Male Osteoporosis-Part 2
The rate of bone turnover can be increased by excess production of thyroid hormones and this can make the development of osteoporosis more likely, although treatment to maintain the normal range of thyroid hormone concentrations is straightforward. Five percent of men who suffer from this condition do so because of consumption of excessive alcohol and they have three times the risk of suffering a hip fracture compared to people who do not drink. The activity of bone producing cells called osteoblasts is suppressed by alcohol, with other side effects such as the reduced absorption of nutrients and calcium, all contributing to bone loss and the tendency to fall.
Disease of the gastrointestinal tract and operations on the stomach can increase our risk of developing osteoporosis, but the exact mechanism is not clear. Coeliac disease, an intolerance to gluten in the diet, results in inflammation of the lining of the intestine, causing poor absorption of vitamins and minerals. Half of patients suffering with coeliac disease were shown in a study to be exhibiting low bone density even on the correct diet.
If the risk to an individual of developing osteoporosis is higher than a certain level then a measurement of bone density may be requested. Bone density has to drop by 30% at least before the results show up on an x-ray so this is not a good way of estimating bone loss or monitoring it over time. DEXA scanning (Dual Energy X-ray Absorptiometry) is a much more reliable and sensitive method of calculating bone loss and following the changes which might occur with treatment. The level of bone density on DEXA scanning correlates well with the risk of fracturing and it is a very easy, safe and convenient technique due to the low radiation levels used and lack of undressing.
A general practitioner or a specialist in osteoporosis such as a rheumatologist may prescribe treatment on the basis of a scan or if there has been a fracture or other risk factor. Scan results fall in a range which is compared to the average, falling into normal, osteopoenic (some bone loss) to osteoporotic. In men other tests will be undertaken to look for any specific conditions which might impact on bone density, as treating them can have significant affects on increasing bone density. Testosterone replacement therapy can be given by tablets, implants, patches and injection, but has its risks as well as benefits which should be discussed with the doctor.
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.
Immobility or lack of use leads to the skeleton, a dynamically changing tissue, to suffer loss of bone as it adjusts to the reduced stresses put upon it. Bone increases its density is response to repeated impact stresses and examples of this are skipping, weight training, tennis, aerobics, fast walking and running. These activities all involve jarring and since this is absent to a great extent from cycling and swimming these sports are much less effective. To maintain fitness it is recommended to take a twenty minute exercise session three times a week. New research continues into exercise and drugs treatments.
About the Author
Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Nottingham visit his website.
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