Fractures in Osteoporotic Men and Women

Osteoporosis is a condition in which there is a gradual softening of the bones which makes them fragile. It is caused by the loss of calcium. Our current understanding has been that osteoporosis occurs most often in women after the age of menopause. Men can suffer from osteoporosis as well when they experience low levels of testosterone.

Bone fracture is a common complication of osteoporosis. One in two women and one in five men over the age of 50 will have a fracture. A person may lose height if the vertebra collapses due to osteoporosis. One may develop a hump if several vertebrae collapse.

Other causes of osteoporosis for men and women are: long-term use of corticosteroid medication, maternal osteoporosis, smoking, heavy drinking, sedentary lifestyle, low body weight and medical conditions that affect absorption, such as celiac disease. Diagnosis of osteoporosis is made by measuring bone mineral density.

A recent article in the CMAJ says that our understanding of and approach to osteoporosis is in the middle of a revolution. Research now shows the bone loss begins before menopause and involves other hormones in addition to estrogen, and that measuring bone mineral density alone is an inefficient way of addressing the clinical burden of osteoporosis.

The ongoing Canadian Multicentre Osteoporosis Study also shows that both men and women experienced an additional phase of accelerated bone loss from age 70 onward. Hormone replacement therapy with estrogen in women does protect against bone loss over time.

The finding that bone loss began before menopause indicates that estrogen loss alone cannot account for the changes. Therefore, interest has focused on other hormones whose levels change in early menopause such as follicle-stimulating hormone and the activins and inhibins. The role of steroid produced in the body and the size of the body composition is being determined.

The current national guidelines recommend that the test for osteoporosis (measuring bone mineral density) should be done every 2-3 years. In one of the CMAJ articles, Berger and colleagues suggest that densitometry for most women can be repeated every five years rather than every 2–3 years because the average changes in bone density over 2–3 years is small and comparable to the measurement error in the scanning technique.

There is also a question whether women who are already receiving treatment for osteoporosis should have follow-up assessments of bone density at all, since changes in density as a result of therapy account for only a small component of the effectiveness of these medications, says the CMAJ article.

There are four key points in the CMAJ articles: bone loss in women begins before menopause and is accelerated in old age, medications which reduce the loss of calcium from the bone helps preserve bone density, the interval between bone density assessments can safely be increased to 5 years for many untreated women and finally, decisions about when to test and treat will increasingly focus on estimates of absolute fracture risk as indicated by the bone density test.

Osteoporosis is treated with calcium and vitamin D supplements, a variety of hormone treatments (hormone replacement therapy like estrogen) and Bisphosphonates, a group of drugs that prevent bone breakdown and can be very effective in osteoporosis. But prevention is better than cure. So, increase calcium and vitamin D in your diet, increase the amount of weight-bearing exercise you do, reduce your alcohol intake and quit smoking.

The reduction in risk was greatest among elderly individuals who were most adherent to therapy and among those who received at least 1200 mg of calcium and 800 IU of vitamin D daily.

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