Why Men Need to Think About Bone Health Too

The Misconception That Puts Men at Risk

Ask most people who gets osteoporosis, and you will hear the same answer: older women. It is a deeply ingrained assumption -- one reinforced by decades of public health messaging, screening guidelines aimed primarily at postmenopausal women, and a general cultural belief that bone loss is a female problem.

That assumption is wrong, and it is costing men their health and their lives.

The International Osteoporosis Foundation reports that approximately one in four men over the age of 50 will suffer a fracture due to osteoporosis. Worldwide, roughly 30% of all hip fractures occur in men. And here is the statistic that should get every man's attention: men who suffer a hip fracture are more likely to die within a year than women who suffer the same injury.

Bone health is not a women's issue. It is a human issue. And men are dramatically underserved when it comes to screening, diagnosis, and treatment.

The Numbers: Why This Matters

The data on male osteoporosis paints a sobering picture:

• Up to 25% of men over 50 will experience an osteoporotic fracture in their remaining lifetime -- roughly equivalent to the lifetime risk of prostate cancer.
• Men account for nearly 30% of all hip fractures globally, according to data from the International Osteoporosis Foundation.
• One-year mortality after hip fracture is higher in men than women. Studies published in the Journal of Bone and Mineral Research report mortality rates of approximately 37% in men versus 20% in women within the first year following a hip fracture.
• Only about 10-20% of men who have an osteoporotic fracture receive appropriate follow-up evaluation or treatment, compared to roughly 30-40% of women -- already an inadequate rate.

The gap between the reality of male osteoporosis and the medical attention it receives is enormous. Men are breaking bones, being hospitalized, and dying from a condition that is both detectable and treatable -- but only if someone thinks to look.

Why Men Are Underdiagnosed

Several factors contribute to the systematic underdiagnosis of osteoporosis in men:

Cultural Bias

Osteoporosis has been framed as a women's disease for so long that many men -- and many of their physicians -- simply do not consider it. Men are less likely to bring up bone health concerns, and providers are less likely to recommend screening for male patients who present with fractures.

Screening Guidelines

The USPSTF currently has no recommendation for routine osteoporosis screening in men, citing insufficient evidence. The Endocrine Society suggests screening men over 70, or men aged 50-69 with risk factors. In practice, this means millions of at-risk men never receive a bone density assessment.

Different Presentation

Men typically have larger, denser bones than women and do not experience the abrupt hormonal decline of menopause. Their bone loss tends to be more gradual, which can make it easier to miss. By the time a man presents with a fragility fracture, significant bone deterioration has often already occurred.

Attribution Errors

When an older man breaks a hip in a fall, it is often attributed to the fall itself -- an accident. What frequently goes unrecognized is that the bone was already compromised, and a healthy bone would have withstood the same impact. The fracture caused the fall as much as the fall caused the fracture.

Testosterone and Bone Health

Just as estrogen plays a critical role in women's bone health, testosterone is essential for maintaining bone density in men. Testosterone contributes to bone health both directly and through its conversion to estradiol (a form of estrogen) via the enzyme aromatase. Men actually need both testosterone and estrogen for optimal bone health.

How Low Testosterone Affects Bone

Testosterone levels in men decline gradually with age -- approximately 1-2% per year after age 30. This decline, sometimes called andropause or late-onset hypogonadism, does not produce the dramatic bone loss seen in female menopause, but the cumulative effect over decades is significant.

Men with clinically low testosterone (hypogonadism) have measurably lower bone density and higher fracture rates. Conditions and treatments that suppress testosterone -- including androgen deprivation therapy for prostate cancer -- can cause rapid, severe bone loss that mirrors the postmenopausal pattern in women.

Risk Factors Specific to Men

While some risk factors for osteoporosis are shared between men and women (family history, low body weight, smoking, sedentary lifestyle), several risk factors are particularly relevant for men:

Glucocorticoid (Steroid) Use

Long-term use of corticosteroids such as prednisone -- commonly prescribed for conditions like asthma, rheumatoid arthritis, and inflammatory bowel disease -- is one of the leading causes of secondary osteoporosis in men. Glucocorticoids directly suppress bone formation and increase bone resorption. Men on these medications for three or more months should discuss bone health monitoring with their provider.

Excessive Alcohol Consumption

Heavy alcohol use (more than three drinks per day) is a well-established risk factor for osteoporosis in men. Alcohol interferes with calcium absorption, suppresses bone-forming cells, and can contribute to falls. Moderate consumption (one to two drinks daily) appears to have a neutral or mildly protective effect, but the threshold between moderate and harmful is lower than many men realize.

Certain Medications

Beyond glucocorticoids, several medication categories can accelerate bone loss in men:

• Androgen deprivation therapy (ADT) for prostate cancer
• Proton pump inhibitors (PPIs) used long-term for acid reflux
• Certain anti-seizure medications
• Selective serotonin reuptake inhibitors (SSRIs) used for depression
• Thyroid hormone replacement at excessive doses

Low Body Weight and Eating Disorders

While less commonly discussed in men, eating disorders and chronically low body weight are significant risk factors for male osteoporosis. Male athletes in weight-class sports, endurance sports, or aesthetic sports (gymnastics, wrestling, cycling) may be at particular risk due to caloric restriction combined with high training volumes.

Other Medical Conditions

Several conditions increase osteoporosis risk in men:

• Type 2 diabetes (associated with altered bone quality despite sometimes normal density)
• Chronic kidney disease
• Celiac disease and other malabsorption conditions
• Rheumatoid arthritis
• Chronic obstructive pulmonary disease (COPD)
• HIV/AIDS and antiretroviral therapy

The Mortality Gap: Why Hip Fractures Are More Dangerous for Men

The most alarming aspect of male osteoporosis is not the fracture rate itself -- it is what happens afterward. Men consistently show higher mortality rates following osteoporotic fractures, particularly hip fractures, compared to women.

Research published in the Journal of Bone and Mineral Research and other peer-reviewed journals has documented that men are approximately twice as likely as women to die within the first year after a hip fracture. Contributing factors include:

• Later diagnosis: Men tend to fracture at older ages and with more comorbidities.
• Less rehabilitation: Men may receive less aggressive post-fracture rehabilitation.
• Higher complication rates: Men experience more post-surgical complications including pneumonia, cardiovascular events, and infections.
• Delayed treatment: Because male osteoporosis is under-recognized, men are less likely to receive bone-protective medications after a fracture.

This mortality gap makes prevention even more critical for men. A hip fracture in a man over 70 is not just a broken bone -- it is a potentially life-threatening event.

Screening Recommendations for Men

Given the gaps in formal screening guidelines, men should consider bone health assessment if they have any of the following:

• Age 50 or older with a history of fragility fracture
• Age 70 or older regardless of risk factors
• Long-term glucocorticoid use (three months or more)
• Low testosterone levels (diagnosed or suspected)
• Current or past androgen deprivation therapy
• Family history of osteoporosis or hip fracture
• Significant height loss (more than 1.5 inches)
• Heavy alcohol use or current smoking
• Any of the medical conditions listed above

Technologies like REMS (Radiofrequency Echographic Multi-Spectrometry), used in HALLĒ's Full Picture Assessment, offer men a comprehensive ultrasound evaluation of both bone density and bone quality. Because REMS is an ultrasound reading, it can be repeated as often as your clinician finds useful.

Exercise and Nutrition for Male Bone Health

The same principles that protect women's bones apply to men, with some additional considerations:

Exercise

Men should focus on a combination of:

• Resistance training two to three times per week, focusing on major muscle groups and compound movements (squats, deadlifts, presses, rows)
• Weight-bearing cardiovascular exercise such as walking, running, hiking, or playing sports
• Balance training -- particularly important for men over 65, who may underestimate their fall risk

The key is progressive loading: your bones adapt to the stress placed on them, so gradually increasing intensity over time is more effective than maintaining the same routine indefinitely.

Nutrition

• Calcium: Men over 50 need 1,000-1,200 mg daily. Many men fall short, particularly those who limit dairy intake.
• Vitamin D: 1,000-2,000 IU daily, with blood level testing to confirm adequacy. Men are just as likely as women to be vitamin D deficient.
• Protein: 1.0-1.2 grams per kilogram of body weight daily to support both bone and muscle health.
• Limit excessive alcohol: No more than two drinks per day.

It Is Time to Pay Attention

The bone health conversation needs to include men -- not as an afterthought, but as a priority. The data is clear: men get osteoporosis, men break bones, and men die from fractures at higher rates than women. The tools to detect and address bone loss exist. The only thing missing is awareness and action.

If you are a man over 50 -- or if you have risk factors at any age -- knowing the state of your bones is not just a good idea. It is one of the most important health decisions you can make.