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

Diets High in Tomatoes Have a Lower Cancer Risk

Doctors may have found a new weapon in the battle against prostate cancer: the tomato. Researchers from the University of Illinois at Chicago found lower DNA damage and lower PSA levels among a group of men who consumed a pasta dish made with tomato sauce once a day for three weeks before undergoing surgery for the condition.
Prostate cancer is currently the second leading cause of cancer-related death among men in the United States. Research has linked the cancer to oxidative DNA damage caused by free radicals. Tomatoes are high in lycopene, a substance that counteracts this damage. Previous studies, for example, have shown that men who eat diets high in tomato sauce have a 40 percent lower risk of prostate cancer than those who eat lower amounts.

In this study, investigators measured the DNA damage and PSA levels (a marker for prostate cancer) in 32 men, mostly blacks, who were scheduled to have surgery for their prostate cancer, then put the men on the special tomato sauce diet. Each of the daily tomato sauce-based entrees contained 3/4 cup of tomato sauce.

At the end of the three-week period, researchers checked the participants’ DNA damage and PSA levels again. Results showed a 21.3 percent decrease in oxidative damage compared with the earlier tests. When compared to a group of men who did not eat the special diet, men in the study had 28.3 percent less DNA damage. Their PSA levels also dropped, by 17.5 percent, but the investigators were unsure whether that decline was related to the diet or other factors.

Source: Journal of the National Cancer Institute, 2001;93:1872-1878

Soy protein and prostate cancer

Prostate cancer is the number two cancer killer of men in this country. Treatment options range from surgery to “watchful waiting.” Researchers at Moffitt Cancer Center and Research Institute in Tampa, Fla., are studying a dietary supplement that could be a treatment option someday.

Although 73-year-old James Nichols has prostate cancer, he doesn’t let it affect his active life. “I think exercise is the best thing you can do for your health, no matter what you’ve got,” says James.

James was diagnosed with prostate cancer in 1994. Because his tumor is slow growing, his doctor is taking a “watchful waiting” approach to the cancer. However, now he’s part of a study that will help doctors find out if there’s an easy way to keep prostate cancer from spreading. It would mean eating something not many men eat these days: soy protein.

Karen Besterman-Dehan, R.D., a research dietician at the Moffitt Cancer Center & Research Institute, says, “Western populations seem to have a higher risk of prostate cancer. They have a higher incidence as opposed to men from Asian countries where there’s a higher intake of soy.”

Moffitt Cancer Center and Research Institute is studying a soy supplement called genistein to see if it has an effect on the cancer. Study participants take 60 milligrams of a specially made soy mixture every day for three months.

Karen says, “What we’re hoping in this study is that the rate at which the cancer cells multiply will decrease.”

Incorporating soy into his already healthy diet was a seamless transition for James. “After the first week or so, I actually got so I kind of liked it,” says James. He says a sense of humor and zest for life helps.

Soy can be found in tofu, miso, soymilk, soy nuts, soybeans and soy chips. The American Institute of Cancer Research recommends three to four servings of soy per week. However, it does not recommend taking soy supplements because the long-term effects are unknown.

Help to Reduce Prostate Cancer Risk

Prostate cancer is one of the most common cancers in American men, second only to skin cancer. Each year, about 200,000 men are diagnosed with the disease and 31,000 die. While regular screening has helped reduce the number of deaths, doctors say more is needed. Now, researchers are looking for men to help as part of a nationwide study.

You might say Dan Feeney is one in about 32,000. That is because Feeney is one of 32,400 men in a nationwide study looking for a way to prevent prostate cancer.

He says, “It seemed like a very easy thing to do. There’s nothing else I can really do to help it.”

Feeney lives a healthy lifestyle. He eats right and exercises regularly. “I met my wife roller blading five years ago,” he says.

Now he takes an additional step with selenium and vitamin E.

Urologist Eric Klein, M.D., of the Cleveland Clinic Foundation, says, “This is the largest, best-designed trial looking at nutrient supplements, not pharmaceuticals but nutrient supplements, that are found in the diet, to prevent the most common cancer in the United States.”

Dr. Klein heads the SELECT trial at the Cleveland Clinic Foundation. Patients are given either vitamin E, selenium, both or placebos. The trial is based on previous studies, with different goals. One was for skin cancer.

“The incidence of prostate cancer was markedly reduced for men who took selenium,” says Dr. Klein.

As for vitamin E, that idea came from a lung cancer study that found a 40-percent reduction in prostate cancer in men taking the supplement.

Dr. Klein says, “We have to do the right kind of study with the right kind of scientific controls before we can conclude that these two agents are useful in preventing cancer.”

Feeney hopes to roll through the study without any problems, but if nothing else … “Make sure that I get regular check-ups for one thing, just for my own self,” he says.

The study will follow patients for a period of 7 to 12 years. It is being conducted at 400 centers around the United States, Puerto Rico and Canada. White men must be 55 or older to participate and black men 50 years or older.

NSAIDs help prevent prostate cancer

Daily use of aspirin or another of the class of pain relievers known as NSAIDs could help prevent prostate cancer in older men, say Mayo Clinic researchers. Their study found less than half as many cancers in men who took the drugs on a regular basis than in those who did not.

Prostate cancer is the most commonly diagnosed cancer, affecting about 189,000 men every year. It is also the second leading cause of death from cancer among men.

While new and better detection methods are allowing the disease to be identified at earlier and more treatable stages, these methods do not help prevent the condition. Studies are currently underway to determine the effect of several substances, including selenium, Vitamin E, Vitamin D, and green tea, on prostate cancer risk.

The Mayo scientists decided to study the impact of NSAIDs — nonsteroidal anti-inflammatory drugs — on prostate cancer after other studies linked the drugs to a reduced risk of other cancers. They analyzed data on about 1,300 men participating in a study of urinary tract symptoms. The men were enrolled in the study in 1990 and followed for an average of six years. Information on daily medication use was gathered throughout the study.

The study found 4 percent of the men who reported daily NSAID use developed prostate cancer by the end of the follow up. This compares to 9 percent of those who reported no regular NSAID use. The link between NSAID use and a reduced risk of prostate cancer was more significant in men over age 60.

SOURCE: Mayo Clinic Proceedings, 2002;77:219-225

How big of a problem is prostate cancer?

It’s the most common cancer in men in the United States. Its been about 200,000 cases a year for the last five years or so. That means in the last five years, there are a million affected really with prostate cancer. It’s also the second most common cancer killer in men in the United States, after lung cancer. What’s really important for people to understand is that African-Americans are about three times the risk of getting prostate cancer and three times the risk of dying from prostate cancer.

There are many, many reasons for that, probably although no one knows the relative contribution of each of those reasons. Some of it has to do with access to care, some of it has to do with education, but even in a system like the military where race does not play a factor in access to care, prostate cancer behaves more aggressively in black men than Caucasians. So, there probably is something biologic to it as well.

The good news is that the mortality due to prostate cancer in Caucasian men is now lower than it was before PSA screening was introduced in 1987, but the mortality rate in the United States for African-Americans hasn’t changed at all in the last several decades.

There’s a lot of laboratory evidence to suggest that both vitamin E and/or selenium act as antioxidants. Oxidants are cellular toxins that can cause DNA to mutate and turn into cancer. The real interest in vitamin E and selenium came from two large-scale, randomized trials using lots of participants, looking at other diseases. In the case of selenium, it was a study called the Clark Trial, where they looked at whether or not selenium would prevent recurrence of non-melanoma skin cancer. It didn’t have any effect on skin cancer, but as what we call a secondary end point — sort of a surprise — the incidence of prostate cancer was markedly reduced in the men who took selenium. And, for vitamin E, it was an even larger trial — 29,000 finished smokers — and there the hypothesis was that vitamin E would prevent lung cancer. What was interesting is in fact, the smokers that took vitamin E actually had more lung cancer. So, it doesn’t always work. That’s why we need to do studies. But, again, as a surprise, as a secondary end point, the incidence of vitamin E was markedly reduced by about 40 percent in the men who, rather the instance of prostate cancer was markedly reduced in the men who took vitamin E.

Prostate cancer is still a major killer in the United States. It’s second only to lung cancer with around 31,000 deaths a year. But, even if you don’t die from prostate cancer, if you’re diagnosed with prostate cancer in your 40s or 50s, the side effects of treatment are pretty substantial. Because of the anatomy of the male, treatment for prostate cancer, whether its by radiation or by surgery, can cause difficulty with urination, it can cause difficulty with sexual function, and it can cause bowel difficulties. It would be a lot easier to prevent that from happening than to have many hundreds of thousands of men go through treatment every year and experience all those side effects.

Source: Ivanhoe News