Osteoporosis affects 10 million Americans, mostly women, and 34 million more have low bone mass. It is defined as "a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture." 1 While no accurate overall measurement of bone strength exists, bone mineral density (BMD) is frequently used as a proxy.
We need calcium for strong bones, but vitamin D is equally important -- it helps the body with calcium absorption. In fact, calcium supplements plus vitamin D can increase calcium absorption by up to 65%. Americans up to age 50 are advised to take 200 IU (international units) of vitamin D daily. From age 51 to 70, the advised dose is 400 IU. For people over age 70, it's 600 IU.

Vitamin D is also made in the skin when it is exposed to sunlight. However, concern about skin cancer has caused many people to limit their time in the sun and an increasingly indoor workforce certainly doesnt help either. In addition, during the winter across the northern half of the U.S., there is an insufficient amount of the sun's rays reaching the skin to stimulate production of vitamin D. Studies have shown the positive effects of extra vitamin D and along with calcium supplements, you should take take vitamin D with calcium to promote calcium absorption.

Osteoporosis is a condition normally associated with postmenopausal women but osteoporosis, or brittle bones, is also seen in men. Indeed, osteoporosis in men has received much less attention; however, it is increasingly recognized as a problem. Studies have shown that 30 percent of all hip fractures occur in men and vertebral fractures are much more common in men than previously thought. The female-to-male ratio is only 2-to-1, so osteoporosis is clearly not a problem that is isolated to women.

These facts underscore the importance of osteoporotic fractures:
* Only one third of patients regain their prior level of functioning after a hip fracture, and one third are discharged to nursing homes. 2
* About 1 in 5 patients dies within a year after a hip fracture.
* Vertebral fracture may result in chronic back pain and disability. 3
* Existence of a fracture greatly increases risk of subsequent fractures. 4
* Direct medical costs for osteoporotic fractures are estimated at $13.8 billion in 1995 dollars. 5


Strong bones require the action of two cells in the body. Osteoblasts use dietary calcium and minerals to manufacture new bone, while osteoclasts clear away old or damaged bone. Osteoporosis and increased likelihood of fractures results when the clearing-away process is faster than the formation of new bone.

The main cause of osteoporosis is aging. The sex hormones, estrogen and testosterone, both produced (but in different amounts) in men and women, are key to the balance between bone renewal and deterioration. Women who are entering menopause can fight osteoporosis with exercise, a calcium-rich diet, calcium supplements, and estrogen-replacement therapy and other medications. Note that estrogen replacement therapy has recieved considerably bad press lately, and its use is strongly discouraged.

Men in their 60s rarely receive any such medical alert that their bones are becoming brittle, even though their testosterone levels decline and some men suffer from male menopause, or andropause. These men need to be supplemeting with calcium. For those men and others, osteoporosis is a real risk. Because the optimum levels of testosterone on the tests actually decline, this can appear to be part of "normal aging" and is not given a second thought, until osteoporosis sets in. Declining testosterone levels contributes to a plethora of other problems, but this will be discussed elsewhere as it is not relevant to the topic at hand. Suffice it to say that low free (and total) testosterone levels can contribute to an enhanced risk of osteoporosis in men.

In addition to the decline in sex hormones, certain other medical conditions and lifestyles predispose both men and women to the dangers of osteoporosis at an earlier age than normal. Osteoporosis is classified as primary or secondary. Primary osteoporosis develops without any known risk factors, whereas secondary osteoporosis is the result of another medical condition.

Men frequently have an underlying secondary cause of osteoporosis; men with such problems should be aware of the possibility of osteoporosis and take necessary preventative measures. Hypogonadism (low testosterone activity) is the most frequent condition associated with secondary osteoporosis; it causes a decline in testosterone. Corticosteroid prescription medications like prednisone are also important causes of secondary osteoporosis.

Other risk factors are chronic bowel disease, which may result in malabsorption of nutrients; hyperthyroidism (an over active thyroid); and smoking. People who smoke tend to lose more calcium than nonsmokers. So, if you smoke, take more Calcium. Lack of exercise is another problem that predisposes us to osteoporosis. Exercise at any age helps to build bones; the best exercise is walking up and down stairs. When you do this you are lifting your whole body weight, plus you are strengthening the muscles of the thighs and the underlying bones as well.

Like women, men should ensure that they are getting enough calcium and vitamin D in their diets. Vitamin D is required to help absorb calcium. Men should also have a bone-density test done if they are on corticosteroids. This is a very simple, noninvasive test that measures the thickness of some of the major bones in the body. It only takes a few minutes to perform and should be done as a simple, preventative measure.

References
1. Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consensus Statement Online 2000 March 27-29; 17(1):1-36.

2. NIH Consensus Development Panel on Osteoporosis Prevention Diagnosis and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001; 285:785-795.

3. Gold DT. The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone. 1996; 18(suppl 3):185S-189S.

4. Black DM, Arden NK, Palermo I, Pearson J, Cummings SR. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1999; 14:821-828.

5. Ray NF, Chan JK, Thamer M, Melton LJ 3rd. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997; 12:24-35.