Osteoporosis has long been viewed as a “women’s disease,” yet it affects millions of men—often with severe, life-altering consequences. Despite its prevalence, osteoporosis in men remains significantly under-recognized and undertreated. In a recent episode of Spine Talks, Dr. Rita Roy, CEO of the National Spine Health Foundation (NSHF), discussed this important issue with Dr. Paul Anderson, orthopedic spine surgeon at the University of Wisconsin and co-chair of NSHF’s Bone Health Task Force, and Dr. Benjamin Elder, neurosurgeon and spine surgeon at the Mayo Clinic in Rochester, Minnesota, and a member of the NSHF Bone Health Task Force.
What Is Osteoporosis, and Do Men Get It?
Osteoporosis is a chronic condition characterized by decreased bone mineral density, resulting in fragile bones that are more prone to fractures. While often associated with women, especially postmenopausal women, osteoporosis affects men as well. In fact, “one out of four people with osteoporosis are men,” according to Dr. Anderson. Referred to as a “silent disease,” osteoporosis is often undiagnosed until a fracture occurs, because it progresses without obvious symptoms.
Why Are So Many Men Undiagnosed?
Men with osteoporosis often have underlying health conditions—such as neurologic or metabolic disorders—that contribute to bone loss and increased fracture risk. Despite the risks, men are significantly less likely than women to be screened for osteoporosis. Dr. Anderson notes that men are only one-third as likely as women to undergo bone density testing. Dr. Elder adds that while many of his female patients have had recent bone density scans, fewer than 10% of his male patients have ever been tested. This discrepancy may be partially attributed to the public perception of osteoporosis as a women’s health issue, leading many men to dismiss the need for evaluation. Compounding the problem is a lack of male-specific screening guidelines. Most national osteoporosis screening recommendations focus on postmenopausal women, leaving a gap in guidance for male patients. Cultural stigma and insufficient awareness among primary care providers further exacerbate the issue.
How Can Men Get Diagnosed?
Osteoporosis typically becomes a concern for men between the ages of 60 and 80, with the risk increasing significantly after age 70. The primary diagnostic tool is a DEXA scan, which measures bone mineral density. A Vertebral Fracture Assessment may also be used to detect existing fractures that could indicate low bone density. A comprehensive evaluation should also include an assessment of risk factors such as nutrition, smoking, alcohol use, medical history, comorbidities, and lifestyle habits.
Treatment Options for Men
While living with osteoporosis can be challenging, it is manageable through a combination of lifestyle changes and medical treatments. Dr. Elder emphasizes minimizing risk factors like smoking and excessive alcohol consumption. Maintaining adequate levels of calcium and vitamin D is also crucial for bone health.
Pharmacological options include bisphosphonates, commonly used to prevent fractures in those already diagnosed. For severe cases or patients with spinal or hip fractures, anabolic medications such as teriparatide (Forteo) and abaloparatide (Tymlos) may be recommended to stimulate bone growth.
Why Bone Health Matters
Bone health is a critical factor in overall well-being, especially when it comes to surgical outcomes. Dr. Anderson highlights the importance of bone density in spinal procedures, where the ability of screws to anchor properly can be compromised by low bone quality. Poor bone health increases the risk of surgical complications and reduces the likelihood of a successful recovery. Additionally, men experience higher mortality rates following fragility fractures. Loss of mobility due to multiple fractures often leads to long-term care or loss of independence. According to Dr. Anderson, proactive screening and treatment are key to “preventing loss of independence even more than fractures themselves.”
Taking Control of Your Bone Health Journey
The first step in managing osteoporosis is recognizing personal risk and initiating a conversation with a healthcare provider. Dr. Elder underscores the importance of empowering men to advocate for themselves—seeking evaluation, treatment, and education. Raising awareness through community engagement and encouraging healthcare providers to include men in osteoporosis education are critical steps in addressing this public health gap.
“Osteoporosis and bone health are of critical importance in both men and women,” says Dr. Elder. Although often overlooked, osteoporosis in men is a significant health issue that can profoundly affect quality of life and independence. Fortunately, early diagnosis, regular screening, and effective treatment options can help men maintain strong bones and lead active, healthy lives. Promoting bone health as a routine part of men’s preventive care is an essential step forward.
