Most of the people who read this blog are women, and most of what I write assumes that. This post is different. It's for the men in your life: your husband, your brother, your father, the neighbor who just broke his wrist slipping on the ice. If one of them comes to mind as you read, please send it to him.
Osteoporosis is often thought of as a women's disease. It isn't. Men do get it less often than women. They're also much less likely to be diagnosed, and they tend to do worse once a fracture happens.
How Common Is It in Men?
Women do have osteoporosis more often. In US national survey data, about 20 percent of women over 50 have osteoporosis, compared with about 4 percent of men (US Preventive Services Task Force, 2025).
But that lower number hides a lot of broken bones. A 2024 international guideline on osteoporosis in men estimates that about one in five men over 50 will have a fracture caused by osteoporosis at some point in the rest of their lives (Evidence-Based Guideline for osteoporosis in men, 2024). One reason is that most men who break a bone don't have a T-score in the osteoporosis range. The Endocrine Society points out that the majority of men who fracture have bone density that looks better than the official cutoff (Endocrine Society guideline, 2012). Age and falls matter a great deal, whatever the T-score says.
Why Men Fare Worse After a Fracture
This is the part that surprises people. When men do break a hip, they're more likely than women to die in the months that follow.
A large analysis pooling studies from many countries looked at what happens after a hip fracture. In the first three months, a woman's risk of dying was almost six times higher than for a woman the same age who hadn't broken her hip. For men, it was about eight times higher. And at any given age, the extra risk stayed higher in men for years afterward (Haentjens and colleagues, 2010). The 2024 guideline on men says the difference is thought to come from men having more other health problems and more infections during recovery.
A hip fracture is a serious event at any age, for anyone. For men, it's even more serious than most people realize.
Why Men Get Missed
Women have menopause, a clear signal that prompts doctors to start thinking about bone. Men have no equivalent milestone, so bone health often doesn't come up at all.
Screening guidelines reflect that gap. The US Preventive Services Task Force recommends bone density screening for all women 65 and older, and for younger postmenopausal women at higher risk. For men, it concluded that the evidence isn't strong enough to make a recommendation either way. The Task Force was clear that this is not a recommendation against screening men. It's a call for more research, and in the meantime it says men and their doctors should decide together.
The Endocrine Society is more direct. It suggests bone density testing for men 70 and older, and for men 50 to 69 who have additional risk factors. It singles out a broken bone after age 50 as a particularly important reason to be tested.
Even after a fracture, men are less likely to be treated. In a study of nearly 97,000 Americans hospitalized for a hip fracture, being male was one of the factors linked with a lower chance of starting osteoporosis medication within a year (Solomon and colleagues, 2014). The 2024 guideline on men says plainly that the disease is underdiagnosed and undertreated in men.
Risk Factors to Watch for in Men
Men share many of the same risk factors as women, including age, low body weight, smoking, a past fracture, and a parent who broke a hip. A few deserve extra attention in men:
- Low testosterone. Both the Endocrine Society and the Task Force list it as a risk factor. Part of testosterone's bone protection in men comes from the body converting some of it into estrogen.
- Prostate cancer treatment. Androgen deprivation therapy, which lowers testosterone on purpose, causes fast bone loss. Spine bone density typically drops about 3 to 4 percent in the first year (Endocrine Society).
- Long-term steroids, such as prednisone for lung disease or arthritis.
- Heavy drinking. Alcohol is a well-known risk factor for fractures in men, and the Endocrine Society notes that the risk can stay elevated even after drinking is cut back.
- Chronic lung disease (COPD), which the Endocrine Society lists among reasons to test men under 70.
Several medications that weaken bone apply to men as well. My post on medications that can quietly weaken your bones goes through them.
Signs That Should Prompt a Conversation
Osteoporosis is silent until something breaks. These are the signals that a man should ask his doctor about his bones:
- A broken bone after age 50 from a minor fall or bump, such as a fall from standing height.
- Losing height. Measure against a wall and compare with your tallest adult height.
- A new stoop or rounding of the upper back.
- Sudden back pain without an obvious injury, which can be a spine fracture.
- Any of the risk factors above, especially prostate cancer treatment or long-term steroids.
Testing in Men
Testing works the same way it does for women. A DEXA scan of the spine and hips measures bone density. FRAX, the fracture risk calculator, works for men too, and the 2024 guideline recommends it as the main tool for deciding who needs treatment. My post on FRAX and FRAX-plus explains how it works.
Your doctor should also look for other causes. Both the Endocrine Society and the 2024 guideline recommend checking testosterone as part of the workup, along with basic blood tests like vitamin D, calcium, and kidney function. If a man might have spine fractures he doesn't know about, a quick extra scan called VFA can check during the same DEXA visit. I explain it in my post on TBS and VFA.
Treatment Works for Men Too
Several of the same medications used in women are FDA-approved for men with osteoporosis. These include alendronate (Fosamax), risedronate (Actonel), zoledronic acid (Reclast), denosumab (Prolia), teriparatide (Forteo), and abaloparatide (Tymlos). One exception: romosozumab (Evenity) is approved in the US only for postmenopausal women.
The 2024 guideline names oral bisphosphonates, alendronate or risedronate, as first-line treatment for men at high risk of fracture. That matches the approach for women.
The research in men is thinner. Several of these drugs were approved for men based on bone density gains rather than fewer fractures. The FDA labels for alendronate, risedronate, and denosumab, for example, describe them as treatment "to increase bone mass" in men. The clearest fracture result comes from a trial of zoledronic acid, the once-a-year infusion, in 1,199 men with osteoporosis. Over two years, about 2 in 100 men getting the drug had a new spine fracture, compared with about 5 in 100 men getting a placebo (Boonen and colleagues, 2012). That's about three fewer spine fractures for every hundred men treated. As with almost every osteoporosis trial, this compared the drug with a placebo, not with other medications. My guide to the osteoporosis injections explains why those comparisons matter.
What about testosterone? If a man's levels are low, testosterone replacement may be considered. But the 2024 guideline says men with osteoporosis and low testosterone should usually still get an established osteoporosis medication, whether or not they also take testosterone. Testosterone on its own isn't a substitute for osteoporosis treatment.
The Basics Are the Same
Everything else on this site applies to men. Strength training and weight-bearing exercise build bone in men as well as women. Men need enough calcium, vitamin D, and protein. Fall-proofing the house matters just as much. If the man in your life is a weightlifter already, good. My post on squats, lifting, and bending with osteoporosis covers how to keep doing it safely.
How to Bring It Up
Men often don't ask about bone health, and many doctors don't raise it unprompted. That's where you come in.
If your husband, brother, or father is over 70, or over 50 with any of the risk factors above, encourage him to ask at his next checkup: "Should I have a bone density scan?" If he's already broken a bone after 50, he should ask whether osteoporosis played a role. And if he's starting treatment for prostate cancer, he should ask about protecting his bones before or soon after he starts.
You can be the reason a man gets tested before his first fracture rather than after it.