Touching Lives - June 2003
Osteoporosis -- it's a man's thing too
Osteoporosis is also known as brittle bones and is typically thought of as being a condition that only affects women. But a staggering one in 12 men also suffer with osteoporosis. The disease can occur in men as young as those in their twenties or thirties.
It is a condition that can affect any bone in the body. Our bones are continuously being broken down and then rebuilt by the body but, as we age, the rate at which they are broken down is greater than the speed at which we can replace them. So our skeletons become lighter and weaker.
This process of bone renewal is thought to be controlled by the sex hormones — oestrogen in women and testosterone in men. One of the reasons why osteoporosis is so common in women is that oestrogen has a protective effect on their bones but during the menopause oestrogen levels rapidly drop and women suffer bone loss as a result. Men however, also synthesise low levels of oestrogen which, we know from other recent research, may be equally important for their bone.
Although osteoporosis can be an age-related disease there are some risk factors that can affect its development. These include taking steroids, alcohol and smoking as well as lack of calcium in the diet.
^Osteoporosis is known as ‘the silent epidemic’^ because so many of those who are affected only become aware of the problem after they have experienced a fracture of the wrist, or more seriously the hip or spine. A hip fracture almost always requires hospitalisation and major surgery. It can impair the ability to walk unassisted and may cause prolonged or permanent disability, or even death.
In an Action Medical Research-funded project worth £67,000 Dr Isobel Braidman of the University of Manchester looked at men for whom there was no obvious reason that they would have osteoporosis. This condition affects around one third of male osteoporosis patients and is called Male Idiopathic Osteoporosis (MIO). Brian has MIO.
The team has found that some men who develop osteoporosis in their thirties or forties have a defect in a ‘receptor’ in their bones. This receptor recognises the hormone oestrogen in the body and regulates what bone cells do in response to the hormone. The research has found that some of these men had normal levels of oestrogen compared with the control group; so one possible explanation could lie in the way that the bone responds to available oestrogen.
In men with osteoporosis one of the receptor molecules, which enables bone to respond to oestrogen, may be shortened — which would interfere with the action of oestrogen on bone cells.
Dr Isobel Braidman, the senior lecturer in cell biology and who led the study, said: “Osteoporosis is little understood in men and it is very difficult to treat. It is tragic, but men are more likely to die from their fractures than women so it is vital that men look after themselves and take preventative measures in the form of food and exercise.
“Unfortunately there is only a limited range of treatments available for men with osteoporosis as it is not possible to treat men with hormone replacement therapy. These therapies mostly work by stopping the bone being reabsorbed by the body but some of them have unpleasant side effects.
“What is crucial is that we need to understand why these men get the condition in the first place, which means more research into the role of oestrogen and how it affects bones. This opens up an interesting avenue of research from which new therapies could be developed for the future. The best thing about this is that then treatments can be tailored to where they are needed.”
Dull aches and losing inches
Brian, who is 65, has had a bad back for around twenty years but he was only diagnosed with osteoporosis ten years ago. This was after doctors took a bone sample from his thigh in a rather unpleasant procedure that uses an instrument a bit like a cookie cutter to extract a piece of bone.
Brian told us: “I remember being in the ward and being surprised that there were more men than women having the procedure done. Then when they told me that I had osteoporosis, well, I didn’t really know what it was. I just thought to myself ‘why have I got that?’ It’s a women’s thing!
“I have recently been for a scan and have been told that I have 4 fractures to my spine. That probably explains the dull ache in my lower back that I have all the time! I have been taking two different drugs every day for ten years now.
“These try and get the bone to grow back again but I may be going to have a new procedure done that uses something like Polyfilla to fill the cracks. I am lucky that I haven’t had any major fractures because ^my condition is not too far advanced, although I have lost two inches in height!^
“I have had back pain for so long I can’t imagine living without it. Getting in and out of chairs is hard but I don’t let the condition stop me from going out and doing things. My one complaint is that sitting on the bus isn’t as comfortable as it used to be!
“I think it is amazing that this Action Medical Research project has maybe found a possible reason why men like me develop osteoporosis. If research could lead to better treatments or even to stopping the condition developing then I think that would be really fantastic.”