Do men get osteoporosis too?
Men do indeed get osteoporosis, and the consequences of a fracture are on average more serious for them than for women. Only 1 in 10 men with osteoporosis receives treatment, so if you have risk factors, it is worth discussing them with your doctor.
Yes, men get osteoporosis too. Approximately 40% of all osteoporotic fractures worldwide occur in men. In the ninth decade of life, 4% of men have had a wrist fracture, 7% a vertebral fracture, and 5% a hip fracture. It is therefore a recognised public health problem.
Men begin losing bone mass from around the age of 35. They naturally have larger and denser bones than women and lose less bone mass over their lifetime. As a result, they fracture less often, but the risk does not disappear. After a hip fracture, outcomes are more serious for men: they die more often than women following such a fracture, and their risk of a subsequent fracture is also greater.
In men, an underlying cause can be identified in 40 to 55% of cases. The most common are low testosterone production (found in up to 20% of men with vertebral fractures), prolonged use of corticosteroids such as prednisone, and excessive alcohol consumption. Stomach surgery, epilepsy treatment, and certain forms of cancer can also play a role. Particularly noteworthy is the role of oestrogen: men also produce this hormone in small amounts, and research shows that bone density in older men correlates more strongly with oestrogen levels than with testosterone levels.
Yet osteoporosis in men is severely undertreated: only 10% of men with osteoporosis receive adequate treatment. This is concerning, because good options exist. Medications such as alendronate, denosumab, and teriparatide increase bone density in men with effects comparable to those seen in women. Whether they actually prevent fractures is somewhat less certain, because the studies in men were smaller and of shorter duration. The foundation remains adequate calcium and vitamin D intake and regular exercise. If you have risk factors such as prolonged prednisone use or low testosterone production, it is advisable to discuss this with your doctor.
This answer is based on several large population studies and systematic reviews of the existing literature, including research with long follow-up in older men. The evidence that men develop osteoporosis and that the consequences are more serious than in women is robust. The evidence base for medications is somewhat thinner, because the studies in men were smaller than those in women and fracture reduction as an endpoint has been less thoroughly investigated.
How do I know if I am at risk of osteoporosis?
You can get a good sense of your risk based on age, sex, hormonal history, medication use and lifestyle. If you have multiple risk factors, ask your general practitioner for a bone density measurement.
Does physiotherapy really help if you already have osteoporosis?
Supervised exercise genuinely helps if you have osteoporosis: it slows bone loss, improves your balance and muscle strength, and reduces fear of falling. Consult a physiotherapist for a safe and effective personalised programme.
Does strength training help against osteoporosis just as well as medication?
Strength training demonstrably improves bone density and offers additional benefits that medication does not, but the two are not alternatives to each other: for a seriously elevated fracture risk, medication has stronger evidence and cannot be replaced by exercise.
What do thyroid problems have to do with osteoporosis?
Both an overactive and an underactive thyroid increase the risk of osteoporosis. If you have a thyroid condition, it is wise to discuss with your doctor whether your bones deserve extra attention.
Do people with darker skin have a higher risk of osteoporosis (bone loss)?
People with darker skin have a greater chance of vitamin D deficiency, but that does not automatically mean greater bone loss. Whether you are actually at risk depends strongly on your age, eating habits, and how often you spend time outdoors.
How do you prevent bone loss when losing weight at an older age?
Strength training while losing weight is the best protection against bone loss, but cannot prevent it entirely. Combine it with adequate protein intake and discuss it with your doctor if you are losing weight quickly or in large amounts.