The following is a question put to The Royal Gazette’s former medical advice columnist, Dr. Alan Douma in March 2005.

Dear Dr. Douma: I recently had a fracture of one of my vertebrae. Afterwards the doctors told me it was because of osteoporosis. Many years ago my father died shortly after breaking his hip.

Could this have been osteoporosis, too? I thought that osteoporosis was a problem mainly for women. — D.W., Hempstead, New York

Reply:<$> Osteoporosis (“osteo-” bone; “porosis” porous) is a condition that causes bones to become less dense. This gradually makes them weaker, more brittle and subject to fracture. As this disease progresses, an increase in fractures is seen, especially in the vertebrae, hipbone and thighbone.Osteoporosis is the most common metabolic bone disease in North America and the cause of hundreds of thousands of fractures a year. The disease usually becomes evident in older age, and it affects women more than men. But it is also a very common side effect of the chronic use of steroids at any age.

Postmenopausal women are most at risk for osteoporosis because of decreasing levels of oestrogen. But other risk factors include hormonal imbalance due to other causes, sedentary lifestyle, tobacco use, excessive alcohol use, tumours, genetic disorders, and some vitamin and mineral deficiencies.

Men also produce estrogens that have an impact on the bones. And, as with women, the amount of oestrogen hormones decreases with age. Lower levels of male hormones (androgens) such as testosterone also increase the risk of osteoporosis.

There also appears to be a genetic factor influencing which men develop this condition, and your father may have had it.

Men who are having the prostate problems treated with GnRH agonists have been found to have an increased risk.

It’s estimated that about two million men in North America have some degree of osteoporosis. Over a lifetime, about one in four men will have a so-called fragility fracture because their bones are weakened by osteoporosis.

The US Preventive Services Task Force is recommending that women get screened for osteoporosis when they reach the age of 65.

It also says that screening as early as age 60 may be beneficial for women at a higher risk of getting osteoporosis.

Because of a lower incidence in men, it’s less clear when or how often men should be screened.

Preventing osteoporosis is the best course of action for men and women. This consists primarily of having an adequate diet containing vitamin D and calcium, which may require supplementation. It’s also been shown that people with diets low in zinc have a higher risk of osteoporosis.

A very important component of osteoporosis prevention is weight-bearing exercises. This not only helps maintain the strength of the bones, but it also helps prevent falls by maintaining better muscle strength.

I recommend that people who are older get some professional advice on which and how much exercise to start with.

The main drug treatments for osteoporosis in women seem to work well for men as well. They can be taken alone and in combination with calcium and vitamin D supplements. Parathyroid hormone regulates the amount of calcium in the bones, so a newer drug called teriparatide (brand name Forteo), which acts like this hormone, has been found to be effective.

Bisphosphonates such as alendronate (Fosamax) inhibit bone loss and can reverse the progression of osteoporosis, as well as reduce fracture risk.

It is important to follow directions closely when taking bisphosphonates, even more so than with other drugs. For maximum benefit, each tablet should be taken with plain water (not juice or coffee) first thing in the morning, at least 30 minutes before any food. Also, you should not lie down for at least 30 minutes after taking the drug, to prevent heartburn.

Another drug for the treatment of osteoporosis is called calcitonin (brand name Miacalcin). Calcitonin, which can be used as a nasal spray or injection therapy, increases bone density and reduces spinal fractures. The usual dosage of calcitonin is one puff (200 units) each day. The more common side effects include cold and allergic symptoms.