The Overlooked Epidemic in Men
When most people hear the word osteoporosis, they think of older women. While it is true that women are more commonly affected, osteoporosis in men is far more prevalent and dangerous than most people realize. Approximately one in four men over age 50 will sustain a fracture due to osteoporosis in their lifetime. Even more alarming, men who suffer osteoporotic hip fractures are twice as likely to die within a year compared to women with the same injury.
Despite these statistics, men are rarely screened, rarely diagnosed, and rarely treated for osteoporosis. At Zimmer Medical Group, we believe bone health should be on every man's health radar, especially after 50.
Why Men Are Underdiagnosed
The underdiagnosis of osteoporosis in men stems from several factors:
The Perception Problem
Osteoporosis has been framed as a women's disease for decades. Public health campaigns, screening guidelines, and pharmaceutical advertising have all focused almost exclusively on postmenopausal women. As a result, many men and their doctors do not think about bone density until a fracture occurs.
Later Onset, Bigger Impact
Men generally reach a higher peak bone mass than women and do not experience the rapid bone loss that accompanies menopause. However, once bone loss begins, it often goes unnoticed. By the time a man presents with a fracture, the underlying osteoporosis is typically advanced. According to the International Osteoporosis Foundation, up to 80 percent of men who sustain osteoporotic fractures are never diagnosed with or treated for osteoporosis.
Screening Gaps
Standard screening guidelines recommend bone density testing for women at age 65, but guidelines for men are less clear and less widely followed. The Endocrine Society recommends screening for men at age 70, or earlier if risk factors are present. In practice, many men are never offered a bone density test.
Risk Factors for Osteoporosis in Men
Several factors increase a man's risk of developing osteoporosis:
Medications
- Glucocorticoids (steroids). Long-term use of medications like prednisone is one of the most common causes of secondary osteoporosis in men. Even moderate doses taken for three months or longer can significantly weaken bones.
- Androgen deprivation therapy. Men treated for prostate cancer with medications that suppress testosterone experience accelerated bone loss.
- Certain anticonvulsants, proton pump inhibitors, and excess thyroid hormone can also contribute to bone loss over time.
Hormonal Factors
- Low testosterone (hypogonadism). Testosterone plays an important role in maintaining bone density in men. Low levels, whether from aging, medical conditions, or medications, accelerate bone loss.
- Low estrogen. Men also need small amounts of estrogen for bone health. Estrogen deficiency in men, often related to low testosterone (since testosterone is partially converted to estrogen), contributes to osteoporosis.
Lifestyle Factors
- Excessive alcohol consumption. More than three drinks per day increases fracture risk through direct toxic effects on bone-forming cells and through increased fall risk.
- Smoking. Smokers have lower bone density and higher fracture rates than nonsmokers. The effect is dose-dependent and partially reversible with cessation.
- Sedentary lifestyle. Weight-bearing and resistance exercise stimulate bone formation. Physical inactivity accelerates bone loss.
- Low calcium and vitamin D intake. Many men do not consume adequate calcium or get enough vitamin D, both of which are essential for bone maintenance.
Medical Conditions
- Celiac disease and malabsorption disorders impair calcium and vitamin D absorption
- Chronic kidney disease disrupts vitamin D metabolism and calcium balance
- Rheumatoid arthritis involves chronic inflammation that accelerates bone loss
- Type 1 and type 2 diabetes are associated with increased fracture risk
- Chronic obstructive pulmonary disease (COPD) is associated with low bone density, partly due to steroid use and physical inactivity
Family History
A parent who sustained a hip fracture significantly increases your risk, suggesting a genetic component to bone strength and fracture susceptibility.
DEXA Screening for Men
The gold standard for measuring bone density is a dual-energy X-ray absorptiometry (DEXA) scan. It is a painless, noninvasive test that takes about 15 minutes and measures bone density at the hip and spine. Results are reported as a T-score:
- T-score of -1.0 or above: Normal bone density
- T-score between -1.0 and -2.5: Osteopenia (low bone mass, a precursor to osteoporosis)
- T-score of -2.5 or below: Osteoporosis
When Should Men Be Screened?
- Age 70 and older: All men should be screened regardless of risk factors.
- Age 50 to 69: Men with risk factors (steroid use, low testosterone, excessive alcohol, smoking, family history of fractures, previous fracture, or medical conditions that affect bone health) should discuss screening with their doctor.
- Any age: Men on long-term glucocorticoid therapy or androgen deprivation therapy should be screened at the start of treatment.
This screening can be discussed as part of your annual physical exam. Understanding your blood work results, including calcium and vitamin D levels, provides additional context for bone health assessment.
Treatment Options
Lifestyle Interventions
- Weight-bearing exercise: Walking, jogging, hiking, climbing stairs, and dancing force your bones to work against gravity, stimulating bone formation.
- Resistance training: Lifting weights or using resistance bands strengthens both muscles and bones. Focus on exercises that target the hips, spine, and wrists, the most common fracture sites.
- Balance exercises: Tai chi and balance training reduce fall risk, which is critical since most osteoporotic fractures result from falls.
- Adequate calcium: Men over 50 need 1,000 to 1,200 mg of calcium daily, preferably from dietary sources (dairy, fortified foods, leafy greens, canned fish with bones).
- Vitamin D: Most adults need 800 to 1,000 IU of vitamin D daily. Many men are deficient, and a blood test can determine your level and guide supplementation.
Medications
When lifestyle measures are not sufficient, several medications are available:
- Bisphosphonates (alendronate, risedronate, zoledronic acid) are the most commonly prescribed osteoporosis medications. They slow bone breakdown and are approved for use in men.
- Denosumab (Prolia) is an injectable medication given every six months that inhibits the cells responsible for bone breakdown. It is effective in men, including those on androgen deprivation therapy for prostate cancer.
- Teriparatide (Forteo) is a daily injectable medication that stimulates new bone formation. It is reserved for men with severe osteoporosis or fractures despite other treatments.
- Testosterone replacement may be appropriate when low testosterone is a contributing factor, though it is typically used alongside bone-specific medications rather than as standalone osteoporosis treatment.
Fall Prevention
Since fractures result from the combination of weak bones and falls, preventing falls is as important as strengthening bones:
- Remove tripping hazards at home (loose rugs, clutter, poor lighting)
- Install grab bars in bathrooms
- Have vision checked regularly
- Review medications that may cause dizziness or unsteadiness
- Maintain muscle strength and balance through regular exercise
The Bigger Picture
Osteoporosis in men is preventable, detectable, and treatable, but only if it is on your radar. If you are over 50, take a few minutes to review the risk factors listed above. If any apply to you, bring it up with your doctor. A simple DEXA scan and blood work can provide the information you need to protect your bones for decades to come.
For a broader discussion of bone health strategies, see our guide on bone health after 50.
Concerned about your bone health? Contact Zimmer Medical Group to discuss screening and prevention strategies. Strong bones are the foundation of an active life, and it is never too late to start protecting them.
