Male Osteoporosis And It’s Causes

                                                                                         

The increase in porosity of our bones and the consequent loss of strength is known as osteoporosis and reduces our bones' capacity to counteract normal functional activities. The bone's outer layer is called the cortex and is dense and strong to resist mechanical stresses. The inner bone structure is more like a structural meshwork known as cancellous bone, with bone marrow, blood vessels and collagen tissue filling the interstices. The bony interstices become larger as osteoporosis progresses and there is a reduction in bone strength with the loss of the cross connecting struts. The whole skeleton is affected by the disease but it exhibits itself mostly in the hip, spine and wrist.

Bone looks static but is living and so in a constant state of change, with older bone being broken down and replaced, a process that in an adult takes about seven to ten years to replace the whole skeleton. Bone turnover is the name given to this natural and important process. Children have an altogether faster rate of bone turnover and can replace their skeleton in two years. Our bones finish growing in length from around sixteen to eighteen years of age by which time we have achieved our final size, but our bone density continues to increase for a bit longer, into our mid-twenties.

Bone turnover then maintains a balance between the building up and breaking down processes which remain stable for the period of our early adult lives. Reaching middle age starts a phase of bone life in which the breakdown process becomes more dominant and we begin to lose a proportion of our bone mass. The loss of bone density is more accelerated and more profound in particular patient groups, most obviously in older women after menopause. Osteoporosis does occur in men and risk factors for this include long-term steroid treatment, poor nutrient absorption from colitis, long term immobility, alcohol abuse, being too thin, low male hormone levels and smoking.

Osteoporosis will affect one in three women at some time in their life and it is often considered a condition which afflicts women. However, it has been recognised that osteoporosis affects men too, with an incidence of one in twelve even though only thirty percent of hip fractures and twenty percent of spinal fractures are in men. There may be various reasons why men are less likely to suffer from osteoporosis: they do not have a dramatic bone loss effect in middle age and they start off from a higher level of bone density, losing less cortical bone in particular than women.

There are usually no signs of anything going wrong as osteoporosis develops and the first sign of something wrong is often the severe fracture pain of a broken wrist or spinal wedge fracture, perhaps from a relatively minor input. The wedging which occurs in the thoracic spine is acutely painful and can produce significant disability which can become chronic. Crush fracturing and wedging can occur quietly and without the drama of severe pain, appearing as a kyphosis, a form of spinal curvature, or as a remarkable loss of stature. A severely kyphotic spine can cramp the ribcage and cause pressure on the lungs and gut with consequent problems.

In men with osteoporosis there is no identified reason for the disease in forty-five percent of cases, and genetic factors are thought to play a large part in this. If a close family member has osteoporosis means that a man will be at increased risk of having lowered bone density and increased risk of suffering a fracture of the spine. Testosterone levels maintain levels of bone density and if levels are low then osteoporosis is more of a risk, as a thirty year old man produces twice the hormone levels of a man of seventy. If an endocrinology specialist thinks it appropriate then testosterone replacement can be prescribed.

Steroids are strong anti-inflammatory medications used for asthma and ulcerative bowel disorders as well as for a number of less common conditions. Six months treatment with a steroid such as prednisolone can increase the levels of bone loss but steroids are only used when they are vital for health. Steroid doses should never be changed by the individual without careful consultation with a doctor or the side effects of the change could be severe.

About the author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Glasgow. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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