Osteoporosis in Men

We are used to thinking that osteoporosis only affects women as a general rule. Well, this is definitely not the case. This disease can occur in men too. We are going to take a look at some of the principal causes and how to diagnose it and then most importantly how to prevent it. But before this, let’s define exactly what is this disease called osteoporosis.

It is the fragmentation of bone tissue, usually due to the natural aging process, and it does occur in men with much more frequency than we are led to believe. Another myth we have to demystify is that osteoporosis is caused only by aging. In fact, it can be brought on by various other risk factors, like cigarette smoking, lack of exercise and sedentary lifestyles, and a high usage of steroids drugs. In the case of steroids, it is more common in people who take cortisones over a long period of time like asthmatics and patients who have sarcoidosis, a disease that causes abnormal accumulations of inflamed cells – granulomas- (in many organs of the body) and other chronic diseases.

Another cause of osteoporosis in men is hypogonadism, which is a deficiency of testosterone, the masculine hormone par excellence. Also, malnutrition, obesity, and alcoholism are potential risk factors for osteoporosis.

The most visible signs and symptoms of osteoporosis, other than a susceptibility to fractures, are a curved posture, pain in the back regions and a slight shrinking in height (you may already have noticed how some elderly people appear somewhat shorter, both men and women.) It may also be that in the initial stages of osteoporosis there are no symptoms whatsoever.

To diagnose osteoporosis, your doctor will examine you and ask questions about your symptoms and sometimes request a bone-density test to measure the status of your bones. The results are immediate and the test does not need any preparation on your part.
To prevent osteoporosis, you could try to do the following:

a) stop smoking

b) limit your alcohol consumption (2 glasses per day maximum for men, one a day for women)

c) Exercise regularly

d) Take vitamin D supplements (ask your doctor for the right dose for you)

e) Expose your body to sun for 10 to 15 minutes at least 2 to 3 times per week. This will activate the vitamin D which in turn will activate the metabolism of your calcium levels to reinforce your bones.

f) Eat calcium-enriched foods, like dairy products, vegetables and greens, sardines, salmon, tofu and almonds.

There are medicines and treatment for osteoporosis which can help you to avoid serious fractures. These medicines and procedures can already help to prevent osteoporosis occurring in those who are taking regular steroids for other diseases.

In the case of men, check your testosterone levels at your next doctors’ appointment because it is now known that a deficiency of this male hormone, or hypogonadism, is a leading cause for osteoporosis in men.

The Importance of Seeking a Second Medical Opinion

I remember many cases of patients coming to see me from far and wide, from Queens or from Goiania, from Staten Island or from Brussels because they had particular medical concerns. They could not make decisions on what best to do faced with incomprehensible diagnosis and with costly and uncertain treatment options. The Internet is a huge source of clinical information but understanding and managing all the information we read on the web is not an easy task. It is not even easy for us doctors to interpret the avalanche of information that assails us day and night. We have to meticulously research the data to ensure that it is accurate and reflects studies that are unbiased or not sponsored by a particular drug company for their own marketing gain. This sometimes means reading between the lines or undertaking further research and sometimes even relying on your own personal and tried and tested experience.

So we can imagine what it must be like for the patient! No doubt, it is a good idea to seek a second opinion when the diagnosis is a complicated one. And especially if there is surgery involved. This should not offend the surgeon or doctor involved at all. If it does then that is their problem not yours. It is about your health not theirs. Don't feel embarrassed to ask for your medical file to obtain a second opinion from another doctor. There is no problem with this. On the contrary, you will feel relieved and reassured to know that the doctors are all in agreement with the diagnosis and treatment options.

I saw a patient once who came to see me with his medical file bulging with notes and test results from exams done in Rio and Sao Paulo. He had been diagnosed with prostate cancer that had metastisized, meaning it had already started to spread over his body. His urologist in Rio had referred him to Sao Paulo where he had been taking injections of female hormones to combat the spread of the cancer. He came to see me in New York where I reviewed his bone scan. I saw that it showed no signs of cancer at all. It was a simple case of osteoporosis. The patient stopped taking the hormones and was so relieved and thanked me wholeheartedly. Even today I still remember with great affection seeing his face light up when I told him he could return home and celebrate his "cure".