A legacy of gender bias in medicine
For decades, medical professionals primarily focused on women's bone health, especially after menopause. This has created a self-reinforcing cycle where men are less likely to be screened, diagnosed, and treated for osteoporosis. The misconception that men are not at risk persists among both patients and healthcare providers. Men, on average, have higher peak bone mass and experience a slower rate of age-related bone loss compared to women, but this does not make them immune. The lack of awareness is particularly dangerous because men who suffer a hip fracture are twice as likely to die from complications as women.
Evolving and inconsistent clinical guidelines
Another major factor contributing to the under-screening of men is the lack of universal, consistent clinical guidelines. While organizations like the Endocrine Society and the National Osteoporosis Foundation recommend bone mineral density (BMD) testing for all men aged 70 and older, and for men aged 50–69 with risk factors, other bodies have different stances. The U.S. Preventive Services Task Force (USPSTF), for example, states there is insufficient evidence to recommend routine screening in men. This inconsistency creates confusion and can lead to lower screening rates, as physicians may be less likely to recommend testing if the guidelines are not uniform.
The crucial role of secondary osteoporosis
While women often develop osteoporosis primarily due to age and menopause-related hormonal changes, a significant portion of male osteoporosis is secondary, meaning it is caused by an underlying medical condition, medication, or lifestyle factor. This adds a layer of complexity to diagnosis and screening. Up to 60% of men with osteoporosis have an identifiable secondary cause.
Some common secondary causes in men include:
- Long-term use of certain medications, such as corticosteroids for conditions like asthma or arthritis, and androgen deprivation therapy for prostate cancer.
- Chronic diseases, including hypogonadism (low testosterone), chronic kidney or liver disease, gastrointestinal disorders (like celiac disease), rheumatoid arthritis, and certain hematologic disorders.
- Lifestyle factors, such as excessive alcohol consumption, smoking, and sedentary behavior.
Overlooked risk factors and presenting symptoms
Because osteoporosis is often asymptomatic until a fracture occurs, men may not notice signs of bone loss. Unfortunately, a fracture is often the first and most painful sign of the disease, and by that point, bone density is already significantly compromised. Men should be aware of key risk factors and symptoms that might indicate a need for screening. This includes a history of fracture from a minor fall, significant height loss, or gradual spinal curvature.
Comparison of Osteoporosis in Men vs. Women
| Feature | Osteoporosis in Men | Osteoporosis in Women |
|---|---|---|
| Prevalence | Lower, approximately 4.4% of men over 50. | Higher, about 19.6% of women over 50. |
| Onset | Later, typically 10 years later than in women. | Earlier, accelerated after menopause. |
| Mortality after Hip Fracture | Higher, men are twice as likely to die from complications. | Lower compared to men, but still a serious risk. |
| Primary Cause | More likely to be secondary (underlying disease, meds). | Often related to postmenopausal hormonal changes. |
| Awareness & Screening | Lower awareness; underdiagnosed and undertreated. | Higher awareness; more routine screening. |
The path forward: Improving male bone health
Improving osteoporosis care for men requires a multi-pronged approach involving increased public awareness, refined clinical guidelines, and better communication between patients and providers. Men, especially those over 50, should proactively discuss bone health with their doctors, particularly if they have any risk factors or a family history of osteoporosis. For healthcare professionals, staying updated on the latest research and guidelines is crucial, as is considering osteoporosis in their male patients, not just their female ones.
Furthermore, broader awareness campaigns and potentially revised screening guidelines could help close the treatment gap that currently exists. A coordinated effort involving public health initiatives, medical organizations, and patient advocacy groups is needed to ensure men at risk are identified and receive the care they need to prevent life-altering fractures. For more in-depth information and resources on bone health, the National Osteoporosis Foundation website is a valuable resource that can assist in further research.
Conclusion
While osteoporosis is less prevalent in men than in women, the consequences of underdiagnosis and undertreatment are more severe, including higher mortality rates following a hip fracture. The question of why aren't men tested for osteoporosis is rooted in historical biases, inconsistent guidelines, and low overall awareness. By addressing these systemic issues and encouraging a more proactive approach to male bone health, we can significantly reduce the devastating impact of this silent disease on men and their families.
