We hear a lot about women and osteoporosis. In fact, half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime, according to the U.S. Preventive Services Task Force.
Osteoporosis, which literally means "porous bone," makes bones more fragile and susceptible to breakage, especially if the person falls.
The reason women are more likely to develop osteoporosis is due to hormone changes, specifically due to lowered estrogen levels and the fact that women have a lower bone density than men to begin with.
Women start losing bone mass right after menopause, however, by the ages of 65 to 70, men and women lose bone mass at the same rate.(6)
Men are not immune to developing osteoporosis, though we hear much less emphasis on their risk factors.
“As many as one in four men over the age of 50 years will develop at least one osteoporosis-related fracture in their lifetime,” according to a 2015 clinical epidemiology study.(2)
Osteoporosis has primary and secondary causes. Primary causes are those related to aging, ethnicity and genetics. Men who had fathers with osteoporosis have a greater chance of having it as well.
"Hypogonadism, corticosteroid use, smoking, excessive alcohol consumption, low calcium intake, and vitamin D deficiency are common secondary causes of osteoporosis in men," according to an American Association of Family Physicians article.(3)
“The most common cause of male osteoporosis is testosterone deficiency, according to Paul Mystkowski, MD, an endocrinologist at Virginia Mason Medical Center in Seattle and clinical faculty member of the University of Washington in Seattle.(1)
Glucocorticoids are steroid medications that are often used to treat asthma or rheumatoid arthritis. They can affect testosterone levels in men and and also lead to bone loss.
Lifestyle practices are also common causes of osteoporosis in men.(4)
Bone loss and increased incidence of hip and vertebral fractures are higher in those that smoke, though the exact cause for this is unknown. It is suggested that the chemicals in tobacco may block the absorption of calcium and other nutrients needed to maintain bone mass.
Alcohol overuse has been found to affect bone density.
Calcium and Vitamin D
The Food and Nutrition Board, Institute of Medicine, suggested in 2010 that men take 1,000 mg of calcium a day and 600 International Units of vitamin D per day, up to age 70. Calcium should be increased to 1,200 mg and vitamin D to 800 IU once over the age of 70.
Bones are stimulated to lay down more bone by the pull of muscles against them. This occurs more from activities such as walking or jogging, and less so from weight training. Men need to make sure they take time to exercise as they age.
Screening guidelines for men are not as rigorous as for women. Men are often not evaluated for osteoporosis until they have had a fracture or complain of back pain.
In Canada, one study said, "On average, only about 20% of male patients older than 65 years had been screened for osteoporosis, so most of these men were not being screened by bone mineral density (BMD) testing as recommended in the guidelines."(5)
Primary care providers should increase screening of aging men to prevent injuries before they occur. This can be accomplished through medical history, lab work, X-rays and a BMD test if the doctor thinks it is needed.
Michele is an R.N. freelance writer with a special interest in woman’s healthcare and quality of care issues.
Edited by Jody Smith
1) Male Osteoporosis: Bone Mass Matters. WebMD.com. Retrieved Aug. 3, 2016.
2) Willson, Tina et al. The clinical epidemiology of male osteoporosis: a review of the recent literature. Clin Epidemiol. 2015; 7: 65–76. Published online 2015 Jan 9.
3) RAO, SHOBHA S. MD et al. Osteoporosis in Men. Am Fam Physician. 2010 Sep 1;82(5):503-508.
4) Osteoporosis in Men. National Institutes of Health.com. Retrieved Aug. 3, 2016.
5) Cheng, Natalie MD et al. Osteoporosis screening for men. Can Fam Physician. 2008 Aug; 54(8): 1140–1141.e5.
6) Osteoporosis in Men. Cleveland Clinic.org. Retrieved Aug. 3, 2016