How osteoporosis manifests itself in men. Does testosterone level play a role?
Stoyan K. - Pleven
Although osteoporosis is most commonly associated with postmenopausal women, men are also at risk. Diet, exercise and previous medical conditions are among the risk factors, but the most common cause of osteoporosis in men is low or reduced testosterone levels.
In men too, osteoporosis leads to bone loss, which is associated with a natural decline in the production of the hormones estradiol (a type of estrogen) and testosterone with age. Instead of losing trabecular bone, men suffer from trabecular thinning, which is why patients with osteoporosis have delayed bone loss, with smaller decreases in bone mineral density.
Men are physically more active throughout their lives than women, which helps prevent bone loss.
Bone density in men decreases around the age of 70. In general, they do not go through periods of rapid hormonal change, but they can still develop osteoporosis as a result of low levels of hormones in the body, especially testosterone.
Testosterone deficiency can be caused by one or more factors:
• Age. Although the decrease in hormone levels may not be as great as in menopausal women, it may be enough to significantly affect bone mineral density.
• Cancer treatment, especially prostate cancer, can lower testosterone levels.
• Glucocorticoids, used to treat asthma and rheumatoid arthritis, and often taken long-term, can reduce testosterone levels.
• Hypogonadism – a condition in which the male body does not produce enough testosterone. This condition may be congenital or develop later in life due to injury or disease.
Typical causes of osteoporosis in men include: certain medications, including steroids, immunosuppressants, and anticonvulsants; excessive consumption of drugs or alcohol; smoking; hypothyroidism; some gastrointestinal and musculoskeletal diseases, incl. ankylosing spondylitis and rheumatoid arthritis, and last but not least – immobilization.
Regarding diagnosis, it is not known whether the standard WHO guidelines used to diagnose osteoporosis in women are appropriate for male patients. The independent organization "International Society for Clinical Densitometry" suggests use for a different set of guidelines.
A bone fracture is usually the first symptom of osteoporosis. Although they fracture later in life than women, men are more likely to die from osteoporosis-related complications of a hip fracture.
About 20,000 people break their hip every year, and 60% of those who survive that first fracture are more likely to suffer a second fracture. Since osteoporosis does not cause pain unless a fracture occurs, here are the indications that men should be tested:
• If they have lost 5 or more inches of height, or have low testosterone levels.
• For men over 50, bone density measurement is strongly recommended for: significant reduction in height; drop in hormone levels; taking medications or diseases that cause bone loss; family history of osteoporosis or fractures.
Treatment of osteoporosis is a combination of lifestyle changes, incl. diet, exercise and medication. If necessary and after consultation with your doctor, you can include testosterone replacement therapy.
Used to treat a wide range of conditions caused or affected by low testosterone, incl. low bone mass, sexual and metabolic dysfunctions. Your treating physician must monitor you and if it is found that there is no improvement, it should be discontinued.
Treatment of osteoporosis includes many of the steps to prevent this disease:
• Diet and nutrition. Aim for proper calcium and vitamin D intake by avoiding foods high in sodium, caffeine, or protein.
• Stopping the use of nicotine and reducing the number of alcoholic beverages to a more moderate level is an important step in maintaining bone he alth.
• Exercise and fitness will increase bone strength and promote good balance.
• Regularly scheduled appointments with a doctor allow monitoring of the condition and good treatment.
