According to most information available on osteoporosis, it is a bone disease
that affects women. Dr. Robert Lindsay, MD, PhD and President of the National
Osteoporosis Foundation says that a majority of the 1,000 men recently
questioned by a Gallup survey believed they could not have osteoporosis.
However, Dr. Eric Orwoll, a leading medical researcher in the field of
osteoporosis in men says that 1.5 million men have osteoporosis and another 3.5
million are at high risk. Men and Osteoporosis places these numbers slightly
higher at 2 million with osteoporosis and another 3 million at risk. American
men over 50 years of age have a higher risk of suffering an osteo-related
fracture than developing clinical prostate cancer. One-third of the men who
suffer hip fracture will die within a year. The lack of knowledge about
osteoporosis and its complications are particularly dangerous because
osteoporosis has no early warning. It is called sometimes the silent disease.
Education is the key so that an individual can assess risk and seek help. There
is no cure for this disease, but it is preventable, detectable and treatable.
The National Osteoporosis Foundation is an
excellent source for self-educating with a free kit available for men entitled
"Bone Wise Strong Bones for Life", NOF, Post Office Box 96616, Dept. MQ,
Washington, DC 20077.
For the individual the real significance of osteoporosis lies in the danger
of fractures. Low bone mass may be asymptomatic but it predicts future fractures
as well as high cholesterol or high blood pressure predict the risk of heart
disease or stroke. As bone mass decreases, fracture risk increases
exponentially. Prevention of the first fracture is the goal
Osteoporosis is the loss of bone mass. Bone
is living tissue. Specialized cells called osteoclasts break down older bone while other
cells called osteoblasts form new bone. Travecular bone, one type of bone which comprises
20% of the skeleton, has lattice-like quality. When more bone is broken down than built,
the bones become thinner and more brittle. As the condition continues to be imbalanced,
that is more old destroyed than new being built, then the brittle disease of osteoporosis
develops. This condition may deteriorate to the point that even everyday stress on the bone
may cause fracture. Areas of the skeleton high in trabecular bone such as hip, wrist and spine
tend to fracture more often due to osteoporosis. Bone Scan A picture of normal travecular bone
and osteoporotic bone may be found at this same site. Children's bodies produce more bone
than is removed, so their skeletons continue to grow in size and strength. Bone mass usually
reaches peak amounts by the mid 30's. It is at this point that the decline in bone mass
begins.
Women have been the primary emphasis of this
illness because it occurs more frequently in them--one in four. But it also occurs in
one in eight men over 50. Osteoporosis occurs more frequently in women because of the
rapid bone mass loss they suffer following menopause. Women are also usually smaller thus
beginning with less bone mass, and they may not do as much weight bearing exercise as men.
But by the age of 65 to 70, men and women begin to lose bone mass at the same rate and
calcium absorption decreases in both men and women. Osteoporosis and Men According to Ego
Seeman, BSc, MBBS, FRACP, MD, men with back fractures who develop osteoporosis at relatively
young ages may have underlying illnesses which should be investigated by a physician.
Another problem involving men with this illness is that little or none of the research has
studied men. Decisions regarding this illness are based on studies in women even though the
pathogenesis in men and women is different.
Risk factors are similar in men and women with the inclusion of menopause in women.
Advanced Age
Family History
Small or Thin Build
Low Calcium and Vitamin D Intake
Physical Inactivity
Taking Corticosteroids, Thyroid Medications, Anticonvulsants or Anticoagulants
Smoking
Excessive Alcohol
Excessive Caffeine
Chronic Diseases of Kidney, Lung, Stomach and Intestines
Undiagnosed Low Levels of Testosterone
Men of all ethnic groups are affected, however
white men appear to be at the greatest risk for osteoporosis. Osteoporosis Facts
Educate yourself and as soon as
possible begin preventative actions to "head off" this disease. Know whether or not you
are at risk and take action. Visit with your private physician about whether or not he
feels you are at risk and have testing. The sooner an individual begins preventative
measures, the better.
Current technology is available for patients to be evaluated
if they are deemed to be at risk. There are scans which study bone mineral density and give
physicians accurate and precise measurements with low radiation exposure. Radiation dosages are
less than typical chest x-rays.
The most widely used technique for the measurement of bone mass is called
DEXA for Dual Energy X-Ray Absorptiometry. Other tests are available, but the
low radiation and excellent precision of this test can be used to measure the
spine, hip and total skeleton.
Any assessment and testing would need to be discussed and requested by your
physician according to your needs. The exam is non-intrusive, painless and
usually takes only 5 to 10 minutes.
Low bone mass in an a symptomatic patient predicts future fracture as well as
high cholesterol and high blood pressure predict the risk of heart disease or
stroke. As bone mass decreases, fracture risk soars. Prevention of even the
first fracture is important.
Because of the accuracy of techniques used to measure bone mass, they can be
used both for the presence of osteoporosis and for the indication of future
fracture. Because fracture risk depends on the amount of bone present, standards
for testing in women could be applied to men.
The cost of a DEXA exam varies from state to state. When comparing costs of
osteoporosis estimated to be greater than 10 billion dollars, a DEXA is a
relatively inexpensive test. And of course the benefits to the individual who
may have an early diagnosis before a broken bone are immeasurable. The broken
wrists, broken hips and back problems could largely be eliminated with both
preventative treatment and treatment after diagnosis.
Recent developments in medicine address
the problem of osteoporosis in those who have had a definite diagnosis. There are drugs
available that are non-hormonal and which make significant advances in the treatment of
osteoporosis. Previously, only calcium supplements, hormone replacement and
exercise were available, and all reduced the progress of the disease, but with
aging, the bones continued to become more brittle and porous. Costs of
complications of osteoporosis had been expected to skyrocket as the population
continues to age and live longer. The new treatments available today should help
avert these expenses and enhance life.
Currently available is a drug by Merck called Fosamax. It is already
prescribed to many patients with osteoporosis. Another drug called Evista
(raloxifene) has just been recommended by the advisory panel of the FDA for
approval. If it does receive FDA approval, the drug may be on the market in six
months. It is a selective estrogen receptor modulator that works by mimicking
the effects of estrogen, for example, protective effects on bone, while
inhibiting bad effects such as increasing cancer risk in some instances. Trials
have shown that raloxifene can increase bone density, but less than with
traditional hormone therapy with estrogen or rival drug Fosamax. If approved,
this drug would compete with Premarin and Fosamax. Fosamax is still not approved
for men, and Evista would not be a solution for men either. Although Fosamax
does not have FDA approval for men, it is being prescribed often now for them
too. Early clinical trials were completed on women only, so that is why it was
approved for women. It has not been shown to be harmful to men, and tests are
underway to prove its effectiveness in men also.
Choices regarding treatment of osteoporosis should be discussed with your
physician.
It is interesting to note that there is no known treatment for osteoporosis
in men because there have not been trials for men and the pathogenesis in men
and women is different. As a matter of fact the National Osteoporosis Foundation
does not recommend the drugs used for women because they do not have FDA
approval for men. National Osteoporosis Foundation
Studies are currently underway however to prove its effectiveness in men too.
Advances in modern medicine are only
beneficial if we avail ourselves of their presence. More than 1.3 million osteo-related
fractures occur in the US each year with over 25 million people affected by this disease.
We are part of an information age which affords each of us the technology and education
to be our own best advocates whether it be in medicine or many other fields. Our best
hope for a healthy future is to utilize what is available to us and educate
ourselves. Lack of knowledge about osteoporosis and its devastating consequences
is dangerous.