Men's Osteoporosis — It Is Not Just a "Women's Disease"

• That osteoporosis is a real and common problem in men
• Male-specific risk factors
• Which men should be screened for osteoporosis
• How diagnosis and treatment differ from women
• Prevention strategies you can start today

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The numbers

• Approximately 300 million men worldwide have osteoporosis or low bone mass
• About 25% of hip fractures occur in men
• About 30% of spinal compression fractures occur in men
• Approximately 1 in 4–6 men over 50 will experience an osteoporotic fracture in their lifetime

Why is it missed so often?

• The assumption that osteoporosis is a "women's disease"
• Men are rarely offered bone density screening
• Even after a fracture, men are less likely to be tested for osteoporosis
• There are no symptoms until a fracture occurs

Osteoporosis in men is an "underdiagnosed disease." Many men discover it only when they fracture a bone.

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In women, the primary cause is estrogen loss at menopause. In men, the causes are more varied and often involve a combination of factors.

Aging

• Bone density declines 0.5–1% per year after age 50
• Fracture risk rises steeply after age 70
• Gradual decline in testosterone also contributes

Secondary causes (another condition or medication is responsible)

In men, about half of all osteoporosis cases have an identifiable cause:

Cause	Examples
Steroid medications	Treatment for arthritis, asthma, IBD
Low testosterone	Prostate cancer hormone therapy, aging
Excess alcohol	More than 3 standard drinks per day
Smoking	Current smokers
Diabetes	Type 2 diabetes (via bone quality reduction)
Digestive conditions	Post-gastrectomy, IBD, celiac disease
Kidney disease	Chronic kidney disease (CKD)
Anticonvulsants	Long-term use affecting vitamin D metabolism

For more on steroid-induced bone loss, see Steroids and Your Bones.

Lifestyle factors

• Sedentary lifestyle: Desk work, reduced activity after retirement
• Poor diet: Insufficient calcium and vitamin D
• Low body weight: BMI below 20 is a risk factor
• Heavy drinking

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If any of the following apply, you should discuss a bone density test with your doctor.

Testing recommended for:

• All men aged 70 and over
• Men aged 50 and over with any of these risk factors:
  • Fracture after age 50
  • Height loss of 3 cm or more
  • Steroid use for 3+ months
  • Prostate cancer hormone therapy
  • Heavy alcohol use or smoking
  • A parent who fractured their hip
• Any age, if:
  • You fractured a bone from minimal force
  • An X-ray incidentally showed a fracture

The test

The standard test is a DEXA scan (dual-energy X-ray absorptiometry) of the hip and spine — the same test used for women.

For more about DEXA scans, see DEXA Scans Explained.

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Diagnostic criteria

The criteria are the same as for women:

• T-score −2.5 or below: Osteoporosis
• T-score −1.0 to −2.5: Low bone mass (osteopenia)

However, men's T-scores are compared to young healthy male reference values, not female values.

Investigating the cause

Because secondary causes are so common in men, blood tests are often performed to check:

• Testosterone levels
• Calcium and phosphorus
• Vitamin D
• Thyroid function
• Kidney function
• Bone turnover markers

If a cause is found and treated, bone density may improve without specific osteoporosis medication.

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Effective treatment is available for men

Osteoporosis in men is treatable, and nearly all of the major osteoporosis treatments work just as well in men as in women. Men are sometimes left untreated simply because the condition is overlooked — not because good options don't exist.

The best approach depends on your bone density, your fracture history, and any underlying cause. Talk to your doctor about which treatment is right for you, and don't let the idea that osteoporosis is "a women's disease" keep you from getting care.

Treating the underlying cause

When a secondary cause is identified, addressing it is part of the treatment:

• Testosterone replacement (when appropriate)
• Reducing steroid dose where possible
• Treating vitamin D deficiency
• Alcohol reduction

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Hormone therapy for prostate cancer (androgen deprivation therapy, or ADT) dramatically lowers testosterone, causing rapid bone loss:

• Bone density can drop 4–5% in the first year of ADT
• Fracture risk increases early after starting treatment
• Preventive treatment is recommended

If you are on hormone therapy for prostate cancer, ask your urologist about bone protection. Effective treatments are commonly used to prevent bone loss in this situation — your doctor can advise on what's appropriate for you.

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Diet

• Calcium: Aim for 700–800 mg per day (dairy, small fish, tofu, green vegetables)
• Vitamin D: Fatty fish, sun exposure, supplements if needed
• Protein: Adequate intake from meat, fish, eggs, legumes
• Moderate alcohol: No more than 1–2 standard drinks per day

Exercise

• Walking: At least 30 minutes daily (gives bones weight-bearing stimulus)
• Strength training: 2–3 times per week (squats, push-ups, resistance bands)
• Balance exercises: Single-leg standing, heel-to-toe walking (fall prevention)

Men often become significantly less active after retirement. Making conscious exercise habits is important.

Lifestyle

• Stop smoking (smoking lowers bone density and raises fracture risk)
• Limit alcohol (more than 3 drinks daily is a major risk factor)
• Prevent falls (nighttime bathroom trips, stairs, wet bathroom floors)

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Q. Can I get a bone density test at a regular health checkup?

In many countries, routine bone density screening programs are aimed at women. However, you can request a DEXA scan from your doctor — especially if you have risk factors. It is usually a covered test when there is a clinical indication.

Q. At what age should men start worrying about their bones?

Without specific risk factors, screening is generally recommended at age 70. With risk factors (steroids, heavy drinking, prostate cancer therapy, previous fracture), attention is needed from age 50.

Q. Are fractures more dangerous in men?

Yes. One-year mortality after hip fracture is approximately 20–25% in men compared to 10–15% in women. This is likely due to later age at fracture, more comorbidities, and lower rehabilitation participation rates.

Q. My wife has osteoporosis. Should I be tested?

Osteoporosis itself is not inherited directly, but lifestyle factors (diet, activity levels) tend to be similar between spouses. If either parent fractured their hip, you have a genetic risk factor. If you are over 70, getting tested together is a sensible idea.

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1. If you are over 70 — or over 50 with risk factors — discuss bone density testing with your doctor
2. Check your alcohol intake (are you above 1–2 drinks per day?)
3. Stay physically active after retirement (walking, strength training)
4. Ensure adequate calcium and vitamin D
5. If you are on prostate cancer treatment, ask about bone protection

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• Japanese Society for Bone and Mineral Research et al. Guidelines for Prevention and Treatment of Osteoporosis 2025
• Ebeling PR, et al. Secondary Osteoporosis. Endocr Rev. 2022
• International Osteoporosis Foundation. Osteoporosis in Men

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This article provides general medical information and is not intended as a substitute for professional medical advice. If you have concerns about your bone health, please consult your doctor.

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