Some
Men Have Risk Factors for Osteoporosis
Everyone knows that women need to fend off osteoporosis
as they age. But what is less well-known is that 30 percent of elderly men
who suffer a hip fracture will die within a year of that fracture - double
the rate for older female patients.
But despite this increased risk, experts say many men view
brittle bones as a "woman's problem."
One recent US study, reported in the journal Osteoporosis
International, "validated what we thought - that men who have fractures
are woefully undertreated.
"Just one in every six men who had a spine or hip fracture
was treated with osteoporosis medications" to strengthen ailing bones, says
Dr. Thomas J. Weber, an assistant professor of medicine at Duke University
Medical Center.
According to the same study, just 1.1 percent of men brought
to the hospital for a serious fracture received a bone density test to evaluate
their overall risk.
A bone density test is used to measure the bone mineral
content and density. This measurement can indicate decreased bone mass, a condition
in which bones are more brittle and more prone to break or fracture easily.
"Now, doctors wouldn't hesitate to do that for a woman,
but it seems we just don't think of it in terms of men," Dr. Weber says.
It is true that men start out with denser, healthier bones
than women.
"Women have less bone to begin with, and then they get a
big hit at menopause," says Dr. Joseph Lane, chief of the metabolic bone disease
service at the Weill Cornell Medical College's Hospital for Special Surgery
in New York City.
"The overall rate of bone loss for men and women is the
same, but because men start higher they don't get into trouble as quickly -
osteoporosis is not an issue for men until 70 and beyond," he says.
But when a fracture occurs in the elderly, brittle bones
can quickly become a life-or-death concern.
"There are a number of reasons people can die after fracture," Dr.
Weber explains. "They may have underlying cardiovascular disease that leads
to congestive heart failure. They may develop infection and there's a suggestion,
based on some evidence that perhaps in 25 percent of male patients death is
related to the consequences of the hip fracture itself."
While menopause is a major cause of bone deterioration in
women, factors such as smoking, alcohol consumption, and the use of certain
medicines increase fracture risks for men, Dr. Lane notes.
The gradual age-related decline in circulating testosterone
is another factor.
"A young guy has a testosterone value of about 1,000 and
older men are down to about 300," he says.
All of these risk factors are preventable, either through
quitting smoking and heavy drinking, or with the help of medications, says
Dr. Lane, who is also a spokesman for the American Academy
of Orthopaedic Surgeons.
And there is diet and exercise.
"In general, men over the age of 50 should be getting 1,200
mg of calcium a day from diet, or diet and supplements combined," Dr. Weber
says.
Dr. Lane advises men to use calcium citrate - not bicarbonate
- supplements, because the bicarbonate formulation raises risks for kidney
stones.
The current recommended daily allowance for another bone-strengthener,
vitamin D, is 400 International Units (IU) per day for older men, but Dr. Weber
says that level is currently under review and will no doubt be revised.
"I think maybe upwards of 800 to 1,000 IU can be safely
recommended for men," he says. Many foods, including milk, come fortified with
vitamin D (check the label) and cod liver oil capsules are particularly high
in the nutrient.
Skin also manufactures vitamin D under strong sunlight. "It
has to do with the sun's angle, though, so go out there between 10 a.m. and
2 p.m. rather than taking a walk in the early morning," Dr. Weber says.
As for exercise, its benefits are more about balance than
bones, according to Dr. Weber.
"Exercise's effects on the skeleton tend to be fairly modest," he
explains. "When we prescribe exercise for older people we're doing it not only
to help bone density but to increase strength and reduce their risk of falls."
Dr. Lane agrees. "You need two things for a fracture: bad
bones and a fall. There's an easy way to tell if you're at high risk for falling:
try standing on one leg for 12 seconds. If you can't do that, then by definition
you're an unsteady individual who needs fall protection" such as sturdy shoes,
a cane, or walker, he says.
But failing balance can be restored, and one of the world's
oldest interventions remains among the most effective.
"The most successful method is Tai Chi," Dr. Lane says. "All
of the YMCAs in New York now teach Tai Chi, and we send all the people who
fail the one-leg test to the Y to learn it."
Always consult your physician for more information.
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The US Food and Drug Administration
(FDA) recently ordered updated labeling for the impotence drugs
Viagra®, Cialis®, and Levitra® to reflect a small number
of reports of sudden vision loss among users.
The agency is advising consumers to stop taking these
medications and call a physician immediately if they experience sudden or
decreased vision loss in one or both eyes.
This condition is known as NAION (nonarteritic ischemic
optic neuropathy) and occurs when blood flow is blocked to the optic nerve.
Anyone taking or considering taking one of these erectile
dysfunction medications should also tell their healthcare provider if they
have ever had severe loss of vision, which might reflect a prior episode
of NAION.
Such patients are at an increased risk of developing NAION
again, the FDA says in a statement.
The agency states it had not yet been able to determine
if the medications were the cause of the loss of eyesight or whether the
problem was related to other factors such as high blood pressure or diabetes,
or to a combination of these problems.
The move followed an announcement by the FDA that
it had received 43 reports of varying degrees of vision loss - including
blindness - among 38 users of Viagra, four users of Cialis, and one user
of Levitra.
But, health experts caution, this type of vision loss
also is linked to the same illnesses - such as heart disease and diabetes
- that can lead to impotence or erectile dysfunction.
FDA spokeswoman Susan Cruzan
says the labeling change was "based on adverse event reports, a total of
43 for all three drugs. But we have not established that this is a cause-and-effect
relationship.
"We're not sure we can establish it as the cause, because
this is a population with other problems. If and when we get other reports,
based on media interest, we will continue to evaluate and monitor the report," she
says. "That's what we do for every drug."
An estimated 23 million American men take these impotence
medications.
The FDA states that the
vision problems are attributed to NAION, which is considered one of the most
common causes of sudden vision loss in older Americans. Estimates suggest
there are anywhere from 1,000 to 6,000 cases a year.
Risk factors for NAION include diabetes and heart disease
- two of the leading causes of impotence. For that reason, it may be impossible
for the FDA to determine whether the impotence
medications contribute to vision loss.
Dr. Robert Cykiert, an ophthalmologist at New York University
Medical Center, says "these drugs are known to have effects on the blood
vessels in various parts of the body."
Viagra can cause blood pressure to drop, which may cause
insufficient blood flow to the optic nerve, resulting in vision loss, he
explains.
"Probably, patients need to be careful about using this
drug," Dr. Cykiert says. "If somebody has bad vascular disease, then they
are at an increased risk of developing vision problems. The risk is low,
but it is a possible risk factor."
Always consult your physician for more information.
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