injections, implants, skin patches or with gels and creams.
- Parathyroid hormone therapy – helps new bone to grow and increase mass. This medication is administered by daily injection.
Be guided by your doctor. Recommended lifestyle changes for treating osteoporosis in men may include:
- Exercise – if you have osteoporosis, it is recommended that your physical activity is reviewed and prescribed by an exercise professional, such as a physiotherapist or exercise physiologist. This is because some activities like jumping, running and twisting can be hazardous to weaker bones, particularly if you have had a fracture. Other forms of exercise such as strength training and brisk walking can actually benefit the bones. A well-designed, individual program will help make sure that exercise is beneficial, comfortable and safe.
- Sunshine – a bit of sunshine exposure will boost your skin’s production of vitamin D. To minimise the risk of sunburn and skin cancer, avoid the sun when the UV Index is above three.
- Quit smoking – smoking reduces the density of bone minerals.
- Consume alcohol and caffeine in moderation.
- Falls prevention program – falls are responsible for 90 per cent of hip fractures and 50 per cent of vertebral fractures in older people. A falls prevention program can provide strategies to help you prevent falls from occurring.
- Make sure you are consuming enough calcium – adults need a minimum of 1,000 mg of calcium each day, with men aged over 70 needing 1,300 mg. Calcium can be obtained from diet, supplements when prescribed by your doctor, or both.
Be guided by your doctor. Recommended dietary changes may include:
- Increase the amount of calcium-rich food (such as dairy products) in your daily diet. Dairy products are a good source of calcium, but calcium can be found in small amounts in other foods including breads, cereals, fruits and vegetables, fish with edible bones (for example, tinned salmon and sardines), tahini, almonds, figs and foods fortified with calcium.
- Boost your vitamin D intake. There are small quantities of vitamin D in a few foods, such as fatty fish (salmon, herring and mackerel). It is also in liver, eggs and fortified foods such as margarine. There are very small amounts of vitamin D in some low-fat milks. Most people do not get enough vitamin D from diet alone. Your doctor may suggest that you take vitamin D and calcium supplements.
- Eat a healthy diet. Increase your daily intake of fresh fruits and vegetables, lean meats, wholegrain cereals and dairy products.
- Reduce your intake of fatty, salty and processed foods.
- Consume alcohol and caffeine in moderation.
Where to get help
- Your doctor
- Arthritis and Osteoporosis Victoria Tel. 1800 263 265
- Musculoskeletal Help Line 1800 263 265
- Exercise physiologist
Things to remember
- Osteoporosis is a serious health risk for men.
- Treatment may include medication to boost bone density, treatment for any underlying condition, lifestyle changes (such as regular exercise) and dietary improvements.
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