Male Osteoporosis And It’s Causes-Part 2

                                                                                         

Production of excess levels of thyroid hormone also speeds the rate of bone turnover, increases the risk of developing osteoporosis. This can be easily treated to keep thyroid hormones in the normal range. Consuming excessive levels of alcohol is the reason for osteoporosis in five percent of male sufferers, with an increase in hip fracture risk of almost three times above that for non-drinkers. Alcohol affects the osteoblasts, bone building cells, reducing their activity. Alcohol abuse can also cause poor absorption of nutrients and calcium and increase the likelihood of us falling, both of which factors increase the risk of developing osteoporosis or fractures.

Stomach surgery and gastrointestinal tract diseases make the likelihood of developing osteoporosis more likely but the precise reason for this is not certain. Being intolerant to gluten in the diet, known as coeliac disease, initiates intestinal lining inflammation and this leads to the absorption of vitamins and minerals being poor. In a study of patients with coeliac disease, half were found to have low bone density despite following 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.

Treatment may be prescribed by a rheumatological specialist or a general practitioner on the basis of a risk factor, fracture incidence or on the results of a scan. The results of a scan are checked against typical average results and overall fall into the osteoporotic, osteopoenic or normal ranges. Since many individual conditions can alter bone density in men these will be diagnosed, investigated and treated as they can have large effects in improving bone stock. Replacement therapy for testosterone can be as patches, injections, implants or tablets but this treatment is not risk free and discussion with a medical adviser is recommended.

Bisphosphonates are a class of drugs which slow down the actions of the osteoclasts, the bone cells which break down bone, allowing the bone building cells (osteoblasts) to work with less opposition and so increase the density of the bone. Examples of these drugs are risedronate, alendronate and etidronate. Calcitonin also interferes with the bone breakdown cells and is particularly used to relieve the acute pain of recent spinal fractures. Anabolic steroids can be used in some cases, especially where their muscle building effect is required. It is not clear exactly what role calcium and vitamin D supplements have in managing osteoporosis in men, but a good diet and some sunlight exposure outside are useful for this.

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.

Being an active tissue, bones respond to not being used by losing some of the strength which does not seem to be necessary. Weight bearing exercise causes regular impacts onto the bone, stimulating it to maintain itself or get denser. Examples of useful exercise are fast walking, running, weight training, aerobics, tennis and skipping, all impact activities. Swimming and cycling do not give this impact effect so are less useful. A typical recommendation is to perform suitable exercise for 20 minutes continuously three times a week for best results. New treatments are continually being developed for drugs and exercise therapy.

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 Rugby. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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