How Does Osteoporosis Affect Men?

Osteoporosis is a bone disease that causes bones to become weak and brittle. Because bones get so fragile, some as simple as bending over or coughing can cause a fracture (bone break). Women are four times more likely to get osteoporosis than men, but men can still get the condition. By age 70, men will catch up with women in the rate that they lose bone tissue.

Because men tend to be older when they get osteoporosis, fractures can mean more serious complications for them. Learn about how osteoporosis affects men and the ways in which men can protect themselves from osteoporosis and complications associated with this condition.

Male Risk Factors for Osteoporosis

Bone loss in men usually occurs later in life and progresses more slowly. Unlike women, men have no period of rapid hormonal change that will lead to bone loss.

By age 65 or 70, men and women will start to lose bone mass at the same rate, and calcium, which is important for bone health, starts to decrease in both sexes. Excessive bone loss will eventually make bones more fragile and more likely to fracture.

Research shows when men experience osteoporosis fractures, they are more likely to become disabled. Fractures from osteoporosis most commonly affect the hip, spine, or wrist.

Hip fractures in older men are more dangerous. According to a 2014 review in the journal Bone Research, one-third of hip fractures occur in men and men are twice as likely to die within a year after a hip fracture.

Risk factors for men that lead to bone loss and fractures include:

• Certain medications, such as proton pump inhibitors, anti-depressants, dopamine antagonists, thiazolidinediones, and immunosuppressives
• Chronic diseases of the kidneys, lungs, or stomach or that might alter hormone levels
• Undiagnosed low levels of the sex hormone testosterone
• Unhealthy lifestyle habits like smoking, excessive alcohol use, low calcium intake, and a sedentary lifestyle
• Having a small body frame
• Increasing age
• Family history: Osteoporosis runs in families
• Race: White men seem to have the highest risk for osteoporosis, but men from all ethnic groups can develop the condition

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Sex Differences

Researchers do know that men have larger bones than women. That means they will have larger bone reserves to draw upon as they get older, so their bone loss is much slower. Also, men do not experience the same rapid bone loss that women experience during and after menopause, the time in life when menstrual periods stop.

Because bone loss is delayed in men and osteoporosis doesn’t typically cause symptoms, most men do not know they have the condition until they have a fracture. But osteoporosis tends to be unrecognized and undertreated in men. And according to a 2015 report in the journal Clinical Epidemiology, the number of men with osteoporosis is unknown.

Generally, osteoporosis is diagnosed using tests that measure bone strength and mass of bone called bone mineral density (BMD) tests. But these tests aren’t particularly useful for diagnosing men. This is because the guidelines for bone density are standards designed with women in mind.

And the average bone mass for most healthy women is always lower than what is seen in healthy men. That means a man can have a lower bone mass compared to other men, but in comparison to women, their bone mass will be higher. That makes it harder to determine if a man has a low bone density (osteopenia) or osteoporosis.

A study presented at the 2020 American College of Rheumatology (ACR) annual meeting confirms the sex disparities in osteoporosis and that men with osteoporosis are often underdiagnosed and undertreated even after they experience fractures.

The ACR study looked at 9,876 American males who experienced fractures from 2010 to 2014. Of this group, 61% were 75 years or older around 90% were white.

Here, the researchers found less than 6% had undergone BMD testing in the two years prior to their fractures. This was despite the fact that more than 60% had musculoskeletal pain and 48.5% had a history of opioid use.

Additionally, among the study participants, 92.8% did not have a diagnosis of osteoporosis and were not treated for osteoporosis at the time of their fractures. Less than 3% were diagnosed with osteoporosis before the fracture but never received any treatment. Around 2% had a diagnosis and were receiving appropriate treatment.

Prevention

Early detection of osteopenia or osteoporosis is the most important step towards preventing and treating osteoporosis in men.

Even if you are diagnosed with osteopenia or osteoporosis, there are still things you can do to stop the progress of bone loss. But effective treatment and prevention can’t occur if men don’t know they have osteoporosis or that they are at risk for the condition.

The only way to accurately test the strength and mass of bones is with a BMD test. The National Osteoporosis Foundation recommends BMD testing for men who:

• Are over age 70
• Are ages 50 to 69 with risk factors
• Have had an X-ray of the spine showing a break or bone loss
• Have had back pain with a possible break in the spine
• Have height loss of 1/2 inch or more within one year
• Have a total height loss of 1 1/2 inch to their original height

Treatment

Treating osteoporosis isn’t much different than treating women with the condition. It generally involves the adoption of healthy habits and medications to reduce bone loss and build bone thickness.

Medicines used to treat or prevent osteoporosis include:

• Bisphosphonates, such as Fosamax (alendronate) and Reclast (zoledronic acid) to slow down bone thinning and increase bone density
• Prolia (denosumab) to reduce fracture risk in men who have an increased risk for fracture or who are receiving androgen deprivation therapy
• Parathyroid hormones like Forteo (teriparatide) to treat men with severe osteoporosis or who have a higher fracture risk. Forteo is given by injection.

You can also slow down osteoporosis with healthy habits, including:

• Not smoking
• Limiting alcohol consumption
• Getting plenty of weight-bearing exercises, such as walking jogging, and lifting weights, to strengthen bones
• Getting enough vitamin D and calcium in your diet
• Doing what you can to prevent falls, including making sure your home is well lit, reducing clutter around your home, and using handrails on stairs and assistive devices, such as a cane

A Word From Verywell

Osteoporosis—regardless of your sex—can have serious effects. It can lead to fractures, which can be painful, take longer to heal, and that might lead to other problems.

If you think you might have osteoporosis or have risk factors for the condition, including family history, talk to your healthcare provider. They can work with you to put together a prevention plan to improve your bone health and reduce your risk for fractures.

If you have been diagnosed with osteoporosis and it is affecting your quality of life, talk to your practitioner about possible solutions. Try to keep a positive outlook as you figure out newer and safer ways to continue doing the things you enjoy.