This is going to surprise a lot of you, but osteoporosis is not just a woman's disease. We all know, of course, or at least we should that osteoporosis is a major cause of disability and death in women. About 20 % of women who suffer a hip fracture, for example, die within a year. Of the remainder, a significant number suffer permanent disability as a result of that fracture, not to mention that osteoporosis leads to a great deal of loss of mobility as well as chronic pain in women from fractured vertebrae and fractured wrists, and so on.
But what we - and that includes all of us: doctors, the public, and the media - don't seem to pay nearly enough attention to is that osteoporosis also takes a huge toll on men's lives.
Surveys reveal, for example, that most people still consider osteoporosis to be mostly a women's disease, even though one-third of osteoporotic fractures occur in men, and men tend to have a higher death rate than women following a hip fracture.
What is even more surprising, though, is that doctors also seem to be unaware of, or at least they ignore, the toll exacted by osteoporosis in men. For example, a recent study from a major hospital in the US found that only a shamefully low 4.5 % of male seniors who had suffered a fracture were treated for osteoporosis on discharge from the hospital, even though these fractures strongly indicated that those men were suffering from advanced osteoporosis. By the way, the comparative figure for women was 27 %, which is also shamefully low, if you ask me.
In fact, I can't understand why all of those people were not being treated even before they had suffered their fracture, because, as the lead author of this study said, "The time to treat somebody is well before they have that fracture."
So let me reiterate that osteoporosis is an equal opportunity bone destroyer, and all of us - men and women, young and old - need to do more to not only prevent this disease, but also to treat it adequately once it rears its ugly head.
In terms of prevention, we know that several factors significantly raise the risk of osteoporosis, some of which, however, you can't do much about. I mean it's far too late to change your genes (osteoporosis runs in some families), however appealing that thought might be to some of us, and you can't really do much about the fact that you are Caucasian or Asian, both of which also raise your risk of osteoporosis.
You also can't do much about the fact that the risk of osteoporosis goes up with age.
Other risk factors that can also be more difficult to control include
- taking some medications (oral cortisone, for example, and anticonvulsants)
- suffering from certain other conditions such as hypothyroidism or malabsorption syndromes
- and going through menopause at an early age.
But there are some osteoporosis risk factors that you can, thankfully, do a lot about. Thus, if you want to reduce your risk of suffering a fracture
- don't smoke
- do lots of weight-bearing exercise (such as walking, jogging, stair climbing, and perhaps especially resistance exercises - the stronger your muscles, the stronger will be the bones that they control)
- eat a diet with enough calcium and vitamin D (and if you're over 50, or have other major risk factors, you probably should be on calcium and vitamin D supplements)
- don't drink too much alcohol or too much caffeine (alas!, although as a coffee and wine lover, I hasten to point out that there are other benefits to those beverages that might outweigh the risks to your bones, at least that's what I've convinced myself)
- and don't aim to be too thin. (I hate to mention this but about the only good thing you might say about our increasingly obese culture is that all that poundage will probably lower the future risk of osteoporosis fractures in our overweight population.)
And although it's never too late to start on a bone-building regime, it's better if you start protecting your bones early in life because studies show that kids as young as eight or ten years old who are very active already have stronger bones than do their more sedentary peers, and the more bone mass you build up as a youngster, the more bone mass you retain into your older years and the better cushion you have in preventing osteoporosis.
How can you tell if your bones are beginning to soften. Unfortunately, the simple truth is that except in rare circumstances, you can't, which is why the fist sign of osteoporosis is often a fracture, and by then, it's too late for many.
That brings up the issue of diagnosis. The best way to diagnose osteoporosis is through a bone density test, and the current guidelines from the Osteoporosis Society of Canada recommend that everyone over the age of 65 get a baseline bone scan, although lots of people, including moi, to be sure, believe that most of us would benefit by having a bone mineral density test long before our first tentative steps into "seniorhood".
In terms of treatment, we are now getting away from using hormone replacement therapy in women, thank God!, and it's still way too early to use testosterone as an osteoporosis therapy in men, so the current best bets for therapy include the drugs raloxifene (Evista) or one of a class of drugs called bisphophonates - my favourite is alendronate (Fosamax), but others in this class include Didrocal and Actonel.
The bottom line, though, folks, is this: best to bone up on bone health so you don't become a bonehead with a break.
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