Men and osteoporosis

Why it is missed

Osteoporosis is often framed as a women’s health issue, so men may not get screened or may not recognize a fracture as a bone-health warning sign. That delay matters.

In men, secondary contributors are common enough to look for deliberately: medications, low testosterone, alcohol use, smoking, malabsorption, inflammatory disease, kidney disease, cancer treatments, low body weight, or other medical conditions.

When to ask about bone health

• A fracture after age 50, especially from a simple fall.
• Height loss or concern for spine compression fractures.
• Long-term steroid use.
• Low testosterone or symptoms that raise the question.
• Heavy alcohol use, smoking, or unexplained weight loss.
• Family history of hip fracture or osteoporosis.

A plain way to start the conversation

You do not need to know the answer before the visit. A good first question is simply: “Given my fracture or risk factors, should we evaluate my bone health?”

Evidence review

Biology

Men fracture too. Male bone health is influenced by age, sex hormones, muscle, comorbid illness, medications, nutrition, alcohol, tobacco, kidney function, and fall risk. Low testosterone can matter in some men, but it should not become the only explanation.¹³

Epidemiology and risk

Osteoporosis in men is often under-recognized until a fracture occurs. Secondary causes are common enough that they deserve a deliberate search, especially after a low-trauma fracture, unexpectedly low BMD, glucocorticoid exposure, androgen-deprivation therapy, gastrointestinal disease, kidney disease, or multiple medications.³⁴⁵

Presentation and evaluation

Men may present with hip fracture, vertebral compression fracture, wrist fracture, height loss, back pain, or an incidental imaging finding. Evaluation usually includes DXA, fracture history, fall history, medication review, and targeted labs rather than assuming the problem is simply aging.¹⁶

Treatment strategy

The treatment strategy is the same in principle as for women: reduce fall risk, improve strength and nutrition, correct reversible contributors, and consider medication when fracture risk is high. In men, the threshold for taking a fragility fracture seriously should be low, because the diagnosis is too often missed.¹³

References

1. Morin SN, Leslie WD, Schousboe JT. Osteoporosis: a review. JAMA. 2025. doi:10.1001/jama.2025.6003.
2. Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364-376. doi:10.1016/S0140-6736(18)32112-3.
3. Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary osteoporosis. Endocr Rev. 2022;43(2):240-313. doi:10.1210/endrev/bnab028.
4. Gasser RW, Kocijan R, Zendeli A, Resch H. Drug-Induced Osteoporosis. J Clin Med. 2026. doi:10.3390/jcm15030993. PMID:41682673.
5. Kapszewicz M, Michalska-Kasiczak M, Sewerynek E. Glucocorticoid-Induced Osteoporosis: Pathogenesis, the Impact of Different Administration Routes on Bone Mineral Density, and Fracture Risk and Treatment Options-A Narrative Review. J Clin Med. 2026. doi:10.3390/jcm15072488. PMID:41976789.
6. Matzkin EG, DeMaio M, Charles JF, Franklin CC. Diagnosis and Treatment of Osteoporosis: What Orthopaedic Surgeons Need to Know. J Am Acad Orthop Surg. 2019. doi:10.5435/JAAOS-D-18-00600. PMID:31021891.