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You are here: MEDICA Portal. Our Topics in 2009. Topic of the Month August: The Musculoskeletal System. Alcohol.

Crumbling in Secrecy

Crumbling in Secrecy

photo: elbow fracture

Osteoporosis is insidious as it comes sneakily - it mostly goes undetected at first since frail bones do not hurt. Pain does not appear before the first bones break. A slight fall is often enough; in advanced cases a cough or a sneeze could already be too much. While elderly women’s fractures immediately set off alarm bells for doctors scarcely anybody suspects bone atrophy in men although 1.3 millions are affected in Germany. “The estimated number of unreported cases of the disease is probably high”, suspects Peter Pietschmann, who is in charge of the bone, cartilage and connective tissue research group at the University of Vienna.

Only few men get an appropriate treatment

In principle, it is not difficult to diagnose the disease: a bone density measurement and X-ray images clearly show whether the skeleton is getting crumbly. “Yet a lot of physicians do not strike on the idea that male patients could suffer from osteoporosis and therefore do not undertake these examinations”, says Pietschmann. If the back hurts and bones break frequently – both are symptoms of osteoporosis – medics will rather believe in age-related wear than in bone atrophy. As a result, the patient is administered pain killers instead of getting an appropriate treatment.

After the first bone fracture only ten percent of all male osteoporosis patients receive drugs reducing the activity of decomposition cells. “In most cases bone density can be increased by these bisphosphonates”, explains Michael Pfeifer, who is postdoctoral research fellow at the Institute for Clinical Osteology Gustav Pommer in Bad Pyrmont. Calcium and vitamin D are also important components of the therapy. However, drugs are frequently administered late, which is a serious problem as bone atrophy advances rapidly after the first fracture.

But not as rapidly as in women. That is because of the bigger volume and the higher density of male bones. “There is more bone substance in men. That is why it takes longer to degrade”, Pietschmann explains. In addition, with increasing age the male testosterone level declines more slowly and not as strongly as the female oestrogen level. That is advantageous since sex hormones encourage bone metabolism.


photo: a glass of milk

Men suffer from secondary osteoporosis

In contrast to women, who suffer from osteoporosis in 80 to 90 percent of all cases because of the lack of oestrogen after the menopause, underlying diseases play a decisive role in more than 50 percent of the male osteoporosis cases. The so-called “secondary osteoporosis” often results from alcohol abuse, gonadal hypofunction or from drugs containing cortisone. Therefore, it is especially important to search for primary causes in male patients in order to fight the bone atrophy’s roots.

Also smoking and low calcium food cause porous bones in men. “There are more elderly men smoking than women. Moreover, men usually eat more meat and less dairy products which heightens their risk of osteoporosis”, explains Pfeifer. That is why it is important to stop smoking and drinking alcohol as well as to change diet. The osteoporosis therapy also comprises regular exercises as muscles support the skeleton. The sooner the osteoporosis treatment starts, the better. “Routine preventive bone density measurements are reasonable for men above 60 years with special risks”, recommends Pfeifer.

Sonja Endres


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