Male osteoporosis: the silent disease that every year causes fractures to thousands of men in the world

As we get older, our bone tissue deteriorates and loses quality.

In women, this loss of bone quality becomes very evident after menopause, because estrogens, sexual hormones that have a protective effect on the skeleton, decrease.

But even though men don’t experience a sudden loss of sex hormones, they suffer many more bone fractures from osteoporosis than we imagine.

Osteoporosis is characterized by a decrease in bone mass and by deterioration of the microarchitecture and quality of bone.

These changes increase bone fragility and translate into a greater risk of suffering fractures, especially in some specific areas of our skeleton such as the hip, spine, and wrist.

The disease is estimated to cause more than 9 million fractures per year in the worldbut those affected are many more, around 200 million.

Affected people go unnoticed because often It is a silent, asymptomatic diseasewhich causes our skeleton to deteriorate without warning signs until the first fracture appears.

But why do we lose bone mass?

Throughout life, our skeleton undergoes cycles of bone turnover or remodeling in which the «old» or damaged bone tissue degrades and is replaced by new bone, capable of withstanding all the challenges that we subject our skeleton to. daily.

The problem is that, over the years, this process of replacing old tissue becomes deficientand the cells responsible for forming bone are not able to compensate for the loss of bone removed.

An older man in consultation with his doctor.Hormonal changes that occur during old age increase bone fragility and increase the risk of hip, spine, or wrist fractures. (Photo: GETTY IMAGES)

As a consequence, the bone balance begins to be negative. And we are losing quantity and quality of bone tissue as part of a natural and inherent process of aging.

matter of men

The problem is not just female. It is true that in women the loss of bone quality is very evident after the menopause, a stage that marks a marked decrease in the production of the female sex hormones, estrogens.

These hormones exert an important protective effect against the loss of bone mass and their decrease at the beginning of the menopause also causes a sudden drop in bone mass.

However, around the 25% of osteoporotic fractures occur in men.. And what is more important, the complications and mortality associated with these fractures are higher in men than in women.

In fact, it is estimated that each year around 80,000 men will suffer a hip fragility fracture, and that one in three will die within the first year and as many will fracture again.

Despite these data, osteoporosis in men is underdiagnosed and therefore, in many cases, without treatment. Sometimes, health professionals are not sufficiently aware of the fact that osteoporosis can affect men, which contributes to delaying its diagnosis.

The maximum peak of bone mass is reached during the third decade of life, between the ages of 20 and 30. And from that moment on, we begin to lose bone tissue.

However, in men this peak is reached later, since they start puberty later and stay in it longer than women. In addition, androgens, the male sex hormones, increase bone thickness, which is a definite mechanical advantage.

An older man complains of bone pain.Experts have found that osteoporosis in men is underdiagnosed, and therefore, in many cases, there is no treatment to prevent it from causing fractures. (Photo: GETTY IMAGES)

Another important factor is that in men there is no sudden loss of sex hormones, as occurs in women after menopause: male hormonal decline occurs gradually from the fourth or fifth decade of life.

later and worse

All these factors cause men to develop osteoporosis at least a decade later than women.

This fact contributes to an increase in severity and the risk of mortality after the fracture, among other things because with aging there is also a situation of low-intensity chronic inflammation that accelerates the process of bone degradation, thus increasing the risk of fractures and makes their repair difficult.

With age, vitamin D deficiency also increases, a fundamental hormone for bone mineralization and quality, and muscle function is diminished.

In the case of hypogonadism (a condition in which the testicles in men produce little or no sex hormones), alcohol abuse, or continued treatment with glucocorticoids used as anti-inflammatory or immunosuppressive drugs, the process is further accelerated.

At this point, we must be clear that the quality of our bones has a direct effect on our health, so all of us, men and women, must worry about taking care of our skeleton. Mainly keeping us active, consuming a varied diet rich in calcium and vitamin D, limiting alcohol intake and avoiding tobacco.

*Arancha R. Gortázar and Juan Antonio Ardura are professors of Cellular Biology at CEU San Pablo University (Spain).

*This article was published on The Conversation and reproduced here under the Creative Commons license. Click here to see the original version

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