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Osteoporosis

Symptoms & causes

Osteoporosis is a disease usually affecting older women and men. It is a problem of the skeleton that lessens bone strength and increases the risk of fracture. Bone strength is measured by bone mineral density and bone quality.

Most bones, except those of the face and head, can be affected by osteoporosis; however, the most common sites of fractures are the hip, spine, wrist and ribs.

osteoporosis in men

Image courtesy of Osteoporosis Australia

How common is osteoporosis?

One in three men in Australia over 60 will fracture a bone due to osteoporosis. The disease affects more women than men; however, when fractures happen in men it is more likely to shorten their life, probably because osteoporosis in men is often present together with other serious illnesses.

How does osteoporosis happen?

Osteoporosis happens when bones lose minerals, such as calcium, more quickly than the body can replace them (increased bone turnover), leading to a loss of bone thickness (bone mass or density). With thinner and less solid bones, even a minor accident can cause serious fractures.

At what age in men does bone mass begin to fall?

Peak bone thickness or mass is when bones are at their strongest; in men this normally happens in the early 20s. Bone thickness falls gradually, with up to 25 per cent of peak bone thickness being lost by the age of 50 in men.

Do all men get osteoporosis as they age?

Since men continue to gradually lose bone thickness as they get older, the chance of osteoporosis increases with age. There is no sudden increase in the rate of osteoporosis in men, as seen in women after menopause; however, the ongoing gradual loss of bone thickness in men significantly reduces bone strength and increases the chance of fracture in older men.

What causes osteoporosis in men?

Testosterone, the male sex hormone, is important for the health of a range of body functions including the growth and maintenance of bone strength. Testosterone can be converted to oestrogen in men, and oestrogen is important for regulating the rate of bone turnover.

In some men, low testosterone levels may cause bone thinning, a decrease in muscle mass and increase the rate of bone turnover so bones become less solid. Men with confirmed androgen deficiency (low testosterone levels) are therefore more likely to have bone fractures compared to men with normal testosterone levels.

Low testosterone levels are not the only cause of osteoporosis in men. A range of factors, including genetic factors, can have a strong influence on bone mass.

What other hormones can cause osteoporosis?

Very high levels of the stress hormone, cortisol leads to rapid bone loss and is an important cause of osteoporosis in men. The most common cause of high levels of cortisol is corticosteroid medicines (often used for asthma, arthritis and kidney disease) such as prednisolone. In men taking a corticosteroid medicine, it is important to closely monitor bone density and osteoporosis treatment is often started earlier to prevent bone loss.

High levels of thyroid hormone and parathyroid hormone may also cause osteoporosis in men.

Can trauma or too much exercise cause osteoporosis in men?

Some osteoporosis in men is caused by trauma linked to excessive exercise and poor nutrition, which leads to low levels of testosterone.

Too much exercise can put bones under a high level of stress, causing bones to fracture easily. However, for most men regular physical activity can lower the risk of fractures by improving muscle mass, balance and bone strength.

Men who do little exercise should speak to their doctor first about an exercise plan that will help to avoid injury.

What are the risk factors for osteoporosis in men?

Lifestyle factors including low levels of physical activity, smoking, excessive alcohol intake, and low calcium or vitamin D levels may increase the rate of bone loss.

Other factors linked to osteoporosis include a previous fall or fracture, family history of osteoporosis and being underweight (may be due to chronic disease).

Some medicines, such as corticosteroids and anticonvulsants (commonly used for epilepsy and some psychiatric problems), can also speed up the first signs of osteoporosis.

Androgen deprivation therapy (ADT), used in the treatment of some prostate cancers, acts by turning off the body’s testosterone production and is an important cause of osteoporosis. Men receiving ADT should have their bone health monitored.

Diagnosis

A doctor can diagnose osteoporosis by taking a medical history, measuring height, and other tests such as a DXA (dual-energy X-ray absorptiometry) scan.

The DXA scan, or bone density test, uses a small amount of radiation to measure the density of the bones in the spine and hip that is compared with the bone density of an average young adult of the same sex and ethnicity. The test gives a ‘T score’, which tells the doctor whether or not bone loss has happened.

The T score is classified as normal, low bone density, or osteoporosis. A man who has a T score of -2.5 or lower has osteoporosis and is at high risk of getting a bone fracture; he should talk to the doctor about treatment. A man with osteopenia (low bone density) may be able to lower his risk of further bone loss and/or fracture with lifestyle changes.

ClassificationT score
Normal bone densityGreater than -1.0
Osteopenia (low bone density)Between -1.0 & -2.5
Osteoporosis-2.5 or less
Severe Osteoporosis-2.5 or less with a fragility fracture (fracture that happens as a result of minimal trauma)

Who should have a bone density test?

A bone density test is useful in men with the following:

  • a previous diagnosis of osteoporosis
  • symptoms such as loss of height or past fractures
  • rheumatoid arthritis
  • chronic kidney or liver disease
  • an overactive thyroid
  • using corticosteroids for more than 3 months
  • taking certain anti-convulsive medicines
  • androgen (testosterone) deficiency, including ADT for prostate cancer
  • a family history of osteoporosis
  • aged 70 years or older
  • smoke or consume excessive amounts of alcohol
  • a low body mass index (less than 20)
  • inflammatory forms of arthritis
  • malabsorption from the intestines
  • high urine calcium levels.

Treatment

There are medicines that may stop further bone loss or even improve bone mass, and also prevent spinal fractures. The most common medicine used to treat osteoporosis in men is a bisphosphonate. This may be taken as a weekly or monthly tablet, or a yearly intravenous (into the vein) infusion.

Denosumab is another option for treatment and is given with a small injection every 6 months.

Finally, teriparatide (parathyroid hormone) helps new bone to grow and increases bone mass; it can also be given by daily injections in cases of severe osteoporosis.

Can testosterone replacement therapy lower the risk of osteoporosis?

Returning testosterone levels to normal in men who have confirmed androgen deficiency (low testosterone levels) can improve bone density. There is no evidence that testosterone therapy improves bone density in men with normal levels of testosterone and it is not recommended.

Why is it important for men to maintain good bone health?

Often the only time a man realises he has osteoporosis is when he breaks a bone. Many men do not realise that osteoporosis is not a disease that only affects women or older people.

Having a healthy lifestyle including enough calcium in the diet and normal vitamin D levels and increasing weight-bearing exercise, and paying attention to bone health from childhood throughout life, are the best ways for men to lower their risk of osteoporosis.

Management

How does osteoporosis affect a man’s life?

Osteoporosis can have a major effect on quality of life. It can cause a man pain, disability and depression, and a loss of independence and social isolation can follow. Men with hip fractures and other illnesses may die at a younger age than other men.

Bone fractures can cause a loss of height or curving of the spine that can make it hard to breathe normally.

Can I do anything to prevent osteoporosis?

If osteoporosis is diagnosed early and treated, bone loss may slow down. Having a healthy lifestyle by not smoking, limiting alcohol intake and being active may lower your risk of osteoporosis.

Weight-bearing and resistance exercises, such as walking, jogging and lifting weights will help improve muscle tone and help maintain bone mass.

Getting enough calcium and vitamin D each day is also important to keep bones healthy. You can get enough calcium by eating 3 to 4 serves of dairy foods such as milk, yoghurt and cheese daily. Calcium tablets can be used if there is not enough calcium in the diet. Vitamin D tablets and/or exposure to sunlight can increase vitamin D levels in the body.

Last modified: November 21, 2014
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