The problem with drinking is defining the term “excessive.” Kurland says the meaning of this word can change depending on cultural norms: “In France, for example, what is considered an average daily intake is actually on the high side in our country.”
But it is not only current drinkers who have reason to be concerned. Kurland believes that people who have kicked an alcohol problem may already have done irreparable damage to their bones, especially if the excessive drinking occurred during frat house parties or a youthful stint in the military. After all, men in their early twenties are still accumulating bone mass. “I think it’s really underappreciated as a risk factor,” says Kurland.
Another cause of brittle bones in men is low levels of testosterone. Testosterone levels decline naturally as men age, but men with lower-than-normal levels of the male hormone can experience extreme bone loss. “Men might have low testosterone and never know it,” says Kurland.
Clinical research has determined that testosterone is vitally important to bone health. A study of 403 healthy men aged 73-94 years examined the hypothesis that the decreases in muscle strength, bone mass, and body composition seen in aging males are related to falling testosterone levels.9 The researchers measured the men’s hormonal levels and ran multiple tests to gauge their body composition, muscle strength, and bone mass. They found that muscle strength and bone mass were at optimal levels in men with the highest levels of free testosterone, and concluded that “a number of clinical problems present in older men may be related to androgen [testosterone] deficiency, including reduced muscle mass, changes in body composition, and loss of BMD [bone mass density].”
This hidden contributor to osteoporosis is why Life Extension urges middle-aged and elderly men to have their testosterone levels checked regularly through periodic blood testing. Optimal levels of free testosterone for most men are 18-26.5 pg/mL.10 If your testosterone levels are indeed low, then consider using supplemental testosterone or nutrients that naturally increase testosterone levels. From gels to patches or pills, there are many ways that men can increase their testosterone levels. A growing body of evidence lends credence to the idea of supplementing testosterone in older men. Testosterone supplementation can help reverse the potentially devastating effects of muscle loss and osteoporosis on an aging man’s life. Supplemental testosterone has been shown to increase bone mass of the lumbar spine in elderly men.11
In still other situations, men experience bone loss for unknown reasons. Medication, certain diseases, or a combination of factors may have affected them. In such cases, according to Kurland, physicians still should try to determine the cause of bone loss, as brittle bones may be a sign of an underlying disease or condition. “It behooves the doctor to try to find the cause,” she says.
Finally, as the body ages, the bone-forming cells simply tire out. Bone resorption probably does not increase, but the osteoblasts slowly begin to tire. While the age for this slowdown will vary, experts find that at around 70 years of age, men can expect their osteoblasts to begin slowing down.
Diagnosing Bone Loss
Because men rarely receive counseling for osteoporosis, they are usually diagnosed with the condition only after suffering enough bone loss to result in a fracture. Bones can be expected to break during violent collisions, but if you happen to slip and break your wrist when hitting the ground, you should get a bone scan. Lower back pain and a noticeable loss in height also may be signs of porous bones.
Tests to check for bone density—called bone mineral density tests or bone density scans—are easy to obtain and cost around $100, depending on where the exam is performed. Scanners check lumbar spine density as well as hip density. More-sophisticated models also test the forearms.
Different areas of the body are examined because humans have two types of bone: spongy bone and the more-compact cortical bone, which makes up most of the skeleton.
The spine contains spongy bone and is an important area for fractures, and thus always is examined. The hip contains a mix of spongy and cortical bone, but is always assessed because broken hips are the most deadly type of fracture. Incorporating a scan of the forearm is important to evaluate total cortical bone health. “When you look at the forearm, you’re able to get a glimpse at the cortical bone throughout the body,” according to Kurland.
Once osteoporosis is diagnosed, the likelihood of regaining bone mass is very low. Most therapies are designed to prevent further loss and save the remaining bone.
Two kinds of drug used to treat bone loss are bisphosphonates (brand name: Fosamax®; generic name: alendronate) and the recedrinates (brand name: Actonel®; generic name: risedronate sodium). Taken once a week, these drugs are absorbed and stored by the bone, and inhibit the bone resorption cells until they slow and almost stop the process of breaking down bone. Meanwhile, the bone-forming cells continue to build bone mineral.
Keeping the Bone You Have
Quite apart from taking prescription drugs, there are several ways to keep bones strong. These aspects of bone health also are important in preventing osteoporosis, as studies have found that once men begin having problems with their bones, they are likely to continue having trouble. In part, this is because even after men have been diagnosed with osteoporosis, they are unlikely to receive proper treatment.
In a study of close to 200 patients who had had apparent osteoporosis-related hip fractures, scientists found that fewer men than women received treatment for osteoporosis.12 Men also were less likely than women to have bone scans to detect osteoporosis. The study authors concluded that osteoporosis was highly under-diagnosed in men, even though conflicting studies had found that men are more likely than women to die following a hip fracture.
One of the most important things men can do to increase bone mass is to maintain an active lifestyle that incorporates weight-bearing activity. The term “weight bearing” refers to activities that make the skeleton bear the body’s weight. Certain cells located at the joints and different parts of the bone sense motion and stress, and respond by stimulating bone-forming cells to create stronger bone.
“People hear ‘weight bearing’ and go to the gym and start lifting barbells,” says Kurland. “Now this will certainly help the arms, but it does nothing for the hips and spine.” For best results, Kurland advises moderate exercise such as walking or jogging, or playing tennis or basketball. Swimming, she adds, is not a weight-bearing exercise, because the body is kept afloat by water.
Supplementation Is Critical
Because bone comprises a great deal of calcium, men also need to ensure they have enough of this mineral in their diet. Getting adequate vitamin D likewise is critical, as vitamin D is crucial in absorbing calcium. The National Osteoporosis Foundation recommends a daily intake of 1200 mg of calcium, along with about 400 IU of vitamin D, an amount sufficient to absorb the calcium.
Boron is involved in bone metabolism and has long been known to promote healthy bone density.13 Boron acts an integrator to support the functions of calcium, magnesium, and vitamin D. Calcium and magnesium are important building blocks of healthy bone; however, in instances of adequate calcium supply but deficient magnesium supply, boron appears to substitute for magnesium in the process of bone formation. Under such conditions, boron’s concentration in bone tissue increases. Boron’s effect on bone appears to be mediated by its ability to reduce the urinary excretion of both calcium and magnesium. Where adequate boron intake prevails, the net effect of boron is to raise ionized calcium levels. Boron, in effect, acts to preserve calcium and magnesium in situations of nutritional stress that would otherwise adversely affect metabolic processes involved with these substances.14