Osteoporosis affects men as well as women

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DEAR DR. DONOHUE: I am a 63-year-old male. Through an osteoporosis screening test on my ankles, it was determined I had a T-score of -2. That indicates osteopenia. I am planning on having the full-blown density tests. What is the difference in treatment of osteoporosis in men? At what T-score is medicine prescribed? My wife takes Fosamax for osteoporosis. Could I take the same medicine? – B.G.

ANSWER: Say “osteoporosis” and the mental reflex “woman’s illness” kicks in. More women have it than men, and that’s partially due to the sudden drop in estrogen production with menopause. However, men are not immune to it. Men, throughout life, have thicker bones than women, and men don’t have a precipitous drop in male hormone production like women do with female hormone production, so they are less prone to osteoporosis. All the same, about one-quarter of elderly men suffer from the brittle bones of osteoporosis, and those men are in the same danger of breaking bones as are osteoporotic women. The bones most susceptible to breaking are the backbones, hips and wrists.

The T-score compares the density of a person’s bones with the density of bones when they are at peak strength. A score of -2.5 or lower is osteoporosis. Your score of -2 signifies osteopenia, bones that have lost calcium and are not as robust as they should be but are not yet in the osteoporosis range.

You should have a more comprehensive examination. DEXA (dual-energy X-ray absorptiometry) is the standard osteoporosis test. Readings are taken at the hip and lower back. Many wait until the DEXA T-score is -2.5 to begin treatment; others start sooner.

Treatment for men is the same as treatment for women. Vitamin D, calcium and exercise are important. The daily calcium intake should be 1,500 mg. Quite a few doctors feel that the vitamin dose should be 800 IU, higher than the recommended dose. (Yes, I know the recent controversy about vitamin D and calcium not being effective in preventing fractures. I’ll deal with that another time.) Bisphosphonates such as your wife’s Fosamax work for men, too.

DEAR DR. DONOHUE: Would you write something about myelodysplasia? I would like to know something about it. – F.S.

ANSWER: Dysplasia is abnormal formation. Here “myelo” refers to bone marrow. Myelodysplasia, therefore, indicates bone marrow troubles, the kind of troubles that bungle the production of red and white blood cells and platelets.

Many different disorders fall in this category of blood problems. One is refractory anemia, a deficit of red blood cells that resists a large number of treatments. Another is a leukemia variant. Leukemias are cancers of white blood cells.

The prognosis of a person with myelodysplasia depends on the kind of myelodysplasia he or she has. Some of these illnesses progress slowly; others, quite rapidly.

Causes include radiation (even radiation used for cancer treatment), chemotherapy, chemicals like benzene and the “cause unknown” category.

If anemia dominates the picture, weakness, fatigue and breathlessness when active are prominent symptoms.

Treatment has to be individualized. Sometimes stem cell transplants work. These stem cells are ones taken from adult blood. More often than not, however, older people are not candidates for such a procedure, and older people are the ones who get myelodysplasia. Blood transfusions are given if the red blood cell numbers are low.

DEAR DR. DONOHUE: How is it possible for me to jump from 185 pounds to 225 pounds in one week? I watch what I eat. – C.W.

ANSWER: It’s impossible to put on 40 pounds of fat or muscle in one week even if you don’t watch your diet. That added weight could be fluid, and that’s an enormous amount in one week. If the scale is accurate and if this gain is fluid, you should have swollen ankles and a hard time breathing. You need to have your doctor take a look at you right away. A bad heart or bad kidneys or bad liver can make you retain fluid.

DEAR DR. DONOHUE: I am a daily runner and manage about five miles every day. I have been doing this for a number of years and have never had any trouble. Last week, however, while running, I felt a sudden pain in my left calf. I tried to continue but couldn’t. My calf has a large bruise and is still sore. I can walk, but I can’t run. What do you think happened? – B.J.

ANSWER: You could have torn fibers in your gastrocnemius muscle, the large calf muscle. Sometimes when it happens, people hear a loud snap. They often say they feel like someone has thrown a stone at their calf. The calf frequently swells, and a bruise appears. The bruise comes from blood that has leaked out of broken blood vessels.

It’s too late for you to do this now, but icing the calf for 15 minutes at a stretch four or more times a day in the first two days after the incident is standard treatment.

At this point, keep the leg elevated as long as you can and as many times a day as you can.

Applying heat to the calf will also speed healing and reduce swelling. An elastic wrap around the calf, snug but not too tight, protects the torn muscle and eases pain.

Don’t begin to run until the calf is free of pain and you can move the leg and foot effortlessly. That should take about six weeks. Don’t try to run your usual five miles when you resume running. Go at this slowly. And don’t sprint. You should wait at least 12 weeks before trying that.

I hope you realize that this is a long-distance guess at what you have, so if your leg is not feeling better with a week or so of rest, have it examined. Many other things cause similar pain.

Dr. Donohue regrets that he is unable to answer individual letters. Readers may write him or request an order form for health newsletters at P.O. Box 536475, Orlando, FL 32853-6475, or visit www.rbmamall.com

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