Many people think of osteoporosis as a disease primarily affecting women, especially older or post-menopausal women. However, it is increasingly being recognized that men are also at risk for developing osteoporosis and it is thought that as many as 25% of men over 50 years old will develop at least one osteoporosis-related fracture during their lifetimes.1 Yet, male osteoporosis remains an underdiagnosed and thereby undertreated condition in older men. Furthermore with the aging population continuing to increase across the world, osteoporosis has become a global problem. 2
What is osteoporosis and why is it so dangerous?
Osteoporosis is a disorder of the musculoskeletal system characterized by reduced bone mineral density. The musculoskeletal system is comprised of bones, muscles and associated elements such as cartilage, connective tissues and joints. It provides form, support, and stability to the body, and enables movement. The loss of bone mineral density leads to shrinkage of the skeleton, resulting in fragility and increased risk of fracture.
Since the musculoskeletal system also plays an integral role in binding tissues and organs together, osteoporosis may also be linked to organ prolapse. For example, pelvic organ prolapse and bladder incontinence are common in postmenopausal women and research suggests that women with pelvic organ prolapse may have an increased risk of osteoporotic fractures. 3 This makes sense when one thinks about common cell signaling pathways in the musculoskeletal system such as common collagen signaling that may be involved in both the development of osteoporosis and organ prolapse.
Osteoporosis occurs over time and is among the many unpleasant features of the aging process. Bones become thinner as part of the normal aging process and bone cells are reabsorbed faster than new bone is made. Reabsorption is associated with loss of bone minerals, mass and structure. The bones become weaker and the risk of osteoporosis and fractures increase. Peak bone density is thought to occur at about age 30.
Osteoporosis is generally preceded by osteopenia, a condition associated with lower than normal bone density. Individuals who have osteopenia have an increased risk of developing osteoporosis. However, osteopenia does not always mean that osteoporosis will develop. There are many factors involved including genetic predisposition and lifestyle factors. Exercise, especially bearing exercise, is one of the factors thought to reduce the risk of developing osteoporosis. 2 Researchers are working to elucidate the signal transduction mechanisms underlying the balance between bone formation and bone resorption to help understand the role of exercise in possibly preventing osteoporosis.
Currently, drug therapy is the most common way to treat osteoporosis. 2 However, drugs cannot cure osteoporosis, drugs are expensive and unaffordable by many, and can also have adverse side effects such as increased risk of cardiovascular disease. Exercise can potentially be a safe, economical and effective way to prevent, stave off, or manage osteoporosis.
Scientists know disruption of the bone homeostasis, bone formation and resorption, is a primary causal factor of osteoporosis. Osteoblasts carry out bone formation whereas osteoclasts carry out bone resorption. Bone tissue is dynamic and is continually being broken down by osteoclasts and restructured by osteoblasts.
Mesenchymal stem cells (MSCs) under progressive differentiation stages, including first becoming osteoprogenitors and preosteoblasts, before becoming mature osteoblasts. Whereas MSCs are the precursors of osteoblasts, osteoclasts are derived from the bone hematopoietic stem cells (HSCs). Osteoclasts are actually large multinucleated cells formed by the fusion of many cells derived from the macrophage lineage of HSCs. These cells circulate in the blood as monocytes and fuse together to form osteoclasts.
The dynamic process of bone remodeling is influenced by mechanical loading which acts on the bones through both ground reaction and muscle forces which, in turn, act to increase both bone mineral density and strength. Ground reaction force is the force exerted by the ground on a body when the body is in contact with the ground. Exercise generates both ground reaction and muscle forces which are thought to comprise the key reason exercise can improve bone health. 2 However, the exact mechanisms by which exercise affects bone modeling and re-modeling remain to be fully elucidated.
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- 1. Wilson T, Nelson SD, Newbold et al. The clinical epidemiology of male osteoporosis: a review of the recent literature. Clin Epidemiol 2015;7:65-76. doi:10.2147/CLEP.S40966.
- 2. Yuan Y, Chen X, Zhang L et al. The roles of exercise in bone remodeling and in prevention and treatment of osteoporosis. Prog Biophys Mol Biol 2015. doi:10.1016/j.pbiomolbio.2015.11.005.
- 3. Lee SW, Cho HH, Kim MR et al. Association between pelvic organ prolapse and bone mineral density in postmenopausal women. J Obstet Gynaecol 2015;35(5):476-480. doi:10.3109/01443615.2014.961906.