Male Osteoporosis
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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.
Being active and dynamic is not the typical view of the bony skeleton but it is a growing and changing tissue which is constantly renewed over time, taking between seven and ten years to complete the whole replacement. The renewal process is called bone turnover and it can be much faster to replace the entire skeleton in a child, a process which can be as short as two years. The growth plates of our long bones close around sixteen to eighteen years of age and at this time we stop gaining height and size. It is however not before the middle of our twenties that the process of increasing our bone density reaches its highest level.
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.
One in three women is affected by osteoporosis in their lifetime so it is often thought to be a disease affecting women. However men are affected as well, with one in twelve having this at some time, even though only 20% of spinal fractures and 30% of hip fractures occur in men. Men may suffer from osteoporosis less for several reasons: they attain a higher bone mass to start with so have a higher level to start from and men suffer a much less dramatic bone loss in the middle years of life. Men in particular lose smaller amounts of the structural cortical bone than women.
Osteoporosis is a silent disease and the first indication many people get that they have the disease is the acute pain of fracture such as in the spine or wrist, often because of a trivial fall or blow. Spinal fractures cause wedging of the thoracic spine in particular, with acute pain which can be very disabling, and in some cases becomes chronic. The process of crushing and wedging can also occur quietly without dramatic pain, showing itself by the development of a spinal curvature called a kyphosis or a significant loss of height. A severe kyphosis can restrict the space in the ribcage, causing breathing and digestive problems.
45% of men with osteoporosis have no identifiable cause for their disease, with genetic factors likely to be important in the large majority of cases. Having a history of osteoporosis in the close family predisposes to having a lower bone density and an increased risk of spinal fracture. Levels of testosterone are important in the maintenance of bone density and a low concentration is a major risk for osteoporosis, with a 70 year old man only producing about half the testosterone of someone of 30 years old. Testosterone can be replaced as a treatment if a hormone specialist thinks it is necessary.
Corticosteroid treatment is used to counter the inflammatory effects of ulcerative colitis and asthma as well as other less well known disorders. The levels of bone loss can increase with only six months treatment with a steroid such as prednisolone so they are only prescribed when essential to combat an illness. Individuals should not change their steroid doses with consulting with their medical advisers as this could produce severe side effects.
