Men and Osteoporosis

Osteoporosis is a disease that causes the skeleton to weaken and the bones to break. While most people think of osteoporosis as a woman’s disease, it poses a significant threat to millions of men in the United States.
There are many lifestyle habits that put men at increased risk of osteoporosis, yet few men recognize the disease as a significant threat to their mobility and independence.
Osteoporosis is called a “silent disease” because it progresses without symptoms until a fracture occurs. It develops less often in men than in women because men have larger skeletons, their bone loss starts later and progresses more slowly, and they have no period of rapid hormonal change and bone loss. However, in the past few years the problem of osteoporosis in men has become more recognized, particularly in light of estimates that the number of men above the age of 70 will continue to increase as life expectancy continues to rise.
Bone is constantly changing. Old bone is removed and replaced by new bone. During childhood, more bone is produced than removed, so the skeleton grows in both size and strength. For most people, bone mass peaks during the third decade of life. By this age, men typically have accumulated more bone mass than women. After this point, the amount of bone in the skeleton typically begins to decline slowly as removal of old bone exceeds formation of new bone.

Men in their fifties do not experience the rapid loss of bone mass that women do in the years following menopause. But by age 65 or 70, men and women are losing bone mass at the same rate, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes. Excessive bone loss causes bone to become fragile and more likely to fracture.
Fractures resulting from osteoporosis most commonly occur in the hip, spine, and wrist, and can be permanently disabling. Hip fractures are especially dangerous. Perhaps because such fractures tend to occur at older ages in men than in women, men who sustain hip fractures are more likely than women to die from complications.
In addition to age-related bone loss, there are many lifestyle behaviors, diseases and medications that can hasten bone loss in men. These include:
• Chronic diseases that affect the kidneys, lungs, stomach, and intestines, or alter hormone level
• Regular use of certain medications, such as glucocorticoids
• Undiagnosed low levels of the sex hormone testosterone
• Unhealthy lifestyle habits: smoking, excessive alcohol use, low calcium intake, and inadequate physical exercise
• Age. The older you are, the greater your risk
• Race. Caucasian men appear to be at particularly high risk, but all men can develop this disease.
Osteoporosis can be effectively treated if it is detected before significant bone loss has occurred. An orthopedic physician can order a medical workup to diagnose osteoporosis, including a complete medical history, x-rays, and urine and blood tests. The doctor may also order a bone mineral density test to determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment.
In men, osteoporosis is often not diagnosed until a fracture occurs or a man complains of back pain and sees his doctor. This makes it especially important for men to inform their doctors about risk factors for developing osteoporosis, loss of height or change in posture, a fracture, or sudden back pain.
Once a man has been diagnosed with osteoporosis, his orthopedic physician may prescribe medications as well as a treatment plan including nutrition, exercise, and lifestyle guidelines for preventing bone loss.
Other possible prevention or treatment approaches include calcium and/or vitamin D supplements and regular physical activity.
Experts agree that both men and women should take the following steps to preserve their bone health:
• Avoid smoking, reduce alcohol intake, and increase physical activity
• Ensure a daily calcium intake that is adequate for your age
• Ensure an adequate intake of vitamin D
• Engage in a regular regimen of weight-bearing exercises in which bones and muscles work against gravity. This might include walking, jogging, racquet sports, climbing stairs, team sports, weight training, and using resistance machines
• Discuss with your doctor the use of medications that are known to cause bone loss, such as glucocorticoids
• Recognize and seek treatment for any underlying medical conditions that affect bone health

Understanding ACL Reconstruction

In ACL reconstruction or repair, an orthopedic surgeon restores the function of the normal anterior cruciate (KROO-she-ate) ligament of the knee. This ligament is important in stabilizing the knee in athletics and day-to-day activities. The term ACL is an acronym for the anterior cruciate ligament, and easier to pronounce.

In ACL reconstruction or repair, an orthopedic surgeon restores the function of the normal anterior cruciate (KROO-she-ate) ligament of the knee. This ligament is important in stabilizing the knee in athletics and day-to-day activities. The term ACL is an acronym for the anterior cruciate ligament, and easier to pronounce.

Anterior (front) view of arthritic adult knee from below hip to lower leg showing the bones of leg ghosted within the skin including the femur, patella, tibia and fibula. Osteophytes (bumps) and torn articular surfaces and indicative of osteoarthritis of the knee.

Ligaments are strong bands of tissue that connect one bone to another. The ACL, one of two ligaments that cross in the middle of the knee, connects the thighbone (femur) to the shinbone (tibia) and helps stabilize the knee joint.

ACL injury most commonly occurs during sports that involve sudden stops and changes in direction — such as basketball, soccer, football and volleyball. ACL injuries typically occur in non-contact events on the sporting field. They can also be the result of workplace injuries and traumas such as motor vehicle accidents.

In the past, a torn ACL would mean the end of high level athletic activity for a prolonged period of time and possibly permanently. Today’s minimally invasive arthroscopic reconstruction followed by aggressive rehabilitation can restore the knee’s stability and function.

Not everyone who tears an ACL requires reconstruction. Sedentary people who forgo sports that involve a lot of quick stops and changes in direction usually recover well with conservative treatments and physical therapy. Bracing is also an option.

An orthopedic surgeon may recommend ACL reconstruction if:

  • You are an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting
  • More than one ligament or the cartilage in your knee is injured
  • You are young and active
  • The injury is causing instability in your knee during activities of daily life, such as stair climbing

What to Expect During ACL Surgery

ACL reconstruction is performed on an outpatient basis under anesthesia. The ACL is replaced with a piece of tendon from another part of the leg or from a tissue bank.

Orthopedic surgeons use an arthroscope, a small fiber-optic viewing instrument made up of a tiny lens, a light source and video camera, to perform ACL repair.

The orthopedic surgeon creates a tiny 5mm puncture in the joint space of the knee – about 1/4 of an inch – called a portal. Additional small punctures are made for the insertion of surgical instruments. These punctures result in tiny scars, which become unnoticeable, providing direct access to most areas of the knee joint.

The orthopedic surgeon views the procedure on a large screen monitor as the graft is positioned and then secured with screws or other fixation devices.

In an acute injury, surgery is usually delayed until muscle strength and knee mobility has been improved with physical therapy. People who go into surgery with a stiff, swollen knee often have problems regaining full range of motion after surgery.

What to Expect After ACL Repair

The patient returns home on the day of surgery and immediately begins the rehab process. Before going home, patients practice walking with crutches. To reduce swelling and pain in the days immediately following surgery, the R.I.C.E. model of self-care is followed at home:

  • Rest. Use crutches to avoid weight bearing on the knee.
  • Ice. Applying ice for 20 minutes every two hours when awake will help reduce swelling and ease pain.
  • Compression. An elastic bandage or compression wrap keeps the knee immobile and supported.
  • Elevate. Elevating the leg to heart level reduces swelling and pain.

The orthopedic surgeon will also prescribe medication to help manage pain. Physical therapy strengthens the muscles around the knee and improves flexibility. Most patients can expect a return to full function within 6 to 9 months. Athletes can often return to their sports after 6 to 12 months.

Choosing an Orthopedic Surgeon for ACL Repair

To ensure the best possible outcome, it is important to choose a surgeon experienced performing minimally invasive ACL repair.

Good communications between patient and surgeon is critical. You should be comfortable asking your doctor questions, sharing your concerns, and feel that your surgeon takes the time to respond fully and completely. Together, you and your orthopedic surgeon can create the best plan of care to help return you to normal activities as soon as possible following ACL repair.

Highlights and News

Getting Back to Your Best with Minimally Invasive Surgery.

 Today we are living longer and fully expect to enjoy a long and active life. Minimally invasive orthopedic surgery is helping to keep us in the game of life, restoring function and range of motion in older athletes, relieving pain for individuals with arthritis or work-related conditions such as carpal tunnel syndrome, and helping anyone recovering from a traumatic accident or injury get back on their feet.

“Orthopedic technology advances in minimally invasive techniques, specialized tools and advanced imaging are helping to reduce and eliminate pain and restore functionality and range of motion to key areas of the body such as hips, knees, hands and shoulder joints,” says Dr. Marshall P. Allegra, M.D., an orthopedic specialist in Hazlet, New Jersey.

In an arthroscopic examination, an orthopedic surgeon makes a small incision in the patient’s skin and then inserts a pencil-sized instrument that contains a small lens and lighting system to magnify and illuminate the structures inside the joint. This enables the surgeon to visualize, diagnose and treat problems inside the joint.

“Partial join replacement has become a refined procedure, with sameday surgery, immediate rehab and quick recovery,” says Dr. Allegra. “Hip arthroscopy has emerged as a specialty in the last five or six years, as well as the ability to resolve soft tissue problems, bone spurs, ACL and other ligament repairs – treatments are now available for these conditions in same day surgical settings.”

Excellent outcomes are being achieved thanks to a full continuum of care supporting same day surgery patients. “Patients may receive a continuous pain block that lasts for two or three days after surgery, home care is available for patients who require it, and physical therapy begins almost immediately,” says Dr. Allegra.

“As you go along the age spectrum, a younger active person may have a soft tissue or ligament injury repaired arthroscopically, and an older person may have partial joint replacement. Either way, they can both be back to their normal routines very quickly,” says. Dr. Allegra. “Thanks to minimally invasive procedures and a supportive care environment, these injuries are not the setbacks they once might have been.”

The benefits of minimally invasive procedures include less blood loss, less post-operative pain, lower risk of infection, less damage to musculature and tissue, and earlier return to normal function, work and recreation. “The
techniques of minimally invasive surgery are ‘technically’ more demanding,” adds Dr. Allegra, “so it’s important to seek out surgeons with exceptional training and experience.”

Dr. Marshall P. Allegra, M.D.

Practice Overview

Dr. Marshall P. Allegra is a board-certified orthopedic surgeon in private practice in Monmouth County for over 23 years. Specializing in minimally invasive arthroscopic surgery, full and partial joint reconstruction, hand, foot and ankle surgery, fracture care, and non-surgical treatment options. Dr. Allegra is dedicated to providing one-on-one personalized care to every patient.

Dr. Allegra is the only physician you will see when you visit the practice, and he will supervise each phase of your diagnosis, treatment and recovery.

An experienced diagnostician, Dr. Allegra can expertly determine the causes of chronic and acute pain in his patients due to hip, knee, hand, shoulder and sports-induced injuries, and then determine the best treatment options to return patients back to work, to the playing field, restoring functionality and range of motion as quickly as possible.

Dr. Allegra has performed more than 500 hip and knee replacements on patients from Monmouth County and surrounding areas. Thousands of Dr. Allegra’s patients have returned to active lifestyles thanks to his quality, personalized care and innovative treatment options.