Osteoporosis wouldn’t appear on most people’s list of diseases that ­affect men. But it should. Men over age 50 are more likely to break a bone due to osteoporosis than they are to develop prostate cancer

Other eye-opening facts: About two million American men already have this bone-weakening disease, and at least another 12 million have no idea that they are at increased risk for it.

All told, about one man in five will experience an osteoporosis-related fracture during his lifetime—and when this occurs, the consequences are even more dire than for a woman. 

Why Men Get Overlooked

There’s a good reason why the osteoporosis spotlight focuses directly on women. Virtually all women experience plummeting levels of bone-­protective estrogen during menopause, leading to a significant decrease in bone density. In men, bone loss usually happens later in life and more slowly. But throw a risk factor or two into the mix, and the odds for osteoporosis in men increase substantially. Unfortunately, few doctors test for it in men (let alone offer treatment). That can be a deadly mistake.

The real danger: In the first six months after a hip fracture, the mortality rate in men is approximately double that of similar-aged women, according to the International Osteoporosis Foundation. Even after suffering a hip fracture, men are far less likely than women to be tested or treated for osteoporosis. 

Should You Get Tested?

Doctors routinely test women’s bone mineral density (BMD) starting at about age 65—or even younger if they have risk factors—but the same testing is rarely ordered for men…even if they have glaring risk factors. The best way to stay ahead of osteoporosis is to get tested before you break a bone. 

Factors that increase your risk…

• Long-term steroid use. When used for two or more months, cortico­steroids (such as prednisone), commonly prescribed for chronic conditions like chronic obstructive pulmonary disease (COPD) and rheumatoid arthritis, are the number-one cause of non–age-­related osteoporosis. 

• Regular use of bone-depleting medications. Several prescription and over-the-counter (OTC) drugs deplete bone density, including proton pump inhibitors (PPIs) used for heartburn …selective serotonin reuptake inhibitor (SSRI) antidepressants…aluminum-based antacids…blood thinners…and diuretics. Exactly when the risk for bone loss kicks in depends upon the drug being used. For PPIs, for example, research has shown that risk for fracture occurs after two years and continues to increase over four years. 

• Celiac disease. This condition  blocks the absorption of nutrients, including calcium, making it a common “silent” cause of osteoporosis—even in people who get plenty of calcium.

• Low testosterone. Testosterone levels decline when a man ages, and that can be accompanied by lower levels of estradiol (a form of the female hormone estrogen). Low levels of bioavailable estradiol can increase fracture risk in men. In some studies, low testosterone alone has been shown to increase the risk for osteoporosis and fracture in men. 

• High cholesterol. A direct link between high cholesterol (above 200 mg/dL) and low BMD in men was identified in a study published in ­Molecular Medicine Reports in 2019. High cholesterol damages bone microstructure and accelerates bone turnover, so more old bone is resorbed than new bone is created.

• Gastrointestinal disease. People with conditions such as ulcerative colitis, Crohn’s disease and inflammatory bowel disease (IBD) face a higher risk for osteoporosis and fractures, according to research published in Advances in Clinical and Experimental Medicine. These diseases reduce absorption of essential vitamins and minerals that are needed for healthy bones.

• Vitamin D deficiency. A low ­vitamin D level, which research has shown affects 85% of older adults, leads to lower BMD and higher fracture risk. 

• Family history. A family history of fractures—even if a relative was never diagnosed with osteoporosis—increases your risk for low bone density.

In addition to these risk factors, if you’ve lost height (about two or more inches)…suffered a low-trauma fracture (such as a fall from standing height or less)…or experienced sudden, severe back pain, you may have osteoporosis and should get tested immediately (see below).

Get Tested

Doctors rarely test men (especially those under age 70) for osteoporosis, even if they’ve already broken bones. If you have one or more of the risk factors listed earlier, talk to your doctor about ordering the following tests…* 

• Central DEXA (dual-energy X-ray absorptiometry) is the primary tool for diagnosing osteoporosis by measuring BMD in the hip and spine. Your bone density will be reported as a T-score and classified as normal…low (for osteopenia, a precursor to osteoporosis)…or osteoporosis. 

Normal: T-score of –1.0 or higher
Low (osteopenia): T-score between –1.0 and –2.5
Osteoporosis: T-score of –2.5 or lower

• Vitamin D (serum 25-hydroxy-vitamin D) level is a key indicator of fracture risk. Many professional groups consider a vitamin D level of at least 30 ng/mL to be adequate, but osteoporosis experts recommend aiming for at least 40 ng/mL.

Other blood tests to consider… 

  • Complete blood count
  • Sex hormones, particularly free testosterone and free estradiol
  • Calcium and phosphorous levels
  • Kidney, liver and thyroid functions (related disorders can increase risk for osteoporosis in men)

Bone-Strengthening Steps

To prevent fractures, you must keep your bones healthy and strong. What helps… 

• Take calcium and vitamin D supplements. It’s always best to get vital nutrients from food. However, it’s often difficult to get adequate levels. Recommended supplement dosages: For calcium, 500 mg to 600 mg taken twice daily with food…and 1,000 international units (IU) up to 5,000 IU of vitamin D daily. (Consult your doctor for the dosage that’s right for you.) Good brands: Vitamin D supplements from Douglas Laboratories and calcium supplements from Citracal or Caltrate. To boost absorption, take calcium supplements with a meal. 

• Get plenty of weight-bearing exercise. That doesn’t mean you have to hit the gym and lift weights (though resistance exercise can be helpful). Many everyday activities fit the bill, such as walking, hiking and climbing stairs. If you’ve been diagnosed with low bone density, avoid high-impact exercises (such as running) and twisting motions (like swinging a golf club). Aim for 30 minutes of weight-bearing exercise most days of the week to help keep your bones strong.

• Consider osteoporosis medication.While many drugs have been approved to treat osteoporosis, only a few have been approved for use in men. These include alendronate (Fosamax), risedronate (Actonel) and IV zoledronic acid (Reclast). A man may need one of these drugs if he has osteoporosis…is over age 50 and suffers a fracture from a low-trauma injury…or if a screening DEXA of the spine or hip shows osteopenia and there is a family history of low-trauma fracture. Side effects of these drugs may include upset stomach and back pain.