Osteoporosis in Women and Men

BONES in the skeleton are the firm supportive structure of the body. Our bones are constantly being renewed. However, the renewal slows down as we age and bones may become porous and brittle. One of the most common bone conditions is osteoporosis. As people become older, their bones become fragile because of osteoporosis, leading to fractures. It has become a common disease among the elderly and women, as we all know, are more prone to the disease.

While osteoporosis has been associated with the elderly, there are cases where younger people have suffered from it under certain medical conditions. Some may be physically smaller than average or have osteoporosis as a result of their arthritis or on treatment with steroids. If they take steroids, they will suffer from steroid-induced osteoporosis. Also those who are anorexic, their bones will have low density and they are also prone to this disease.

What do you know about osteoporosis? 

Osteoporosis is a disease in which the density and quality of bone are reduced. As the bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs "silently" and progressively and is often called the "silent disease" due to lack of physical symptoms at early stages and can only be detected when fractures happen.

Because of its silent symptoms, many do not realise that this disease is one of the largest health issues across the world today, but osteoporosis is not recognised as a health-care priority. Even some doctors associate it with the normal process of ageing. However osteoporosis can be prevented and easily diagnosed if people are aware of their risks.

Defined as skeletal disorder, those affected by it have low bone mass and deterioration of bone tissue, which result in increase of bone fragility and fractures. The common sites of fracture are the spine, wrist and hip.

Osteoporosis may cause a painful backache, but the most critical consequence of advanced osteoporosis is bone fractures. The development of osteoporosis can be advanced by factors such as a sedentary lifestyle, lack of minerals, hormones, irregular exercise and long-term use of steroids and thyroid medication. Seventy per cent of osteoporosis is due to genetic causes, and 30 per cent by the environment and lifestyle.

If allowed to progress without treatment, osteoporosis is one of the leading causes of suffering, disability and death in elderly people.

Fractures resulting from osteoporosis can be permanently disabling and most commonly occur in the hips, spine or wrists. An estimated 1.6 million osteoporotic fractures occur every year; close to 25 per cent of those with hip fractures will die within a year. Almost 50 per cent will be permanently disabled.

Hip fractures related to osteoporosis carries higher rate of mortality and morbidity. Once people fracture their hips, they are bed bound and will face other complications such as pressure sores, pneumonia and sepsis due to immobilisation.

Osteoporosis affects all races and it occurs in both men and women. However, bone loss in women is more rapid compared to men, especially in early menopausal stage.

Menopausal women are especially prone to osteoporosis because the body slowly stops producing oestrogen which helps retain calcium to keep bones strong. Once women start to lose oestrogen, the bone loss will increase tremendously. And when they reach 60 or 65 years old, the bone reserve will be so low that it will become thinner and weaker. The bones are easily fractured even when they have a minor incident.

Although it is much more common in women, osteoporosis can strike men too, often with debilitating consequences. There are several reasons for osteoporosis to be less common in men because men have larger skeletons, they achieve a higher peak bone mass and their age-related bone loss progresses more slowly.

What is actually causes or contributes to osteoporosis in men is that the 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. So bones grow in length and density during the younger years.

Bone density relates to the mineral content of the tissue. People reach their maximum height during their late teens, but bone density continues to increase until about age 20 and is maintained at this level until age 30. After that point, bones slowly start to lose density and strength.

Throughout life, bone density is determined by heredity, sex hormones, physical activity, diet, lifestyle choices, and the use of certain medications.

Men in their 50s, for example, do not experience the rapid loss of bone mass that women do in the 5-10 years following menopause. By age 65 or 70 however, both men and women lose bone mass at the same rate, and the absorption of calcium - an essential nutrient for bone health throughout life - decreases in both sexes.

There should be a sense of urgency to treat and prevent osteoporosis. We should promote the concept of skeletal health. Osteoporosis can be prevented through a healthy diet with calcium and vitamin D and living an active lifestyle, as exercise will optimise the bone density.

The dietary prevention and treatment for osteoporosis require sufficient intake of the bone-forming nutrients, getting the right nutrients needed for calcium utilisation, and reducing or avoiding acid-forming foods that may deplete calcium from the bones. Eating right can reduce the risk of developing osteoporosis and various types of arthritis. A high intake of cruciferous vegetables, fruits, wheat germ, nuts and dairy products may prevent osteoporosis. You may also control the intake of red meats, alcohol, caffeine, animal fats, refined carbohydrates and processed foods as these may worsen both arthritis and osteoporosis.

Minerals such as calcium citrate, magnesium, zinc, manganese and vitamin D3 play a vital role in bone health. Inadequate minerals and vitamin D3 levels can affect bone development and increase the risk of developing osteoporosis.

Regular exercise such as brisk walking, jogging and weight lifting help to maintain a good bone status and keep the joint cartilage lubricated.

Treatment of osteoporosis would depend on the cause. Particularly in the case of a man affected by osteoporosis, it is necessary to determine that it is not secondary osteoporosis. Simple investigations to exclude other medical disorders that can cause osteoporosis as a complication, for example hypogonadism, or metabolic causes like hyperthyroidism, hyperparathyroidism or renal bone disease, would be conducted.

The proper measuring of Bone Mineral Density (BMD), sufficient education, continuous monitoring by nurses and convenient drug regimens can successfully help in the treatment of osteoporosis.

Once the diagnosis is confirmed, then appropriate therapy can be initiated. Patients are advised to seek advise from clinicians prior to starting treatment.

There have been a lot of advances in the management of osteoporosis, with many types of drugs that have proven highly effective in improving bone density as well as reducing fracture risk. Nobody needs to experience the pain, morbidity and mortality as a result of these fractures - especially in this present day and age.

With regard to prevention of osteoporosis and attainment of maximal bone density - the recommendations are to have an adequate calcium and vitamin D intake and to maintain an active lifestyle - with adequate weight-bearing exercise.

Young men require a calcium intake of 1,000 mg a day, while men over 65 years, 1,200 to 1,500 mg per day. Vitamin D is also important and at average, men need an intake between 400 to 800 IU a day.

Bone up on Osteoporosis

1 - Risk factors linked to osteoporosis in men:

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

* Undiagnosed low levels of the sex hormone testosterone.

* 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: A son is almost four times as likely to have low bone mineral density (BMD) if his father has low BMD, and nearly eight times as likely if both parents have low BMD.

2 - Causes of osteoporosis in men  for less than 50 per cent of men with osteoporosis, there is no obvious cause. For the remainder, there can be a number of causes.

These include:

* Falling levels of testosterone and oestrogen

* A diet low in minerals such as calcium

* Inability to absorb calcium because of conditions such as celiac disease, Crohn's disease

* Low vitamin D levels

* Smoking

* Changes in bone metabolism due to aging

* Lack of exercise

* Long-term steroid therapies

* Alcohol abuse

* Men with a close family history of osteoporosis

3 - Non-dairy food sources of calcium which help keep osteoporosis at bay:

* Nuts and pulses: almonds, Brazil nuts, hazelnuts, sesame seeds.

* Green leafy vegetables: broccoli, spinach, watercress, curly kale.

* Dried fruits: apricots, dates, figs

* Fish: mackerel, pilchards, salmon, sardines

* Tofu and various calcium-fortified foods