Osteoporosis is a condition characterised by the loss of bone mineral density (BMD), meaning a loss in bone strength, and increased risk of fragility fractures. It is often asymptomatic, until a traumatic incident like a fall occurs, resulting in a possible fracture which is diagnosed via x-ray. BMD is measured through a type of x-ray called a DEXA scan.
Highly prevalent in the western world, usually occurring more in females, and predominantly after the menopause – the lack of oestrogen; a bone preserving hormone, causes a loss in the density of bone. Men of course, have higher levels of testosterone – which aids in bone formation, and this later gets converted into oestrogen in the body. So, as men age, the testosterone levels reduce – the bone formation reduces and bone preserving also reduces.
It is widely under-diagnosed and under-treated in men. It is estimated that 1 in 4 men over the age of 50 will suffer from a fracture at any moment. It is quick becoming a health concern because of the lack of information regarding osteoporosis in men. A Danish study found osteoporosis was in 10% of men over the age of 50, and using the World Health Organisation (WHO) criteria, 1-2 million males have osteoporosis and a further 8-13 million men have osteopenia. A US study has highlighted that one in three men who break their hip, will die within the first year and another third will re-fracture within the first year. It is not quite sure how many suffer from the condition due to lack of screening.
Osteopenia is the pre-cursor to osteoporosis and as you see below, is the reduction in BMD, but not yet osteoporosis. The T score is the measurement from the DEXA scan made in comparison to a healthy young adult, and determines the type of diagnosis.
Normal = T score of more than -1.0
Osteopenia = T score between -1.0 and -2.5
Osteoporisis = T score -2.5 or lower.
You can therefore see how important it is to get screened, diagnosed and take the appropriate action – which will be discussed later. Screening can also take place through the fracture risk assessment (FRAX ®). It often accompanies the DEXA scan and assesses the risk of future fracture.
Causes:
Primary causes – age related (Typically men over the age of 70)
– idiopathic. (Multiple fractures and low BMD, age 65-70)
In primary causes of osteoporosis, there has been a strong familial link, and other genetic factors.
Secondary causes focus around previous medical history and chronic issues such as;
– Chronic obstructive pulmonary disease (COPD)
– Cardiovascular disease
– Rheumatoid arthritis
Excessive alcohol consumption, smoking, hormone related conditions, and the long term use of steroid medication (glucocorticoids) are also factors involved in the development of osteoporosis.
Treatment
Supplement your diet with calcium and vitamin D, although other minerals are vitally important to help the absorption and further bone formation. Prescribed medications vary;
– Bisphosphonates (alendronate, ibandronate)
– Calcitonin
– HRT
There are also further treatments available, seek advice from your GP regarding pharmacological treatment options.
Prevention/Treatment
- Regular Exercise (preferably weight bearing)*
- Balance/Fall prevention exercise*
– Tai chi, yoga and pilates can help - Diet with enough Calcium/Vitamin D and other minerals*
– Calcium (Dairy products, green leafy vegetables, sardines)
– Vitamin D (sunlight, egg yolks, fortified foods, fatty fish, liver)
– Fruits and vegetables (vitamins and minerals) - Avoid smoking and limit alcohol intake
* – Seek further advice from your therapist on the type of exercise for you, to reduce risk of injury, and for further dietary advice.
If you are worried about osteoporosis, you have a family history of it, or you are already diagnosed with osteoporosis/osteopenia, speak to one of us here at the Woodside Clinic. We can help give advice on ways forward to reduce future risk, and improve your general health. Your GP can also help to arrange a DEXA scan, think about your health while you have it; and look after yourself today, for tomorrow.
Written by Mark Thiselton
References:
Nelson, R., Willson, T., Nelson, S., Newbold, J. and LaFleur, J. (2015). The clinical epidemiology of male osteoporosis: a review of the recent literature. Clinical Epidemiology, [online] 7, pp.65-76. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295898/ [Accessed 25 Sep. 2017].