Osteoporosis is a skeletal disorder marked by reduced bone strength and an increased risk of fractures.
Osteoporosis is a skeletal disorder marked by reduced bone strength and an increased risk of fractures. It commonly develops due to aging, genetics, lifestyle factors, and certain medical conditions or medications.
Your bones are largely made up of minerals like calcium and phosphorus that make them strong. Some age-related bone loss is normal, but when bone density falls below specific thresholds, it’s classified as osteopenia or osteoporosis, depending on severity.
The development of osteoporosis can be slow. Many people don’t know that they have it until a bone breaks.
Women are more prone to osteoporosis than men due to hormonal factors and generally having smaller bones. However, osteoporosis is still a risk for older men. It’s estimated that 1 in 5 men over the age of 50 will experience a broken bone related to osteoporosis.
Osteoporosis is often referred to as a “silent disease” because it generally doesn’t cause noticeable symptoms until a bone fractures.
Some other potential signs can include:
Loss of height. Over time, vertebral fractures related to osteoporosis can compress the spine, leading to a noticeable decrease in height.
Stooped posture. As vertebrae collapse, the upper back can develop a forward curve, called kyphosis.
Back pain. While not everyone with vertebral fractures or osteoporosis experiences pain, some men might develop chronic, aching back pain that worsens with standing or walking and improves with rest.
Breathing difficulties. Severe cases of stooped posture can reduce the space in your chest cavity and affect lung function.
Many of these signs and symptoms don’t appear until the disease has progressed significantly.
Up to 40 to 60 percent of osteoporosis cases in men are secondary to an underlying condition. A common contributor is hypogonadism, the medical term for low testosterone. Testosterone plays an essential role in supporting both your bone and muscle strength.
Other conditions that can contribute to the development of osteoporosis in men include:
Age-related testosterone decline. As mentioned, testosterone plays an important role in maintaining skeletal health and bone strength. Low levels of testosterone become more common with age, with a slow decline usually starting around 35.
Medical conditions affecting the testes. Some medical conditions, such as Klinefelter syndrome, mumps, or testicular injuries, can impair testosterone production and may make you more prone to osteoporosis.
Pituitary gland disorders. The pituitary gland produces luteinizing hormone, which stimulates the release of testosterone from your testes. Conditions like pituitary tumors can lead to lower testosterone.
Hyperparathyroidism. Overactive parathyroid glands can accelerate bone breakdown by increasing parathyroid hormone (PTH) levels.
Kidney or liver disease. These conditions can interfere with vitamin D activation and calcium regulation, both of which are essential for healthy bones. People with end-stage kidney disease who have osteoporosis have a 2.5 times increased risk of fracture compared to people with osteoporosis who don’t have kidney problems.
Medications may also affect calcium levels and bone strength. Here are some examples:
Glucocorticoids. These are used to treat many conditions, such as asthma, rheumatoid arthritis, and inflammatory bowel disease. While they are helpful for reducing inflammation, they also suppress bone formation and increase bone breakdown.
Anticonvulsants. Some medications used for epilepsy can interfere with vitamin D metabolism, which is essential for calcium absorption.
Prostate cancer treatments. Androgen deprivation therapy, which lowers testosterone levels, is a major risk factor for bone loss in men being treated for prostate cancer.
Osteoporosis is caused by a mix of lifestyle habits, genetics, and other factors. Risk factors for osteoporosis can be divided into those you can control and those you can’t.
The risk factors you can’t control include:
Age. The older you get, the higher your risk of osteoporosis becomes. Men have a large spike in the risk of fracture after 75 years of age, about 10 years later than women.
Family history. If you have a parent or sibling with osteoporosis, especially if they have experienced a hip fracture, your risk is elevated. Your family history plays a role in determining your peak bone mass.
Race. White and Asian men have a higher risk of osteoporosis compared to other groups, although it can develop in men of all backgrounds.
Previous fracture. If you've already experienced a broken bone from a minor fall after the age of 40, your risk of future fractures is higher.
Small body frame or low body weight. Men with lower body weight or body mass index tend to have lower peak bone mass, increasing osteoporosis risk.
Gastrointestinal disorders. Conditions like Crohn's disease, celiac disease, and ulcerative colitis can impair the absorption of bone-healthy nutrients, including calcium and vitamin D, even if you get enough from your diet.
Modifiable risk factors you can change include:
Low testosterone levels. Low T, or hypogonadism, is a major osteoporosis risk factor. Men with confirmed testosterone deficiency and related symptoms may benefit from testosterone replacement therapy.
Low calcium intake. Your body needs calcium to build and maintain strong bones. If you don’t get enough in your diet, your body will draw it from your bones.
Vitamin D deficiency. Vitamin D is crucial for calcium absorption. Without enough, even a calcium-rich diet won't fully benefit your bones. You get vitamin D through sunlight and foods like oily fish.
Sedentary lifestyle. A lack of physical activity signals to your bones that they don't need to be strong, leading to bone loss. In contrast, regular exercise helps strengthen your bones.
Excessive alcohol use. Alcohol can interfere with calcium absorption and vitamin D activation, increasing your risk of osteoporosis. The risk becomes higher with larger amounts of alcohol. For instance, the risk is higher for people who have two to three drinks per day compared to those who have one to two per day.
Smoking. Tobacco use can also interfere with hormone function and bone density.
Certain medications. Long-term use of specific medications, such as corticosteroids like prednisone, some anti-seizure drugs, and certain prostate cancer treatments, is a well-known risk factor for osteoporosis. Always discuss bone health implications with your doctor if you're on these medications.
Your healthcare provider might suspect osteoporosis based on the results of a physical exam and review of your medical history, especially if you have a history of fractures.
To confirm the diagnosis, you need to receive a bone mineral density (BMD) test. The most common test is a dual-energy X-ray absorptiometry (DXA or DEXA) scan.
A DEXA scan is a painless bone density test that uses a specialized X-ray that measures the composition of your bones, typically in your hip and spine. The results are compared to the bone density of a healthy young adult (T-score) and to people of your own age and sex (Z-score).
Here’s how the results are interpreted:
-1.0 or above: normal, healthy bone density
-1.0 and -2.5: osteopenia, a condition where bone density is lower than normal but not yet at the osteoporosis threshold
-2.5 or lower: low enough to diagnose osteoporosis.
At this time, the U.S. Preventive Services Task Force states there is insufficient evidence to recommend routine osteoporosis screening in men.
Blood and urine tests can help identify potential causes of osteoporosis. These tests can measure:
Calcium and vitamin D levels
Testosterone levels
Thyroid and parathyroid hormone levels
Kidney and liver function
Bone turnover rate
If you've been diagnosed with osteoporosis, treatment aims to stop further bone loss, increase bone density, and reduce your risk of fractures.
Although men have fewer fractures linked to osteoporosis than women overall, the risk of mortality is higher in men after a fracture.
It’s been estimated that only 10 percent of men with osteoporosis receive adequate treatment.
Depending on your underlying causes, your doctor may recommend medications and, in some cases, testosterone replacement therapy if you have confirmed hypogonadism.
Medications are the primary treatment for strengthening bones after an osteoporosis diagnosis. They fall into two main categories.
These medications slow down bone loss. You may receive:
Bisphosphonates. Medications such as alendronate, risedronate, or zoledronic acid are often the first-line treatment for osteoporosis. They can be highly effective at reducing the risk of hip and spine fractures.
Denosumab (Prolia®). Denosumab is an injectable medication given every six months. It's particularly useful for men who can't take bisphosphonates or have kidney issues.
Anabolic medications help stimulate new bone formation, increasing bone density. They are typically reserved for men who don’t respond well to other treatments.
Options include:
Teriparatide (Forteo®) and abaloparatide (Tymlos®). These are daily injectable synthetic parathyroid hormones. They promote new bone formation and can significantly reduce fracture risk.
Romosozumab (Evenity®): This is a newer injectable medication that has a dual effect. It increases bone formation and decreases bone resorption. It's typically given once a month for 12 months.
TRT may be an option for men with confirmed hypogonadism and osteoporosis to help improve bone density. It’s not used as an osteoporosis treatment in men with normal testosterone levels.
We offer telehealth options where you can talk to a licensed doctor about your options for increasing testosterone levels. You can also test your testosterone levels and receive treatment right at home. Learn more here.
You may be able to lower your risk of osteoporosis by addressing the risk factors within your control. Some lifestyle choices that may minimize your risk of osteoporosis include:
A balanced diet is important for maintaining overall health, but getting enough calcium and vitamin D is particularly important for your bones.
Calcium. Most adult men need at least 1,000 milligrams daily, increasing to 1,200 milligrams after age 70, from sources such as dairy, fortified plant-based milks, leafy green vegetables, and calcium-fortified cereals.
Vitamin D. Most men need 600 to 800 international units daily, but some experts recommend higher doses, especially for older adults or those with deficiencies. Sunlight is a natural source. You can also get vitamin D from fatty fish (such as salmon and tuna), fortified dairy, and supplements, if your doctor recommends them.
Your bones are living tissue that respond to stress by becoming stronger. You can lower your risk of osteoporosis with:
Weight-bearing exercise. Weight-bearing exercises include those where you’re on your feet, such as dancing, walking, running, or specific sports.
Strength training. Lifting weights, using resistance bands, or doing bodyweight exercises such as push-ups and squats builds muscle, of course, but also builds bone. Building muscle strength can also improve your balance, reducing your risk of falling.
Balance exercises. Tai chi and yoga can improve balance and coordination, reducing the likelihood of falls, which can lead to fractures.
Other lifestyle changes you can make to decrease your risk of osteoporosis include:
Quitting smoking
Limiting alcohol intake
Treating underlying medical conditions, such as gastrointestinal disorders, that can contribute to bone loss
Talking about your medications with your doctor. There may be alternatives to certain prescriptions known to cause bone loss (like corticosteroids) or bone-protective strategies you can implement in the meantime (like taking calcium or vitamin D supplements).
Osteoporosis is a condition where bone strength and bone mineral density are reduced, increasing a person’s risk of fractures. It’s a serious problem for aging adults. Although it usually doesn’t cause symptoms, it puts you at a high risk of fractures.
It’s important to talk to a healthcare professional if you suspect you might have low bone mineral density, especially if you’ve recently experienced a broken bone after a relatively minor trauma.
The only way to assess whether you have osteoporosis is to have a bone density scan, which uses imaging to examine the structure of your bone. Bone density scans are painless and provide your healthcare provider with essential information.
While low testosterone is a significant risk factor, many men with normal testosterone levels can still develop osteoporosis due to other causes like vitamin D deficiency, long-term steroid use, gastrointestinal diseases, or a family history of the condition.
Not necessarily. Osteopenia is a warning sign that your bone density is lower than normal, but it's not yet osteoporosis. By making lifestyle changes and potentially discussing medication with your doctor, you can often slow or prevent its progression to osteoporosis.
Many of the treatments, particularly the medications like bisphosphonates and denosumab, are the same for men and women. Some sex-specific considerations exist, such as the role of testosterone replacement therapy for men with low testosterone.
No official osteoporosis screening guidelines have been established for men in the United States. If you’re worried that you may have low bone density, it’s best to talk to your healthcare provider to establish a diagnosis and treatment plan.
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