Why the myth persists: How come men don't get osteoporosis?

While it is a common belief that osteoporosis is exclusively a "woman's disease," the reality is far different. In the U.S. alone, millions of men have osteoporosis or low bone mass. Addressing the dangerous misconception behind the question, how come men don't get osteoporosis?, is critical for ensuring men receive the diagnosis and treatment they need to prevent debilitating fractures.

Quick Summary

Men do get osteoporosis, but it is less common and often diagnosed later than in women due to biological differences and lower screening rates. Men's higher peak bone mass and slower hormonal decline offer a temporary protective advantage, but they are still at significant risk, especially as they age.

Key Points

• Osteoporosis affects both men and women: The premise that men don't get osteoporosis is a dangerous and widely held myth; men account for millions of cases and fractures.

• Higher mortality rate in men: Despite a lower fracture rate, men have a significantly higher one-year mortality rate following a hip fracture compared to women.

• Underdiagnosed and undertreated: Due to outdated perceptions and lower screening rates, osteoporosis in men is often missed until a serious fracture occurs.

• Peak bone mass offers temporary protection: Men typically have larger, denser bones and a more gradual hormonal decline, delaying but not preventing osteoporosis.

• Secondary causes are key for men: Medical conditions and certain medications are more likely to be the root cause of osteoporosis in men than in women.

• Fractures are often the first sign: The disease is often silent until a bone breaks, emphasizing the need for proactive risk assessment and screening.

• Lifestyle changes are critical: Maintaining a healthy diet rich in calcium and vitamin D, exercising, and avoiding smoking and excessive alcohol are vital for all adults.

Shattering the Myth: Men Get Osteoporosis

Osteoporosis is a disease that causes bones to become weak and brittle, making them more susceptible to fractures. For decades, it was considered a condition affecting only postmenopausal women, a perception that continues to endanger men's health today. This misconception is largely responsible for why osteoporosis in men is often underdiagnosed and undertreated, even when they suffer severe fractures. Shockingly, men who experience an osteoporosis-related hip fracture have a higher mortality rate within one year than women. The issue is not whether men get osteoporosis, but why it is so frequently missed.

Why Osteoporosis Affects Men Differently

There are several key biological reasons why men typically have a lower prevalence of osteoporosis compared to women. Understanding these distinctions helps clarify why men are not immune to the disease, but merely have a different risk profile.

Differences in peak bone mass and size

On average, men have larger, thicker bones and achieve a higher peak bone mass during their younger years compared to women. This naturally provides them with a greater reserve of bone density as they age, delaying the onset of bone loss and related issues. However, this is not a permanent shield and does not make them invulnerable to the disease later in life.

Hormonal influences and age-related changes

For women, the sharp drop in estrogen levels during menopause is a primary driver of accelerated bone loss. Men, by contrast, experience a slower, more gradual decline in bone-protective hormones like testosterone and estradiol. This slower decline means that bone loss typically begins later in life for men and progresses at a less rapid pace until about age 65–70, at which point the rate of bone loss becomes similar for both sexes.

The role of secondary osteoporosis

While primary osteoporosis, caused by aging, is the most common form in women, secondary osteoporosis plays a larger role in men. In fact, up to 60% of osteoporosis cases in men are linked to an underlying medical condition or specific medication. This includes conditions like hypogonadism (low testosterone), chronic liver or kidney disease, and gastrointestinal disorders that affect nutrient absorption. Long-term use of certain medications, particularly glucocorticoids (steroids), is another significant factor.

Key Risk Factors for Osteoporosis in Men

While biological advantages can delay the onset of osteoporosis, various factors increase a man’s risk over time. Awareness of these risks is the first step toward prevention and early diagnosis.

• Age: Risk increases significantly after age 60, especially after 70.
• Chronic Diseases: Conditions such as rheumatoid arthritis, kidney disease, diabetes, and certain cancers increase risk.
• Medications: Long-term use of glucocorticoids, some anti-seizure medications, and certain prostate cancer treatments (androgen deprivation therapy) can cause significant bone loss.
• Lifestyle: Smoking, excessive alcohol consumption, and a sedentary lifestyle contribute to poor bone health.
• Poor Nutrition: Inadequate intake of calcium and vitamin D can weaken bones over time.
• Family History: A genetic predisposition plays a role in bone density and fracture risk.
• Low Testosterone: Hypogonadism is a major contributor to bone loss in men.

Comparison: Osteoporosis in Men vs. Women

Feature	Men	Women
Peak Bone Mass	Higher and larger skeleton	Lower and smaller skeleton
Prevalence	Lower overall (4.4% of men 50+ in 2017-2018)	Higher overall (19.6% of women 50+ in 2017-2018)
Hormonal Change	Gradual decline in testosterone and estradiol	Rapid drop in estrogen at menopause
Onset of Bone Loss	Later in life (often after 70)	Earlier (rapidly after menopause)
Fracture Mortality	Higher mortality rates after hip fracture	Lower mortality rates after hip fracture
Screening	Often overlooked and under-screened	More routine screening, especially after age 65
Secondary Causes	Up to 60% of cases	Lower percentage of cases

The Path to Proactive Bone Health for Men

Given that osteoporosis in men is often missed until a fracture occurs, a proactive approach is essential. Men should not wait for symptoms to appear before considering their bone health.

Early intervention is key

Discuss your risk factors with your healthcare provider. For men over 70, or younger men with significant risk factors, a bone mineral density (BMD) test, most commonly a DXA scan, is recommended. This can provide an accurate picture of your bone health and determine if treatment is necessary.

Lifestyle modifications

Making healthy lifestyle choices is crucial for preventing and managing osteoporosis.

1. Consume adequate calcium and vitamin D: Aim for 1,000–1,200 mg of calcium and 600–800 IU of vitamin D daily, though some may need more.
2. Engage in weight-bearing exercise: Activities like walking, jogging, dancing, and strength training help strengthen bones and improve balance.
3. Quit smoking and limit alcohol: Both tobacco and excessive alcohol consumption negatively impact bone density.
4. Prioritize fall prevention: For older men, strategies like removing clutter and using nightlights can significantly reduce the risk of fall-related fractures.

Medical treatments

If diagnosed with osteoporosis, several effective medications are available, including bisphosphonates and teriparatide, which are proven to increase bone density and reduce fracture risk. In cases of hypogonadism, testosterone therapy may also be beneficial.

Conclusion: A Clearer Picture of Bone Health

The myth that men do not get osteoporosis is both false and dangerous. While men have certain biological advantages that lead to a later onset and lower prevalence, they are far from immune. Higher peak bone mass and a slower hormonal decline offer a head start, but secondary causes, poor lifestyle habits, and general aging can and do lead to osteoporosis. Awareness of risk factors, proactive discussions with healthcare providers, and regular screening for at-risk individuals are the most effective ways to combat the underdiagnosis and significant mortality associated with this often-overlooked condition in men.

For more information on bone health, visit the Bone Health & Osteoporosis Foundation.

Frequently Asked Questions

If men get osteoporosis, why does it seem so much less common?

It is less prevalent, primarily because men generally have higher peak bone mass and don't experience the rapid, menopausal-related hormonal decline that accelerates bone loss in women. This gives men a protective advantage, but it is not a safeguard against the disease.

What is the biggest difference in osteoporosis risk between men and women?

A key difference lies in the causes. For men, secondary causes—other medical conditions or medications—are responsible for a higher percentage of cases than in women. By contrast, menopause is the main driver for accelerated bone loss in women.

How are the symptoms of osteoporosis different in men?

The symptoms are not different, but they are often overlooked in men, and the disease is often not diagnosed until a fracture occurs. Common signs include back pain, loss of height, a stooped posture, and a bone breaking from a minor fall.

Should men be screened for osteoporosis with a DXA scan?

Routine screening for men is less common than for women, but major health organizations recommend that men over 70, or younger men with significant risk factors, discuss a DXA scan with their doctor. Earlier diagnosis is critical for better outcomes.

What are some of the most common risk factors for osteoporosis in men?

Common risk factors include advancing age (over 60), low testosterone, long-term use of steroid medications, chronic diseases like kidney disease, smoking, excessive alcohol consumption, and a family history of osteoporosis.

Why is the mortality rate higher for men after an osteoporosis-related fracture?

The higher mortality rate is likely due to the fact that men tend to experience fractures later in life, when they often have more comorbidities and are generally in worse health. This makes complications more serious and recovery more difficult.

Can lifestyle changes prevent osteoporosis in men?

Yes, lifestyle changes are a powerful tool for prevention. Regular weight-bearing exercise, a diet rich in calcium and vitamin D, avoiding smoking and heavy drinking, and implementing fall-prevention strategies can help maintain strong bones.