Osteoporosis is not an exclusively female disease: men account for approximately 40% of all osteoporotic fractures worldwide, and their prognosis after a first fracture is worse than that of women. Research into treatment in men is positive but less extensive than in women, and in practice the condition is severely undertreated in men.
Worldwide, approximately 40% of all osteoporosis-related fractures occur in men, and that share is still growing. Yet the widespread misconception persists that osteoporosis is a women's disease. That misconception has real consequences: only 1 in 10 men with osteoporosis receives adequate treatment.
Once a man has suffered a first fracture, his outlook is actually worse than a woman's. Both the risk of a subsequent fracture and the risk of death following that first fracture are greater in men. This makes early recognition and treatment in men not less urgent, but more urgent, than in women.
In men, up to half of all osteoporosis cases have an identifiable underlying cause. The three most common are a testosterone deficiency (hypogonadism), excessive alcohol use, and long-term use of corticosteroids, the anti-inflammatory drugs prescribed for conditions such as asthma, rheumatism, or bowel disease. Anyone with one of these risk factors is well advised to have their bone health checked, even if they have not yet had a fracture.
There is no international consensus on routine screening in men without symptoms. The Bone Health and Osteoporosis Foundation recommends a bone density scan from age 70, or earlier in the presence of risk factors. The U.S. Preventive Services Task Force, however, found insufficient evidence to recommend screening in all men. Those who do have risk factors, such as the ones mentioned above, are eligible for targeted screening.
Bisphosphonates are also used as treatment in men. These medications reduce the risk of vertebral fractures. The evidence supporting this is positive, but less extensive than in women: clinical trials in men enrolled fewer participants and ran for shorter periods. In men with a confirmed testosterone deficiency, testosterone replacement can improve bone density, but only when a clear medical indication for it exists.
All claims are based on one primary source (PMID 36382763), supplemented by two studies on screening (PMID 36920813, 32773051) and two on bisphosphonates (PMID 28492856, 12424871). The research is predominantly observational and guideline-based; for treatment in men, RCT data are more limited than in women.