Dr Q&A on Men & Osteoporosis

How widespread is osteoporosis among men?

Dr. Silverman: Osteoporosis occurs not only in women but men and children as well. If we judge our number of fractures by extreme old age, one in three women will have a hip fracture. By extreme old age, one in six men will have a hip fracture.

When we say extreme old age, what age are we talking about?

Dr. Silverman: By approximately the age 80.

What are the consequences of osteoporosis in men? Are they the same as in women?

Dr. Silverman: Osteoporosis is a brittle bone disease. Its consequences are height loss and resulting changes in posture, with consequences also of fracture, hip fracture, spinal or compression fracture, as well as the common wrist fracture. These fractures certainly have some degree of morbidity and pain for the patient, but there is also mortality. Hip fractures, whether they are in men or in women, are associated with 12 to 20 percent mortality, or death.

What are the consequences of men having osteoporosis?

Dr. Silverman: The consequences of a man or woman with osteoporosis are brittle bones with height loss, resulting in bad posture, bending over the so-called dowager’s hump, and fracture. Fracture is hip fracture, vertebrae fracture or spinal compression fracture, wrist fracture as well as other bones. Hip fracture is the one we are worried most about because hip fracture is associated with death. There is associated incidence of about 12 to 20 percent of patients who sustain a hip fracture may die within two years after a hip fracture.

What happens to them?

Dr. Silverman: They are otherwise normal, healthy individuals and may not be able to get around. They’re lying in the bed. They may have clots or lung problems, or pneumonia. If you take a group of patients who have had a hip fracture, only one out of four of them will ever come back to their same level of function they had before the fracture. Another one out of four will require some assistance. Another one out of four may need to go to some kind of assisted environment such as a board-and-care or nursing home environment. Hip fracture has considerable problems whether you’re a male or female.

Doctors are just recently starting to look at osteoporosis in men. Is that a kind of a recent trend?

Dr. Silverman: We all lose bone after we have reached our peak or personal best bone mass at approximately age 30. Then there is a slow rate of progressive loss of bone in both men and women. It’s more striking in women because women at the time of menopause, approximate age 50, have an accelerated period of bone loss due to estrogen deficiency, and all the time men are still losing bone just like women. However, men also start off with a higher base-line bone mass. If you look at twins and the male twin starts off with a higher personal best bone mass, and that may have to do with specific genetic factors as well as the fact that men may have more muscle than women.

So we all lose bone mass but in osteoporosis the bone loss is more pronounced?

Dr. Silverman: In patients with osteoporosis there is sufficient bone loss due to aging or estrogen deficiency that the bone becomes brittle. It reaches a certain level and then it begins to fracture.

You have been doing some studies about bone loss in men, osteoporosis in men. What have you found out?

Dr. Silverman: I work at the Veterans Administration Hospital here in Los Angeles. We have been looking at factors involved in men who have osteoporosis and looking at ways of treating them. Men are like women in that exposed to certain medicines such as cortisone, prednisone may result in bone loss. There are other risk factors for men such as excessive alcohol consumption and also loss of the normal male hormone, testosterone. Which is a similar effect that we see in women who have lost estrogen.

Why would a man’s testosterone be low?

Dr. Silverman: Some men have deficiencies of testosterone. Some men also with aging appear to be losing some amount of testosterone.

Is there any treatment at this point?

Dr. Silverman: We’re involved in several research studies on treating men. While one would consider certainly the male hormone however in men unfortunately it is associated with risks of prostate cancer. So that’s not going to be a simple treatment that we can use. Rather we’re looking right now at two other treatments, one is calcitonin and the other one is bisphosphonate. Both these medicines affect the rate of bone loss in both men and women. And have been given successfully in women. And we’re not starting to look and see whether these treatments are affective in men as well.

What is calcitonin?

Dr. Silverman: Calcitonin is a hormone that helps to reduce bone loss by turning off the cells which remove bone, the osteoplast.

How does this calcium medication work?

Dr. Silverman: Calcitonin is not calcium. It is a hormone that controls the amount of calcium in our body. It controls the amount of calcium in our body by regulating how much bone is resorbed or removed on a regular basis from our bone. It slows down this process which we call resorbtion.

Do you get it from fish?

Dr. Silverman: This hormone is important in fish such as salmon who use it to regulate how much calcium is coming in from the sea water. But we do not use this hormone in the same way that the fish does, rather we can use it pharmacologically to help control the rate of bone resorbtion and bone loss.

The other drug?

Dr. Silverman: The other drug is etidronate. This is a unique type of compound that mimics one of the chemicals in the bone crystal. Because it mimics the bone crystal it absorbs to it and it too just like the calcitonin will slow down the rate of bone loss by those cells which remove bone during the process of bone growth. Etidronate is the same as didronel which is used in Paget’s disease.

Are these medicines the same medicines that you use for women?

Dr. Silverman: These medicines have been used in women but are at this point although calcitonin is approved for use in osteoporosis in women it is not approved in men. Etidronate is still undergoing FDA approval process for osteoporosis although it’s been approved in Paget’s in women. Approval for men will count on the research we’re doing right now.

What are you doing right now?

Dr. Silverman: We’re looking at men who developed osteoporosis and trying to develop ways of identifying what the causes are although many of the causes we do not understand, we call it eupathic. We are able to identify causes in some men and we’re trying to figure out what are the new and best treatments so we can offer them to prevent the consequences of osteoporosis.

Are these preliminary results showing that these two drugs work?

Dr. Silverman: In the case of Mr. Cooper, Mr. Cooper has responded very well to his medication. He is someone who has had osteoporosis most likely due to his history of steroid use. We’ve not only prevented him from losing more bone while taking the prednisone but actually begun to slowly rebuild his bone mass.

Will this happen with every man?

Dr. Silverman: Our experience is that it seems to be affective in about 88 percent of the people we studied.

You must be very excited about this?

Dr. Silverman: Yes, to different degrees. But the response of the people that we will start on medication after trying one medicine or another only eleven percent continued to lose bone, 88 percent will stop losing bone and some of that group will also begin to rebuild bone as well.

Does it?

Dr. Silverman: One of the interesting things is that Mr. Cooper is still continuing to gain bone and not lose any further bone despite the fact he’s still continuing to take prednisone. For many patients they must take prednisone for asthma or some other disease and they can’t stop that medicine. We think thereby as we learn more about these medicines that patients will be able to take these kinds of medicines.

You did a measurement and it compared very well, do you remember those numbers off hand?

Dr. Silverman: Mr. Cooper gained approximately seven percent in his spine, and another two or three percent in his hip. The hip is an area that gains bone slower than the spine.

Over what period of time?

Dr. Silverman: This is over a period of approximately six months. He takes pills for two weeks every three months. One of the things that there may well also be in the future, we’re also doing studies with different kinds of steroid medications. There are newer kinds of steroid medicines that do not harm the bone as much as prednisone we have used in the past. Those studies are still in progress.

Are these drugs expensive, are they experimental?

Dr. Silverman: They are research studies at this point, there are no approved indications yet for men.

Anybody else in the United States doing these studies?

Dr. Silverman: There are groups of physicians who are involved with trials in osteoporosis in men. Eric Orwoll at Portland, Oregon, also Dr. Ted Haun at UCLA, Dr. Jackson in Texas, and Dr. Woodson in Atlanta, Georgia.

How many patients have you treated with this procedure and over what time period?

Dr. Silverman: We followed approximately 50 patients, over two years.

Any other countries other than the United States testing these?

Dr. Silverman: Not at this time.

Do men need to take calcium supplements?

Dr. Silverman: Men just like women do need calcium supplements. The population average, not per person, is about a thousand milligrams per day in either calcium supplement or diet. The question is elemental calcium, it’s a thousand milligrams. You might have for example, patients who are given nine hundred and fifty milligrams, calcium citrate is really 350 milligrams. The big issue with calcium is how well it dissolves. Any of your viewers who are taking calcium pills should test them out to see if they dissolve with a glass of water or a glass of water with a little bit of vinegar like stomach acid and if it doesn’t dissolve within a half an hour they should buy another brand. Many of the health food store calciums don’t dissolve.

Source: Ivanhoe News

Too Much Vitamin A and Higher Risk of Fracture

Vitamins are considered a healthy part of a person’s diet, but a new study finds too much of a good thing may be harmful. Researchers from Brigham and Women’s Hospital in Boston say too much vitamin A may increase a woman’s risk of hip fracture.

Diane Feskanich, Sc.D., and colleagues, studied more than 72,000 women between ages 34 and 77. The reviewed records of the food the women ate, the supplements they took, and their risk of postmenopausal hip fractures. The women were part of the Nurses’ Health Study, which lasted 18 years.

Vitamin A, for the purpose of this study, encompasses a number of compounds that are required for vision, growth, reproduction, and the well being of the immune system among other functions. Animal studies have suggested too much vitamin A can have a negative effect on the skeleton.

In this study, researchers found women who took 3,000 micrograms or more of vitamin A either through food or supplements had a significantly higher risk of hip fracture. Retinol is considered the most potent source of vitamin A and appeared to have the greatest impact on the rate of fracture.

Researchers say these findings offer a reason for officials to reassess the increased fortification of foods with vitamin A, particularly from retinol. Currently, it’s recommended that men consumer 800 micrograms of vitamin A and women 700 micrograms. The recommendations say 3,000 micrograms is considered a safe level.

SOURCE: Journal of the American Medical Association, 2002;287:47-54