Osteoporosis means that our bones are more porous than normal and have lost some of their strength to resist the forces we put on them in normal life. The outer shell of a bone is known as the cortex and is denser to provide strength and resistance to bending. The inner, honeycomb-like mesh is called cancellous bone and has its holes filled with collagen tissue, blood vessels and bone marrow. When osteoporosis occurs the holes inside the bone become larger, with fewer cross-connecting support struts, reducing the strength of the bone. The effects are usually widespread but fractures typically occur in the spine, hip and wrist.

Being active and dynamic is not the typical view of the bony skeleton but it is a growing and changing tissue which is constantly renewed over time, taking between seven and ten years to complete the whole replacement. The renewal process is called bone turnover and it can be much faster to replace the entire skeleton in a child, a process which can be as short as two years. The growth plates of our long bones close around sixteen to eighteen years of age and at this time we stop gaining height and size. It is however not before the middle of our twenties that the process of increasing our bone density reaches its highest level.

The balance of bone turnover then enters a phase where there is equilibrium between the rate of bone breakdown and the rate of bone formation. From middle age this balance shifts in favour of bone breakdown and we begin to lose bone as we age, with osteoporosis occurring in some cases, especially in women after the menopause due to hormonal changes. Factors which may increase the likelihood of a man getting osteoporosis are low levels of male hormones, low body weight, smoking, high alcohol intake, being very immobile, diet absorption problems from conditions such as ulcerative colitis and long term steroid use for asthma.

Osteoporosis will affect one in three women at some time in their life and it is often considered a condition which afflicts women. However, it has been recognised that osteoporosis affects men too, with an incidence of one in twelve even though only thirty percent of hip fractures and twenty percent of spinal fractures are in men. There may be various reasons why men are less likely to suffer from osteoporosis: they do not have a dramatic bone loss effect in middle age and they start off from a higher level of bone density, losing less cortical bone in particular than women.

There are usually no signs of anything going wrong as osteoporosis develops and the first sign of something wrong is often the severe fracture pain of a broken wrist or spinal wedge fracture,  perhaps from a relatively minor input. The wedging which occurs in the thoracic spine is acutely painful and can produce significant disability which can become chronic. Crush fracturing and wedging can occur quietly and without the drama of severe pain, appearing as a kyphosis, a form of spinal curvature, or as a remarkable loss of stature. A severely kyphotic spine can cramp the ribcage and cause pressure  on the lungs and gut with consequent problems.

45% of men with osteoporosis have no identifiable cause for their disease, with genetic factors likely to be important in the large majority of cases. Having a history of osteoporosis in the close family predisposes to having a lower bone density and an increased risk of spinal fracture. Levels of testosterone are important in the maintenance of bone density and a low concentration is a major risk for osteoporosis, with a 70 year old man only producing about half the testosterone of someone of 30 years old. Testosterone can be replaced as a treatment if a hormone specialist thinks it is necessary.

Steroids are strong anti-inflammatory medications used for asthma and ulcerative bowel disorders as well as for a number of less common conditions. Six months treatment with a steroid such as prednisolone can increase the levels of bone loss but steroids are only used when they are vital for health. Steroid doses should never be changed by the individual without careful consultation with a doctor or the side effects of the change could be severe.

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