Last year, in Built to Last: Protecting Men’s Bones for Life, we covered the fundamentals of osteoporosis in men, including its diagnosis, the roles of hormones in bone health, why it often goes undiagnosed, and available treatments to reduce fracture risk. While these topics remain relevant, they only reflect a small portion of the disease.
An important understanding of osteoporosis is that many of the biggest threats to bone health are not detected in a doctor’s office or through a bone density scan. Rather, they are incorporated into modern routines and habits. Long commutes, desk jobs, increased screen time, and indoor lifestyles have greatly reduced opportunities for movement and weight-bearing activities, which are required to maintain strong, healthy bones.
Quick Recap: The Basics
Osteoporosis is a condition that weakens bones and increases the risk of fractures. While it is often considered a “women’s disease”, millions of men are affected and frequently go undiagnosed until a fracture occurs, which often causes pain and dysfunction depending on the location of the fracture. Additionally, men generally experience higher risks of complications following injury.
The Indoor Generation
Previous generations spent most of their days outdoors working and engaging in physical activity. In contrast, most people today spend the majority of their day inside, sitting at desks, looking at phones and computer screens, and commuting by car. This shift reduces daily movement, limiting production of vitamin D from sun exposure, which is crucial for calcium absorption. To combat these challenges, we can engage in simple but effective tasks to build and maintain our bone strength, such as walking around the work office during breaks, biking places instead of taking a car or public transportation, using the stairs rather than the elevator, and carving out extra time in our days for outdoor recreational and physical activities. It is important to recognize that these changing societal norms affect bone health across all age groups, not just older adults. Building strong bones as a child and young adult are extremely important for our long-term bone health, since most people reach their peak bone mass around age 30.
Hormones and the Modern Man
Hormonal status plays a key role in men’s skeletal health, but is often overlooked in clinical discussions. Two clinically relevant pieces that highlight this relationship are androgen deprivation therapy (ADT) for prostate cancer and testosterone treatment therapy.
ADT is a standard treatment for prostate cancer. Although it is highly effective oncologically, it can accelerate bone loss and increase fracture risk. Additionally, male patients tend to be unaware of the connection between ADT and bone health. Before starting treatment, patients should discuss bone monitoring with their healthcare provider, and come up with strategies to protect bone strength.
Conversations around “low-T”, a common term used to describe low testosterone levels, have grown rapidly, but its connection to bone health may not be routinely discussed. Testosterone treatment is appropriate for male patients diagnosed with hypogonadism, a condition where individuals struggle to produce testosterone or sperm. Although testosterone enhancement can improve muscle strength, mood, and energy levels, it may also have negative long-term effects on bone health and fracture prevention. Individuals should always consult with a physician to determine if testosterone treatment is suitable for their medical conditions.
Hidden Culprits: A Closer Look at Medications
Prescription medications are often necessary for treating medical issues, but studies have shown that some medications have also been associated with bone loss and an increased risk of fractures. If you are taking any of these medications listed below, consider asking your doctor about how they might be diminishing your bone density and strength, and if there are alternative medications they would recommend. However, it is important to not stop any prescribed medication on your own. Always have a conversation with your healthcare provider before making any changes.
Quick reference — “medications to ask your doctor about”
| Medication / class | Common examples | Why it matters for bone health |
| Glucocorticoids (oral steroids) | Prednisone, dexamethasone | Most common cause of drug-induced bone loss; risk rises with dose and duration |
| Androgen deprivation therapy (ADT) | Leuprolide (prostate cancer) | Major, often-missed driver of rapid bone loss in men |
| Proton pump inhibitors | Omeprazole, pantoprazole | Long-term use linked to reduced calcium absorption and higher fracture risk |
| SSRIs (antidepressants) | Sertraline, fluoxetine | Widely prescribed; associated with lower bone density |
| Thiazolidinediones (diabetes) | Pioglitazone | Linked to higher fracture risk |
| Anticonvulsants | Phenytoin, carbamazepine | Interfere with vitamin D metabolism |
| Loop diuretics | Furosemide | Increase calcium loss through urine |
| Long-term opioids | Morphine, oxycodone, etc. | Can lower sex hormones and raise fall/fracture risk |
| Certain HIV antivirals | Tenofovir (TDF) | Associated with bone density loss |
| Excess thyroid hormone | High-dose levothyroxine | Over-replacement can weaken bone |
Posture, the Spine, and Silent Fractures
Everyday habits can have a major impact on how the body feels and functions. Hours spent sitting at a desk, looking down at phones, and driving can all contribute to neck, shoulder, and back issues, including musculoskeletal misalignment, and weakened muscles supporting the spine. Over time, posture can transition from straight to a more rounded position of the neck and shoulders. Under many circumstances, these posture changes can be improved through daily stretching, strengthening muscles around the spine, moving often, and correcting your posture during daily tasks. However, poor posture is not always caused by lifestyle habits. As men get older, changes in posture may be an early sign of declining bone health.
When osteoporosis affects the spine, vertebrae are more vulnerable to small compression fractures. Osteoporotic vertebral compression fractures occur when the bones in our spine deteriorate and collapse under minimal trauma, which a healthy bone would be able to withstand. As these microfractures accumulate, the spine may lose height, curve forward, and become less flexible. Although these changes may develop gradually with little or no pain, they can sometimes cause sudden sharp back pain. Compression fractures permanently change the spine’s structure, making these posture changes nearly impossible to correct compared to those caused by poor postural habits and muscle weakness alone.
The graphic below illustrates how posture can change as the spine is affected by bone loss.
The first stage represents normal alignment, where the head, shoulders, and hips are vertically aligned. This position supports balance, mobility, and healthy spinal function.
The next stage occurs when the shoulders become rounded and the head shifts forward. These changes may result from postural changes or can be a warning sign of mild vertebral compression.
The final stage is kyphosis (stooped back), which occurs when multiple compression fractures accumulate over time. As these fractures compress the vertebrae, the spine gradually loses height and curves forward.
Though often missed, postural changes can be easily detected on their own. Taking a close look at your posture while walking, sitting, and standing may help identify potential signs of poor bone health before more serious problems develop. Some signs men should look for include losing height, having more rounded shoulders, clothes fitting differently, and increased difficulty standing upright. If you notice any of these changes, then ask your doctor about bone health and if a screening test is needed. If you are diagnosed with compression fractures of the spine, then by definition, you have osteoporosis and need treatment for that. Treatment is very important to avoid further fragility fractures, not only in the spine but also to reduce the risk of having a hip fracture. These fractures can be devastating, both from a pain and quality of life stand point. Recognizing warning signs is imperative.
What Men Can Do
The good news is that many of the factors influencing bone health are within our control, and it is never too early or too late to start caring about your bone health. Whether you are a teen or a senior citizen, it is crucial to spend time outside in the sun, exercise often, and eat a balanced diet.
Men under the Age of 40: During this stage of life, it is urgent to build a foundation that can set you up for the rest of your life. Bone mass peaks around the age of 30, so it is crucial to build strong bones early in life. Participating in weight-bearing and resistance training are very meaningful, and can be completed through activities like weight lifting, running, basketball, soccer, football, etc. Physical activity puts healthy stress on your bones, causing them to constantly regenerate and grow. Spending time outside is good for our bodies, as it supports vitamin D production and calcium absorption for bone health. Men in this age group should stop smoking, limit alcohol consumption, drink lots of milk, and consume a significant amount of protein.
Men in their 40s-60s: As bone density slowly decreases with age, it becomes even more critical to stay active. Strength has likely decreased since your younger days, which is okay! Take care of your body and maintain strength and mobility with age appropriate activities. Some physical activities we recommend include resistance training, weightlifting for muscular endurance, pickleball, golf, biking, hiking, running, and walking. Men who spend most of their days sitting in an office chair should take several breaks throughout the workday to move around. It also helps to spend time outdoors, schedule routine check-ins with your physician to review your health and medications, talk to your physician about vitamins and supplements, and avoid smoking and excessive alcohol use. Ask your physician about a DXA scan if you have risk factors for osteoporosis, such as long-term steroid use, ADT, or low body weight.
Men over the Age of 70: Older men can still improve and maintain their bone health through regular physical activity. Light strength training, balance exercises, walking, swimming, and gardening are all excellent ways to support bone strength, mobility, and coordination. Staying active can also help reduce the risk of falls and provide the strength needed for everyday tasks, whether that is carrying light groceries, working in the yard, or lifting grandchildren. Pay attention to changes in posture and height, as these are likely signs of osteoporosis, and not just part of the aging process. Regular visits with your doctor are also necessary for reviewing your health, your full list of medications, and screening your bone health with a DXA scan.
The Bottom Line
Threats to men’s bone health are often impacted by our daily routines and remain invisible until significant changes in our posture or a bone fracture make them detectable. Protecting our spine and bones starts with recognizing early signs of osteoporosis and practicing healthy habits that support lifelong bone health.
While some risk factors are beyond our control, many of the most important influences on bone health are within our control. The choices you make today, such as exercising regularly, spending time outdoors, eating a balanced diet, and talking with your doctor about your bone health, can have a positive impact on your life. The small steps you take now can help keep you strong, active, and independent for years to come. For more information, download the Bone Health Action Plan.
