ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, September 10, 1996 TAG: 9609100017
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: Personal Health
SOURCE: JANE BRODY
Men may be justified, though incorrect, in thinking that they are invulnerable to osteoporosis.
This bone-wasting disease occurs slowly and silently and has been labeled ``a woman's disease'' because women are far more vulnerable to it and the fractures it causes. Half of all women develop it, and one woman in two over the age of 65 suffers one or more bone fractures because of it.
But men get osteoporosis, too, and 20 percent of American men will suffer at least one fracture because their bones have become too thin and weak to withstand the normal stresses of life.
A simple fall that in boyhood resulted in a scraped elbow or knee can mean a fractured wrist or hip for an older man. Hip fractures are serious; one-third of men who break their hips die within a year from complications of the fracture or its treatment. And because grown men rarely have their height checked, many are unaware of the inches they lose with age, the consequence of vertebral fractures caused by osteoporosis.
Sometimes these spinal fractures are all too apparent, causing severe back pain and a bent posture. Even then, many men wait for the discomfort to subside and ignore the developing spinal deformity. However, osteoporosis in men and women can nearly always be prevented. If the condition is detected early, treatment can prevent significant bone loss and fractures.
Who's at risk?
One and a half million men in this country already have osteoporosis, and 3.5 million more are at high risk of developing it. The most common risk factor is age. Bones in men and women continue to become more dense until about the age of 30, then gradually thin out.
Though bone may seem solid and immutable, it is a tissue in constant flux. Calcium and other minerals are continually being leached from bone and replaced by minerals in the blood that are absorbed through the gut from foods and supplements. If the amount of restorative minerals falls short of what is lost or if the hormones that influence bone density are in short supply, the bones slowly get weaker.
In women, particularly those who do not take replacement estrogen, bone loss accelerates dramatically within the first five years or so after the onset of menopause. Since women usually start out with thinner bones than men, this loss puts them at great risk of fractures as they age. Men do not experience a sudden dramatic decline in bone mass, but their more gradual losses add up. The older a man is, the greater his bone loss is likely to be.
But, as one 52-year-old man learned the hard way, you do not have to be ``old'' to develop osteoporosis. In an interview conducted by the National Osteoporosis Foundation, the man, a golfer, said his first indication of a problem had been an intense pain in his back as he swung his club. The diagnosis: an osteoporotic fracture of a vertebra. Another man, 53 years old, was forced by fragile bones to take early retirement from a job he loved.
A low level of the male sex hormone testosterone, which is common in older men, fosters bone loss. Testosterone is converted to estrogen in the body and, as in women, estrogen is crucial to bone strength in men. Men are especially at risk if they have testosterone levels that are low enough to result in impotence and absence of nocturnal erections.
Chronic diseases that affect the kidneys, lungs, stomach or intestines or that alter testosterone levels also place men at a greater than average risk of osteoporosis. Such ailments may require treatments that leach minerals from bone or that interfere with the absorption of bone minerals or their incorporation into bone.
For example, significant bone loss can result from prolonged exposure to steroids drugs (like prednisone or others) , from anticonvulsant medications and from aluminum-containing antacids and some cancer drugs. Aldactone, a diuretic used to treat high blood pressure, can reduce testosterone levels.
But the most prevalent risk factors involve men's smoking and drinking habits, exercise patterns and diet. In a 16-year study of osteoporosis in men, Dr. Charles W. Slemenda and his colleagues at the Indiana University School of Medicine in Indianapolis found that smoking and drinking outweighed heredity as risk factors for osteoporosis. Their study of 111 men, including 48 pairs of twins, found that the more the men smoked, and the more alcohol they consumed, the greater their rate of bone loss was as they got older.
Most of the men in the Indiana study were so sedentary that it was not possible to make a full assessment of the benefits of physical activity. But the researchers could discern a trend indicating that vigorous activity slowed the rate of bone loss. Studies in women have demonstrated that exercising the body's long muscles - in the arms, legs and torso - against gravity can actually build new bone, even late in life.
As for diet, both men and women usually consume inadequate amounts of calcium and of vitamin D, which the body needs to absorb and use calcium. As people age, the amount of vitamin D made in the skin after exposure to sunlight declines, and the body loses some of its ability to convert vitamin D into the active hormone needed for proper calcium metabolism.
As with women, heredity plays a role in the susceptibility of men to osteoporosis. Men with blood relatives who have developed osteoporosis and had osteoporotic fractures are at greater risk than those with relatives who aged without significant signs of bone loss.
Prevention, treatment
While there is nothing a man can do about three common risk factors for osteoporosis - age, heredity and being Caucasian - habits that promote bone loss can certainly be modified. That means quitting smoking and limiting alcohol intake to one or two drinks a day, the amount believed to protect the heart. Regular exercise to build fitness and strength, through aerobic workouts and lifting weights or using resistance machines, is also important in preventing the disease.
But to stay strong, bones need the proper raw materials, primarily calcium and vitamin D: 1,000 milligrams a day of calcium before 65 and 1,500 milligrams after 65, and 400 international units a day of vitamin D. The best, and best-absorbed, sources of these nutrients are low-fat and nonfat dairy products, the daily equivalent of four 8-ounce glasses of skim milk or milk with 1 percent fat.
Other good sources include sardines and canned salmon (be sure to eat the bones) and some dark-green leafy vegetables, especially collard greens. Those who cannot improve their diets adequately should consider taking a calcium supplement or consuming calcium-fortified orange juice or milk. Supplements of calcium citrate or calcium gluconate are good sources; even calcium carbonate, the ingredient in Tums, is absorbed well enough to help maintain bones.
Once osteoporosis develops, there are several treatments, but none of them have been specifically approved for men. These include calcitonin, through a nasal spray or injections, and alendronate, an oral drug. Men with testosterone deficiency can receive replacement therapy.
For more information
The National Osteoporosis Foundation in Washington has prepared individualized ``Bone Wise'' kits for men of all ages and for older men and women, as well as for children, teen-agers, young women and women at midlife.
The men's kit contains four brochures about different aspects of osteoporosis as it applies to men, as well as information about preventing this debilitating disease. To get a free kit, call toll-free (888) 442-WISE (442-9473).
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