Men do get osteoporosis, but doctors often miss it

Yes, men can and do develop osteoporosis. About one in four men over age 50 will break a bone due to osteoporosis in their remaining lifetime. Despite this, osteoporosis is often thought of as a women's disease, which means men are screened less often and diagnosed later — sometimes only after a fracture happens.

The difference is timing. Women's bone loss accelerates sharply after menopause when estrogen drops. Men lose bone more slowly and steadily over time, starting around age 30. By the time a man reaches 70, his bone loss rate catches up to a woman's, but because he started with denser bones and lost them more gradually, the disease often goes unnoticed until a fall or minor injury causes a break.

Men who break a hip, spine, or wrist from a fall that would not normally cause a fracture should be tested for osteoporosis. A doctor may not suggest this test without prompting, so it is worth asking about bone density screening if you have had an unexpected fracture.

Key Takeaways

  • Men develop osteoporosis at older ages than women on average, but one in four men over 50 will experience an osteoporosis-related fracture.
  • Low testosterone, certain medications (including some blood pressure and seizure drugs), and conditions like chronic kidney disease or COPD raise a man's osteoporosis risk.
  • A bone density test (DEXA scan) is the only way to know if you have osteoporosis; you cannot feel weak bones.
  • Men should ask their doctor about bone screening if they have risk factors, a family history of osteoporosis, or have broken a bone from a minor fall.

Why men's osteoporosis is often missed

Screening guidelines for men are less clear than for women. Most guidelines recommend bone density testing for all women at age 65 and for men at age 70, but many doctors do not routinely order these tests. Men are also less likely to report falls or minor injuries to their doctor, which means the first sign of weak bones — a fracture — may be the first time osteoporosis is discovered.

Another reason for missed diagnosis is that men tend to have larger frames and higher peak bone mass than women. A man can lose significant bone density and still have a score that looks "normal" compared to other men, even though his bones are genuinely weak. This means some men with real osteoporosis fall into a gray zone called osteopenia (low bone mass) on their test results, and doctors may not treat it as seriously.

What causes osteoporosis in men

The most common cause of osteoporosis in men is low testosterone. Testosterone helps maintain bone density, just as estrogen does in women. Men whose testosterone drops due to age, cancer treatment, or conditions like hypogonadism face higher fracture risk. Other hormonal causes include low thyroid hormone and too much cortisol (from Cushing's syndrome or long-term steroid use).

Certain medications weaken bones over time. Glucocorticoids (steroids used for asthma, COPD, rheumatoid arthritis, and other conditions) are the most common culprit. Some blood pressure medications, seizure drugs, and prostate cancer treatments also increase bone loss. If you take any of these regularly, mention it to your doctor when discussing bone health.

Chronic diseases raise risk too. Men with kidney disease, liver disease, COPD, diabetes, or rheumatoid arthritis lose bone faster than others. Heavy alcohol use, smoking, and low calcium or vitamin D intake also contribute. A man with multiple risk factors should ask about bone density testing even before age 70.

How bone density testing works for men

A DEXA scan (dual-energy X-ray absorptiometry) is the standard test for bone density. It takes about 10 to 30 minutes, involves no needles, and uses a very small amount of radiation — less than a chest X-ray. You lie on a table while a scanner passes over your hip, spine, and sometimes your forearm. The test produces a T-score that compares your bone density to that of a healthy 30-year-old man.

The results fall into three categories: normal (T-score of −1.0 or higher), osteopenia (T-score between −1.0 and −2.5), or osteoporosis (T-score of −2.5 or lower). Some doctors also order a FRAX score, which estimates your 10-year risk of breaking a hip or major bone. This helps decide whether treatment is needed, especially if your T-score is in the gray zone.

If you have osteoporosis or osteopenia with other risk factors, your doctor may order follow-up tests to check your testosterone level, vitamin D level, and kidney function. These results guide treatment decisions.

Treatment options for men with osteoporosis

The first step is always addressing the underlying cause. If low testosterone is the problem, hormone replacement may help. If a medication is weakening your bones, your doctor may switch you to an alternative. If you have vitamin D deficiency, supplementation is straightforward and important.

Bone-strengthening medications are available if lifestyle changes alone are not enough. Bisphosphonates (such as alendronate) are the most commonly prescribed. They slow bone loss and are taken as a weekly pill or monthly injection. Other options include denosumab (an injection given twice yearly) or teriparatide (a daily injection that actually builds new bone). Your doctor will choose based on your bone density score, fracture risk, kidney function, and other health conditions.

Lifestyle matters just as much as medication. Weight-bearing exercise (walking, jogging, dancing, climbing stairs) and strength training help maintain bone density. Adequate calcium (1,000 to 1,200 mg daily for men over 50) and vitamin D (800 to 1,000 IU daily, or more if your level is low) are essential. Limiting alcohol and quitting smoking also slow bone loss.

When to ask your doctor about bone screening

You should discuss bone density testing with your doctor if you are a man over 70, or if you are younger but have any of these risk factors: low testosterone, long-term use of steroids or other bone-weakening medications, chronic kidney or liver disease, COPD, rheumatoid arthritis, a family history of osteoporosis or hip fracture, or a personal history of fracture from a minor fall.

If you have already broken a bone — especially your hip, spine, or wrist — from a fall that seems minor (like stepping off a curb or falling from standing height), ask for a bone density test. This type of fracture in an older adult is a red flag for osteoporosis and warrants investigation.

Do not wait for symptoms. Osteoporosis has no symptoms until a bone breaks. The only way to know your bone density is to be tested.

Preventing fractures if you have osteoporosis

Once you know you have weak bones, preventing falls becomes critical. Remove tripping hazards at home (loose rugs, clutter on stairs), install grab bars in the bathroom, wear shoes with good grip, and keep your home well-lit. Ask your doctor about vision and balance screening, as poor eyesight and balance problems are major fall risk factors.

If you take medications that cause dizziness or drowsiness, review them with your doctor — sometimes the timing or dose can be adjusted to reduce fall risk. Stay active with weight-bearing and balance exercises; physical therapy can teach you specific movements that improve stability.

Protect your bones during activities. If you have osteoporosis of the spine, avoid bending forward sharply or twisting, as these movements can cause vertebral fractures even without a fall. Your doctor or physical therapist can show you safer movement patterns.

Frequently Asked Questions

At what age should a man get a bone density test?

Most guidelines recommend screening at age 70 for all men. Men under 70 with risk factors — low testosterone, long-term steroid use, chronic kidney disease, or a family history of osteoporosis — should discuss screening with their doctor. If you have broken a bone from a minor fall at any age, ask for a test.

Can osteoporosis in men be reversed?

Osteoporosis cannot be fully reversed, but bone loss can be slowed or stopped with medication and lifestyle changes. Some newer medications like teriparatide can actually increase bone density. The goal is to prevent further loss and reduce fracture risk.

Is osteoporosis in men hereditary?

Family history does raise risk, but osteoporosis in men is usually caused by modifiable factors like low testosterone, medication side effects, or vitamin D deficiency. Even if your father had osteoporosis, you may avoid it by addressing these causes early.

Do I need to take calcium supplements if I have osteoporosis?

Most men can get enough calcium from food (dairy, leafy greens, fortified products). Supplements are useful if your diet is low in calcium or if you cannot tolerate dairy. Aim for 1,000 to 1,200 mg daily total from all sources. Ask your doctor whether supplements are right for you.

What should I do if I fall and think I may have broken something?

Seek medical care right away. Do not try to move the injured area. If you have osteoporosis and break a bone, tell your doctor — this may change your treatment plan. After healing, ask about physical therapy to rebuild strength and prevent future falls.