Mens Health - Osteoporosis

If you follow trends in Mens Health issues, the increase in Osteoporosis is something that you have been aware of for some time.

Why this increase? what can be done about it? What should a man do to prevent bone loss? Is it possible to reverse this conditions?

This page will focus on: Why is there an increase? What are the causes?

1. One of the reasons for an increase in Osteopenia and Osteoporosis as a Mens Health topic is the increase of longevity in the developed world. Given the lengthening of life span, it is now common for both men and women to live into their 80's and 90's.

   Most people reach their peak bone mass during their thirties. Sometime during the third decade the balance in the activity of osteoblasts (bone creating cells) and osteoclasts (cells that remove old bone) begins to shift and we begin to lose more bone that we are building. Once this shift begins we start using up our bone reserves. The longer we live, the more bone we loseand so it is that the older a person becomes, the more likely that they will experience thinning bones (Osteopenia) or porous bones (Osteoporosis). As more men live longer, they have a greater risk.

   It is common for men to experience bone loss in their later years. Among women there is a rapid decline in sex hormones during and after menopause and so many women experience thinning of their bones at midlife.

   In Mens Health it is different for Osteoporosis. As B. Lunenfeld states in "Endrocrinology of the Aging Male" that was published in Minerva Ginecol. 2006 Apr;58(2):153-70:

   "... men experience a slow and continuous decline (of sex hormones). This decline in endocrine function involves: a decrease of testosterone, dehydro epiandrosterone (DHEA), oestrogens, thyroid stimulating hormone (TSH), growth hormone (GH), IGF1, and melatonin. The decrease of sex hormones is concomitant with a temporary increase of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In addition sex hormone binding globulins (SHBG) increase with age resulting in further lowering the concentrations of free biologically active androgens.

2. Mens Health - Osteoporosis. Causes: Am J Health Syst Pharm. 2004 Dec 15;61(24):2637-54; quiz 2655-6. Prevention and treatment of nonpostmenopausal osteoporosis. by Hansen LB, Vondracek SF.

   "Most osteoporosis research has focused on postmenopausal women, but several other populations are at risk for osteoporosis, such as patients taking certain medications that affect bone health and those with various health conditions that cause bone loss, including anorexia nervosa, hyperthyroidism, organ transplantation, chronic obstructive pulmonary disease, and inflammatory bowel disease. Glucocorticoids are the most common secondary cause of osteoporosis. Other medications that have been implicated as secondary causes include anticonvulsants, heparin, warfarin, and methotrexate. Preventing osteoporosis may be even more important in adolescence than after menopause. CONCLUSION: Osteoporosis needs to be recognized, monitored, and appropriately treated in patients taking medications that affect bone health and in patients with conditions that increase the risk of osteoporosis."

3. Mens Health - Osteoporosis: Younger men. Some studies of Mens health and Osteoporosis among younger men show additional possible causes.

   See: For example, a "Study of Male Patients with Forearm Fracture in Northern Ireland" conducted at Musgrave Park Hospitalin Belfast was published in Clinical Rheumatology. in March of 2006.

   The authors, Wright S, Beringer T, Taggart H, Keegan D, Kelly J, Whithead E, McKane R, McNally C, McQuilken M, Finch M.,found:

   "... Male patients aged 30-75 years, presenting with distal forearm fracture in 2000-2001 in Northern Ireland, were identified through a Colles fracture database. A total of 37 subjects consented to have bone mineral density measurements undertaken at the femoral neck, spine and forearm using a Lunar expert bone densitometer. Twenty-seven percent of the men had osteoporosis at the spine, femoral neck or forearm, as defined by a bone mineral density score of less than -2.5. We also found that 49% of patients had vitamin D insufficiency or deficiency, 27% had low serum testosterone, 14% had abnormal liver function test results, and 14% had raised parathyroid hormone."

   These results parallel other studies in Mens Health and Osteoporosis:

   • Mens Health - Osteoporosis. There are a number of studies that show a genetic cause of low vitamin D so if parents, grandparents or even siblings have Osteoporosis or experienced fractures in later life, one might have the same genetic inheritance conerning Vitamin D uptake.Vitamin D is essential for the use of calcium in bone making. To read more about this go to: Vitamin D and Osteoporosis

   • Mens Health- Osteoporosis: Low serum testosterone - testosterone is essential to the bone making process. And surprisingly so is estrogen - even for men. Here is an abstract of a study done at the Mayo clinic:

     "Young adult males who cannot produce or respond to estrogen (E) are osteopenic, suggesting that E may regulate bone turnover in men, as well as in women. Both bioavailable E and testosterone (T) decrease substantially in aging men, but it is unclear which deficiency is the more important factor contributing to the increased bone resorption and impaired bone formation that leads to their bone loss. Thus, we addressed this issue directly by eliminating endogenous T and E production in 59 elderly men (mean age 68 years), studying them first under conditions of physiologic T and E replacement and then assessing the impact on bone turnover of withdrawing both T and E, withdrawing only T, or only E, or continuing both. Bone resorption markers increased significantly in the absence of both hormones and were unchanged in men receiving both hormones. By two-factor ANOVA, E played the major role in preventing the increase in the bone resorption markers, whereas T had no significant effect. By contrast, serum osteocalcin, a bone formation marker, decreased in the absence of both hormones, and both E and T maintained osteocalcin levels. We conclude that in aging men, E is the dominant sex steroid regulating bone resorption, whereas both E and T are important in maintaining bone formation." Source: J Clin Invest. 2000 December 15; 106(12): 1553–1560. "Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men" by Alireza Falahati-Nini,B. Lawrence Riggs, Elizabeth J. Atkinson, W. Michael O’Fallon, Richard Eastell, and Sundeep Khosla1.

   • Mens Health- Osteoporosis: Abnormal liver function test results andOsteoporosis - Liver toxicity appears to be implicated in accelerated bone loss.

     For many years it has been known that alcohol intake is related to to Osteoporosis since alchol interferes with the work of the Osteoblasts. High alchohol intake as well as the use of drugs and exposure to contaminants can make for abnormal liver function tests results. To read more about Osteoporosis and alchohol go to: Alcohol and Osteoporosis

   • Men's Health - Osteoporosis. Cadmium exposure increases the risk of Osteoporosis.Biometals. 2004 Oct;17(5):493-8. Such exposure is a potentially serious issue for Mens Health.

     "Cadmium, osteoporosis and calcium metabolism." by Kazantzis G.The abstract states: " Occupational exposure to cadmium has for long been associated with renal tubular cell dysfunction, osteomalacia with osteoporosis, hypercalciuria and renal stone formation."

4. Mens Health - Osteoporosis. Sickle Cell Disease may cause Osteopenia and Osteoporosis.

   Research at Johns Hopkins University School of Medicine found that: "Sickle cell disease (SCD) is a prevalent genetic disorder in which sickle hemoglobin leads to tissue hypoxia and adverse effects on bone. Published studies suggest that children with SCD often have undiagnosed osteopenia or osteoporosis. Minimal data exist on the prevalence of low bone mineral density (BMD) in adults. Our objective was to describe the prevalence of osteopenia and osteoporosis in adults with SCD and to identify patient or disease characteristics.

   . . . We conducted a cross-sectional study of adults with SCD. Through questionnaires, we collected data about disease course and osteoporosis risk factors. Patients underwent dual X-ray absorptiometry (DXA) measurement of BMD at the hip, spine, and forearm and sampling of blood and urine for markers of bone turnover, sickle cell disease severity, and secondary causes of osteoporosis. Our main outcome measure was prevalence of osteopenia and osteoporosis as defined by WHO criteria. Of 32 adults with SCD (14 men and 18 women) with a mean age of 34 years, 72% (95% confidence interval 53-86%) had low BMD at one or more anatomic sites. Thirteen patients were classified as osteoporotic and 10 as osteopenic. The prevalence of low BMD was greatest in the lumbar spine (66% of patients). Significant correlates of decreased BMD included low BMI (P < 0.01), male sex (P = 0.02), and low serum zinc concentrations (P < 0.01). The prevalence of osteopenia and osteoporosis in young adults with SCD is extremely high."

5. Mens Health - Osteoporosis. Cancer is a risk factor for both women and men. In Mens Health prostrate cancer is the main form studied for Osteoporosis.
   • Coll Antropol. 2005 Dec;29(2):589-91."Changes in bone mineral density in patients with prostate cancer treated with androgen deprivation therapy." by Bernat MM, Pasini J, Marekovic Z. of Zagreb, Croatia.

     "Osteoporosis is a complication of permanent androgen deprivation in men with prostate carcinoma, following either bilateral orchiectomy or treatment with GnRH agonists . The present approach to the problem of osteoporosis includes prevention, adequate follow-up and appropriate treatment as an imperative of contemporary urological and endocrinological management of these patients. Bone densitometry was performed in 18 patients who were on GnRH agonists treatment during 1-3 years.

     The patients under therapy were followed clinically, PSA (prostate-specific antigen) values were determined and bone scintigraphy was performed. The bone mineral density values in 13 patients indicated osteopenia, whereas in one patient the finding was compatible with osteoporosis. Four patients had normal bone mineral density findings. Bone densitometry should be performed before initiation of treatment with GnRH agonists in order to quantify the therapy-related bone loss. Prevention of development of osteoporosis and its complications depends on the assessment of pharmacological treatment in this group of patients, including e.g. bisphosphonates and possible intermittent androgen deprivation."

6. Mens health - Osteoporosis. If you were a 'premie' when born, you may be at increased risk for Osteoporosis. This is true for both men and women but I list it here under Mens Health anyway.

   Premature birth: Orv Hetil. 2005 Dec 4;146(49):2491-7.by Kocsis I, Kis E, Szabo A, Vasarhelyi B, Machay T, Szabo M.

   "The survival rate of premature infants has been significantly increased during the last decades. As a consequence, the problem of less imminent, slowly progressing, but also important disorders such as osteopenia of prematurity has been emerging. The diagnosis of osteopenia of prematurity is based evidence for less bone mineral density compared to fetuses or infants at the same gestational age in the absence of laboratory parameters and/or clinical signs for rachitis or other metabolic bone disease. The incidence of osteopenia among infants born before 28 weeks of gestational age are as high as 30%. The aim of this paper is to review the information regarding the prevention and treatment of osteopenia of prematurity and to summarize the preventive measures to avoid fractures or bone deformations and to achieve the genetically determined peak bone mass. The latter is essential for the prevention of osteoporosis in adulthood".

7. Mens Health: Anticonvulsants and opiods and Osteoporosis.

   "In cross-sectional analysis of NHANES III, anticonvulsants and opioids (but not benzodiazepines or antidepressants) were associated with significantly reduced bone mineral density. These findings have implications for fracture-prevention strategies."

   "We sought to examine the relationship between bone mineral density and the use of benzodiazepines, anticonvulsants, antidepressants, and opioids in a representative US population-based sample. SUBJECTS AND METHODS: We analyzed data on adults aged 17 years and older from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Total femoral bone mineral density of 7114 male and 7532 female participants was measured by dual-energy x-ray absorptiometry. Multivariable linear regression models were used to quantify the relation between central nervous system medication exposure and total femoral bone mineral density. Models controlled for relevant covariates, including age, sex, and body mass index. RESULTS: In linear regression models, significantly reduced bone mineral density was found in subjects taking anticonvulsants (0.92 g/cm2; 95% confidence interval [CI]: 0.89 to 0.94) and opioids (0.92 g/cm2; 95% CI: 0.88 to 0.95) compared with nonusers (0.95 g/cm2; 95% CI: 0.95 to 0.95) after adjusting for several potential confounders. The other central nervous system-active drugs--benzodiazepines or antidepressants--were not associated with significantly reduced bone mineral density. CONCLUSION: In cross-sectional analysis of NHANES III, anticonvulsants and opioids (but not benzodiazepines or antidepressants) were associated with significantly reduced bone mineral density. "Am J Med. 2005 Dec;118(12):1414. "Bone mineral density in subjects using central nervous system-active medications."Kinjo M, Setoguchi S, Schneeweiss S, Solomon DH.

8. Mens Health- Osteoporosis. Saturated Fat intake is a risk factor for both men and women. J Nutr. 2006 Jan;136(1):159-65. " Dietary saturated fat intake is inversely associated with bone density in humans: analysis of NHANES III." Corwin RL, Hartman TJ, Maczuga SA, Graubard BI.

   "Saturated fat intake was negatively associated with BMD at several hip sites. The greatest effects were seen among men < 50 y old (linear trend P = 0.004 for the femoral neck). For the femoral neck, adjusted mean BMD was 4.3% less among men with the highest compared with the lowest quintile of saturated fat intake (BMD, 95% CI: highest quintile: 0.922 g/cm2, 0.909-0.935; lowest quintile: 0.963 g/cm2, 95% CI: 0.950-0.976). These data indicate that BMD is negatively associated with saturated fat intake, and that men may be particularly vulnerable to these effects."

9. Mens Health: Osteoblast disfunction can cause Osteoporosis Calcif Tissue Int. 2006 Feb;78(2):90-7. Epub 2006 Feb 6.

   "Osteoblast dysfunction in male idiopathic osteoporosis." byPernow Y, Granberg B, Saaf M, Weidenhielm L. of the Endocrine and Diabetes Unit, Department of Molecular Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.

   "The etiology of primary osteoporosis in young and middle-aged men is unknown. We have studied osteoblast function in cells derived from men with idiopathic osteoporosis and in control cells from age-matched men with osteoarthrosis. Osteoblasts were isolated from transiliac bone biopsies. Osteoblast function was measured as vitamin D-stimulated osteocalcin production and production of cytokines and factors involved in osteoclast activation and bone formation. Cell proliferation was measured as (3)H-thymidine incorporation. Parathyroid hormone-related peptide (PTHrP) mRNA was measured using reverse-transcriptase polymerase chain reaction. In osteoporotic men, bone mineral density at the femoral neck was correlated to in vitro production of osteocalcin. Osteoblasts from osteoporotic men produced significantly less osteocalcin after vitamin D stimulation but had increased production of macrophage colony-stimulating factor (M-CSF) compared to controls. The osteocalcin response was negatively correlated to production of M-CSF, interleukin-6, and C-terminal propeptide of type I collagen. Basal (3)H-thymidine incorporation was similar in cells from osteoporotic patients and controls. PTHrP (10(-9 )M) significantly increased cell proliferation in control cells but not in osteoporotic cells. Basal PTHrP mRNA levels were significantly higher in osteoporotic cells than in cells from controls. The results are in agreement with previous histomorphologic studies indicating that men with idiopathic osteoporosis have an osteoblast dysfunction with decreased osteocalcin production and increased production of factors stimulating osteoclast activation. This indicates a catabolic cellular metabolic balance leading to negative bone turnover, resulting in osteoporosis. The cause of such cellular dysfunction needs further evaluation. "

10. Mens Health - Osteoporosis. Long-term use of warfarin was associated with osteoporotic fractures, at least in men with atrial fibrillation. Beta-adrenergic antagonists may protect against osteoporotic fractures. Washington University School of Medicine, St Louis, MO Janurary 2006 in ARchives Internal Medicine.

11. Mens Healther - Osteoporosis. Psychotorpic drugs - Clin Psychiatry. 2004 Dec;65(12):1607-18; quiz 1590, 1760-1. "Effects of psychiatric disorders and psychotropic medications on prolactin and bone metabolism." by Misra M, Papakostas GI, Klibanski A.

    "Schizophrenia and major mood disorders are often associated with perturbations in bone metabolism related to factors including nutritional alterations, smoking, and hypogonadotropic hypogonadism, with or without medication-induced hyperprolactinemia. Polydipsia can contribute to bone loss in schizophrenia, whereas hypercortisolemia is often associated with low bone density in depression. Lithium in bipolar disorder and thyroid-stimulating hormone-suppressive doses of L-thyroxine have a negative impact on bone health. Mood stabilizers such as carbamazepine and valproate can also affect bone density. Hyperprolactinemia may lead to bone loss only if associated with untreated amenorrhea in women or testosterone deficiency in men. Some atypical neuroleptics, by causing lesser elevations in prolactin, may therefore have a less marked impact on bone than typical neuroleptics."

12. Mens Health - Osteoporosis. Smoking. To read about this go to Mens Health Osteoporosis: Smoking

End of article about Mens Health and Osteoporosis.