4.

Osteoporosis in Men

Osteoporosis, a disease that causes the skeleton to weaken and bones to break, is a significant threat to over 1.5 million men in the United States today. It affects nearly half of all people, women and men, over the age of 75. Before age 90, 6% of all men will suffer a hip fracture as a result of osteoporosis. It is estimated that one-fifth to one-third of all hip fractures occur in men and that symptomatic vertebral fractures occur about half as often in men as in women.

Osteoporosis develops less often in men than women because men have larger skeletons, bone loss starts later and progresses more slowly, and there is no period of rapid hormonal change and accompanying rapid bone loss. However, in the last few years, it has been recognized that the problem of osteoporosis in men represents an important public health issue, particularly in light of estimates that the number of men above the age of 70 will double between 1993 and 2050.

What causes osteoporosis?

Bone is constantly changing _ that is, old bone is removed and replaced by new bone. During childhood, more bone is produced than removed, so the skeleton grows in both size and strength. The amount of tissue or bone mass in the skeleton reaches its maximum amount by the mid-30s. At this point, the amount of bone in the skeleton typically begins to decline slowly as removal of old bone exceeds formation of new bone.

While women lose bone mass rapidly in the years following menopause, by age 65 or 70, women and men lose bone mass at the same rate, and calcium absorption decreases in both sexes. When bone loss is excessive, bone can become fragile and break. Once bone is lost it cannot, as yet, be replaced. Bones that have weakened are more likely to fracture. Osteoporosis is a silent disease that progresses without symptoms until a fracture occurs. Fractures resulting from osteoporosis typically occur in the hip, spine, and wrist and can be permanently disabling.

What are the risk factors for men?

One risk factor relates to the male hormone testosterone, which plays an important role in bone health. Decreases in male hormones, or hypogonadism, can cause reduced bone mass and lead to fractures. Although men do not undergo the equivalent of menopause, gonadal function does decline in some elderly men and in younger men who have medical conditions that affect their ability to produce testosterone.

There are other risk factors that have been linked to osteoporosis in men:

    •     Prolonged exposure to certain medications, such as steroids used to treat asthma, arthritis, or other diseases, anticonvulsants, certain cancer treatments, and aluminum- containing antacids.

    •     Chronic diseases that affect the kidneys, lungs, stomach, and intestines or alter hormone levels.

    •     Unhealthy lifestyle habits (e.g., smoking, excessive alcohol use, low calcium intake, inadequate physical exercise).

    •     Age: The older you are, the greater your risk.

    •     Heredity.

    •     Race: Caucasian men appear to be at greatest risk, but all men can develop this disease.

How is osteoporosis diagnosed?

Osteoporosis can be effectively treated if it is detected before significant bone loss has occurred. A medical workup to diagnose osteoporosis will include a complete medical history, x-rays, and urine and blood tests. The doctor may also order a Bone Mineral Density Test (BMD) or bone mass measurement. A special type of x-ray, the BMD test is accurate, quick, painless, and noninvasive and can detect low bone density, predict risk for future fractures, and diagnose osteoporosis. It is important to inform the doctor about risk factors for developing osteoporosis, loss of height or change in posture, a fracture, or sudden back pain.

What treatments are available?

If you have already been diagnosed with osteoporosis, your doctor may prescribe one of the medications approved by the Food and Drug Administration (FDA) for use in women with this disease. These include calcitonin by injection or nasal spray and alendronate. If your osteoporosis is the result of testosterone deficiency, your doctor may prescribe testosterone replacement therapy. For more information about which treatment is appropriate for you, talk to your doctor.

How can osteoporosis be prevented ?

There have been fewer research studies on osteoporosis in men than in women. However, experts agree that all people should take the following steps to preserve their bone health.

    •     Avoid smoking, reduce alcohol intake, and increase level of activity.

    •     Ensure a daily calcium intake of 1000 mg/day to age 65 and 1500 mg/day over age 65.

    •     Ensure an adequate vitamin D intake. Normally, enough vitamin D is made from exposure to as little as 10 minutes of sunlight a day. If exposure to sunlight is inadequate, dietary vitamin D intake should be at least 400 IU but not more than 800 IU/day; 400 IU is the amount found in one quart of fortified milk and most multivitamins.

    •     Engage in a regular regimen of weight-bearing exercises where bones and muscles work against gravity. This includes walking, jogging, racquet sports, stair climbing, team sports, lifting weights, and using resistance machines. A doctor should evaluate the exercise program of anyone already diagnosed with osteoporosis to determine if twisting motions and impact activities, such as those used in golf, tennis, or basketball, need to be curtailed.

    •     Discuss with the doctor the use of medications, such as steroids, that are known to cause bone loss.

    •     Recognize and treat any underlying medical conditions that affect bone health.

Bone Basics for Kids

Have you ever thought about your bones? Your bones are the frame that your body is built on. You need healthy bones to help you grow taller and stronger. That's why being a bone builder is so important. You can build bones now that will last for the rest of your life. There are lots of things you can to do to make sure your bones grow bigger and stronger.

Drink Your Milk!!!!!

You may have heard it a million times, but your parents really know what they're talking about. Milk, as well as other dairy foods, has a lot of calcium. Calcium is the mineral that makes bones strong.

Kids age 10 and under need 800-1,200 milligrams (mg) of calcium each day, and those over 10 need about 1,200-1,500 mg a day. How much calcium do you get each day? You can find out how much calcium different foods have by reading the label or looking it up at the library. If you're not getting enough calcium, here are some ways to add more calcium to your daily diet:

    •     Drink three glasses of low-fat or skim milk every day or substitute a milk shake, or make chocolate milk.

    •     Eat more low-fat yogurt and have frozen yogurt once in a while.

    •     Have cheese on hamburgers.

    •     Sprinkle cheese on popcorn and salads.

    •     Make brownies with low-fat or skim milk instead of water.

    •     Eat calcium-rich dark green vegetables like broccoli and collard greens.

    •     Eat a balanced diet including fruits and vegetables everyday. Calcium isn't just found in dairy foods.

Can you think of some more ways to get more calcium in your diet?

Don't Be a Lazy Bones!!!

You can walk, run, hike, skateboard, jump rope, dance, or ski, but do something! Being active and getting plenty of exercise is good for your bones. Don't be a couch potato! Your bones need exercise to grow big and strong just as your muscles do. One way to become more active is to play sports or take dance lessons regularly. Just find something you like and do it!

Recommended Calcium Intakes*

Age                                                                                 Amount of Calcium

Infants

birth_6 months.                                                                      400 mg/day

6 mths_1year                                                                         600 mg/day

Children/Young Adults

1_10 years                                                                             800-1,200 mg/day

11-24 years                                                                            1,200-1,500 mg/day

Adult Women

Pregnant & Lactating_under age 24                                         1,200-1,500

Pregnant & Lactating_over age 24                                           1,200

25_49 years (premenopausal)                                                  1,000

50-64 years (postmenopausal taking estrogen)                         1,000

50-64 years (postmenopausal not taking estrogen)

65+years                                                                                 1,500

Adult Men

25-64 years                                                                             1,000

65+years                                                                                 1,500

*Source: National Institutes of Health Consensus Panel, Optimal Calcium Intake, 1994.