You don’t hear as much about osteoporosis in men. We tend to think of a loss of bone density related to aging as being a “female thing” and something men don’t need to be concerned about. But, men can suffer from a pathological loss of bone density too. If you’re a guy, you can end up with a disabling bone fracture just as women can. Men need to worry about bone health too!
It’s not uncommon to see men in clinical practice who have suffered from a bone fracture due to osteoporosis. The most common sites are the hip, spine, and wrist. Rib bones and bones in the arm and pelvis are also high-risk bones for osteoporosis-related fractures. Unfortunately, hip fractures, in particular, carry a high risk of mortality and long-term disability. We want to avoid them as much as possible!
What’s more, most men don’t get their bone density measured. Maybe that’s because there isn’t enough emphasis placed on bone health in guys. So, if you have a Y chromosome, you may be in the dark about how dense your bones are and whether you’re at a risk of developing a bone fracture due to osteoporosis. It’s something you don’t hear about enough!
Let’s look at some of the cold, hard facts and statistics about men and osteoporosis. You might be surprised!
Osteoporosis in Men: It’s Not as Uncommon as You Think
Think osteoporosis only impacts women? Not a chance! Around 1.5 million men in the U.S.A. have osteoporosis and another 8 to 13 million have low bone density. So, it’s a problem for men too and one that increases with age. However, there are some differences in how osteoporosis impacts men as opposed to women.
Men Develop Osteoporosis Later Than Women
When men develop osteoporosis, it often happens later than it does in women. In fact, the peak incidence of fractures related to osteoporosis in men is around 10 years later. The risk of a developing a hip fracture due to osteoporosis rises quickly after the age of 70 in guys. Since more men are living to this age or longer, the incidence of osteoporosis in older males is increasing and will likely continue to go up.
Are we too lackadaisical about screening for osteoporosis in men? Some experts believe so. With men living longer than ever, we’re bound to see more osteoporosis-related fractures, not just in women, but guys as well.
Men with Osteoporosis Have a Worse Outcome
Although osteoporosis is less common in men than in women, males have a higher mortality if they develop an osteoporosis-related hip fracture. If you’re a woman with osteoporosis and fracture a hip, your mortality rate is 17%. But, if you’re a guy who breaks a hip, your mortality rate is a whopping 31%. That’s a substantial difference! Men simply don’t do as well when they fracture a hip and it’s not clear why.
Here are some other cold, hard osteoporosis statistics:
18%–33% of older patients who fracture a hip die within 1 year of the fracture.
45% of those who live on their own at the time of a hip fracture are transferred to a nursing home after hospitalization.
Most hip fracture patients who survive have reduced ability to get around and care for themselves.
Men Who Have Low Bone Density Are More Likely to Have a Secondary Cause
In men who develop osteoporosis, there’s more often a secondary cause. This means there is some other factor, including health conditions, that reduce bone density & increase the odds of a fracture. In fact, if you’re a guy who
- Taking certain medications (prednisone, seizure meds & drugs that suppress the immune system are common ones)
- Excessive use of alcohol (more than 2 drinks daily)
- Thyroid disease
- Disease involving the parathyroid gland, a gland in the neck that regulates calcium
- Chronic lung disease
- Some disorders of the intestinal tract that reduce calcium & vitamin D absorption
- Cystic fibrosis
- Being immobilized for a period of time
- Increased loss of calcium in the urine
- Rheumatoid arthritis
- Certain genetic disorders
- Chronic kidney disease
- Liver disease
- Eating disorders
As you can see from this list, a number of medical problems increase the risk of developing low bone density. That’s why you should talk to your physician about osteoporosis if you have a chronic medical condition.
If you take steroids, like prednisone, for a long period of time, your risk of developing a fracture due to osteoporosis is 1 in 10. That’s substantial! Bone density decreases sharply during the first 3 to 6 months after starting oral steroids.
The same risks don’t apply to the use of inhaled steroids. Asthmatics frequently used inhaled steroids and they don’t seem to have a higher risk of developing osteoporosis
Other factors that increase the risk of osteoporosis in men include:
- Older age
- Vitamin D deficiency
- Low dietary intake of calcium
- Lack of physical activity
- A low testosterone level
- Having small bones or being underweight
- A history of previous bone fractures
One of the strongest risk factors in males is having a low testosterone level. Testosterone is a hormone that gives men their distinctively male characteristics, including more muscle mass. Testosterone also helps support bone health. That’s why it’s a good idea to know your testosterone level once you reach middle age. It’s easy to check with a blood test.
The link between calcium intake and vitamin D and osteoporosis is a bit cloudy due to recent studies that suggest supplemental vitamin D and calcium don’t prevent bone fractures. But, it’s still important to get enough calcium through diet and to maintain an adequate vitamin D level.
We recommend getting your vitamin D level checked periodically and keeping it at
Some Men Need to Be Screened Too!
The American College of Physicians recommends that women at average or lower risk of developing osteoporosis get screened starting at age 65 years. Believe it or not, there are no clear-cut guidelines on when men should be screened for low bone density.
Here’s what the U.S. Preventative Task Force has to say about it:
“The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men.”
Other groups, such as the American College of Preventive Medicine and the Endocrine Society take a stronger stance. They recommend that men over the age of 70 get DEXA testing to determine bone mineral density at age 70 or older. If you have strong risk factors, consider getting tested earlier.
At the very least, your physician should calculate your risk by using a risk factor screening tool. The most common is called the FRAX fracture risk assessment tool. If you’d like to see what it looks like, here’s a link:
If you’re at higher risk due to secondary causes, you should consider screening as well.
In terms of advanced screening, the most common screening method is a DEXA scan, an imaging study that exposes you to a small amount of radiation. From the results, the technician calculates a T-score. This is a score that compares your bone density to a healthy, 30-year old woman.
Based on your T-score, you can be classified as having osteoporosis, having osteopenia, or having normal bone density. Osteopenia is where you have lower than normal bone density but aren’t at the level of osteoporosis. It’s a red flag that you need to work on lowering your risk!
One study showed that if you screen men at age 65 using a DEXA scan, around 6% will have osteoporosis. Of course, the incidence will be higher in men who have secondary causes, like an illness or medications that increase the risk.
How Men Can Lower Their Risk of Osteoporosis
First, know your risk factors. If you have one or more of the risk factors listed above, talk to your physician about your risks and whether they would recommend a DEXA scan.
Strategies for preventing osteoporosis are similar in men and women. A number of studies have looked at calcium and vitamin D intake in women and the most recent studies don’t show that taking supplemental calcium or vitamin D lowers the risk of fractures. But, it’s important to have an adequate vitamin D level and the best way to find out is to ask your physician to do a blood test called 25-hydroxy vitamin D blood test.
It’s also important to get enough calcium through diet. Men over the age of 50 should get 1,200 milligrams of calcium daily. However, vitamin D and calcium aren’t the only vitamins and minerals that potentially impact bone health. Magnesium and vitamin K2 also play a key role in maintaining healthy bones.
As mentioned, we also recommend checking your testosterone level if you have risk factors for osteoporosis. If you have a low level, normalizing your testosterone can increase bone mineral density, although there’s no evidence that testosterone therapy will lower your odds of a bone fracture if you have a normal testosterone level.
Physical Activity & the Risk of Osteoporosis
Exercise, exercise, exercise. It’s important not just for your heart but for bone health. Studies show that the right kind of exercise can increase bone mineral density even in older men. But, not all exercise is effective.
The two kinds of exercise that ARE effective is high-impact exercise. This is
Another form of exercise that lowers the risk of osteoporosis in men and women is strength training. Although studies are conflicting, most research suggests that you have to lift heavy to stimulate new bone growth. Lifting at 80% of your one-rep max is enough to have a stimulatory impact on the bone cells called osteoblasts that lay down new bone. This would be a weight you can only lift 4 to 6 times before your muscles are completely fatigued.
However, there was a recent study showing that lifting lighter weights and doing high repetitions may improve bone density as well. So, even lighter weights may have some benefits. But, we recommend doing heavier sets since there’s more evidence that using a heavy resistance promotes bone health.
Nix the Bad Habits
Also, focus your strength-training efforts on doing compound exercises, those that
Hopefully, you don’t smoke, but if you do, kick the habit. Smoking has a negative impact on every organ in your body, including your bones. Studies clearly link smoking with lower bone density, but it’s not completely clear whether the link is causal. It may be that people are more likely to have other risk factors. For example, smokers tend to be thinner and that’s a risk factor.
Excessive alcohol consumption is also associated with a higher risk of male osteoporosis and fractures, especially fractures of the hip, wrists, and spine. Alcohol may be harmful to bone health for a number of reasons. For one, it can lower testosterone. Secondly, research suggests that alcohol interferes with calcium metabolism and we know that calcium is important for bone metabolism and health.
In addition, over-consuming alcohol can lower your testosterone level. That’s a negative for your bones! So, stick to no more than 1-2 glasses of alcohol daily, preferably red wine. Even better, don’t drink at all.
The Bottom Line
It’s not just women who get osteoporosis an develop debilitating bone fractures due to weak bones. Guys do too! Now, you know some of the risk factors.
What to do now? Talk to your physician about your own risks and whether you need screening. They can do a risk assessment based on your medical history and help you decide whether you should have your bone density measured.
Make sure you’re doing what you can to lower your risk:
- Eat a balanced diet that contains enough calories. Choose whole foods over processed junk that contains few nutrients.
- Make sure you’re consuming enough calcium via diet, not supplements. Calcium supplements are linked, in some studies, with a higher risk of cardiovascular disease.
- Check your vitamin D level and make sure it’s within the “normal” range. Lower than 20 ng/ml is linked with a higher risk of bone fractures in many studies.
- Get 1000 to 1,200 milligrams of calcium daily through diet.
- Don’t smoke and limit the amount of alcohol in your diet.
- Consider checking your testosterone level after mid-life to make sure you’re not in the deficient range.
- Strength train using challenging weights to preserve muscle and bone health. Gradually increase the resistance that you use over time to increase the challenge. Include upper & lower body exercises.
- Stay physically active. If possible, include some high-impact exercise in your routine. This is
exercisewhere both feet leave the ground, like jumping rope, plyometric moves, jogging, or running.
Hopefully, your bones will remain strong and dense enough to keep you healthy and active for a lifetime!
- Am Fam Physician. 2003 Apr 1;67(7):1521-1526.
- Am Fam Physician. 2008 Oct 1;78(7):882-883.
- U.S. Preventative Task Force. “Osteoporosis Screening”
- NIH Osteoporosis and Related Bone Diseases National Resource Center. “Smoking and Bone Health”