Men do get osteoporosis, but it happens later and less often than in women

About one in four men over 50 will break a bone due to weak bones at some point in their life. Men develop osteoporosis at older ages than women do, usually after 70, because they start with more bone mass and don't experience the sharp hormone drop that women face at menopause. But that doesn't mean men are safe—the condition is real, the breaks are serious, and the risk factors are different enough that many men don't see it coming.

The reason osteoporosis in men gets less attention is partly numbers: women make up about two-thirds of all osteoporosis cases. But that statistic can work against men, because doctors may not screen for it as routinely, and men themselves often don't think of it as "their" disease. A man who breaks his hip at 75 from a fall that shouldn't have caused a fracture has osteoporosis, whether he knew it or not.

Key Takeaways

  • Men typically develop osteoporosis after age 70, about 10 years later than women, because they have more bone mass at baseline and no menopause-related hormone shift.
  • Low testosterone is the single biggest bone-health risk factor for men, and it can happen from age-related decline, medical conditions, or medications like corticosteroids.
  • A bone density test (DEXA scan) is the only way to know if you have low bone density; you cannot feel or see it, and many men have it without symptoms.
  • Men who have had a fracture from a minor fall, take certain medications long-term, or have conditions like COPD or kidney disease should discuss bone screening with their doctor.

Why men's bones weaken differently than women's

Bone loss in men follows a different timeline because testosterone, not estrogen, is what keeps men's bones strong. Men don't lose testosterone suddenly the way women lose estrogen at menopause. Instead, testosterone declines slowly—about 1% per year after age 30—so bone loss is gradual rather than steep. A man can lose bone for decades without noticing, then break a hip from a fall that seems minor.

When testosterone does drop more sharply—from illness, surgery, or medications—bone loss accelerates. A man on long-term corticosteroids for asthma or rheumatoid arthritis can lose bone density fast enough that fracture risk rises within months. Similarly, men treated for prostate cancer with hormone therapy that lowers testosterone face rapid bone loss. These situations create osteoporosis risk that looks more like what women experience, but men often aren't warned about it.

The medical conditions and medications that raise a man's risk

Certain health conditions make osteoporosis more likely in men. Chronic obstructive pulmonary disease (COPD), chronic kidney disease, and inflammatory bowel disease all interfere with how the body absorbs or uses calcium and vitamin D. Men with type 2 diabetes have a paradox: their bones may appear dense on a scan but are actually weaker and break more easily. Prostate cancer treatment, multiple myeloma, and conditions that affect hormone levels all carry bone-loss risk.

Medications matter as much as the conditions themselves. Corticosteroids (prednisone, dexamethasone) used for asthma, autoimmune disease, or transplant rejection are among the strongest bone-weakeners. Anticonvulsants, some diabetes medications, and certain cancer treatments also increase fracture risk. A man taking any of these long-term should ask his doctor about bone density screening, because the medication itself may be the main driver of bone loss.

Lifestyle factors that affect bone density in men

Alcohol use is a major bone-loss factor in men that often goes unmentioned. Heavy drinking—more than three drinks per day—interferes with calcium absorption and damages bone-forming cells. Smoking also weakens bones, independent of other risk factors. Low physical activity, especially lack of weight-bearing exercise like walking or resistance training, allows bone density to decline faster.

Calcium and vitamin D intake matters for men just as it does for women, but many men don't get enough. Men over 50 need 1,200 mg of calcium daily and 800 to 1,000 IU of vitamin D, depending on age. A man who doesn't eat dairy, doesn't spend time in sunlight, or has digestive problems that affect nutrient absorption can develop deficiencies that accelerate bone loss. Unlike some risk factors, these are things a man can change.

When a man should get a bone density test

A bone density test (DEXA scan) is a quick, painless X-ray that measures how dense your bones are. It's the only way to know whether you have low bone density or osteoporosis. You can't feel weak bones, and you won't know you have the condition until you break something—unless you get tested.

Men over 70 should discuss bone screening with their doctor as part of routine care. Men between 50 and 70 should consider screening if they have risk factors: a fracture from a minor fall, long-term use of corticosteroids, low testosterone, COPD, kidney disease, or a family history of osteoporosis. Men who have had prostate cancer treatment should ask about screening, because hormone therapy accelerates bone loss. A single test gives you a baseline; your doctor can then decide whether repeat testing makes sense.

What happens after a bone density test

A DEXA scan produces a T-score, which compares your bone density to that of a healthy young adult. A T-score of -1.0 or higher is normal. A score between -1.0 and -2.5 means low bone density (sometimes called osteopenia). A score below -2.5 means osteoporosis. Your doctor will also calculate your 10-year fracture risk using your T-score, age, and other factors.

If your test shows low bone density, your doctor may recommend changes to diet and exercise, vitamin D supplementation, or medication. Bisphosphonates (alendronate, risedronate) are the most common medications for men with osteoporosis; they slow bone loss. Other options exist depending on your situation. If your bones are normal, the test still gives you a baseline for comparison if you're tested again later. Many men never need medication—diet, exercise, and addressing modifiable risk factors are enough.

Steps to protect your bones now

Weight-bearing exercise is the single most effective thing a man can do for bone health. Walking, jogging, dancing, or resistance training (weights, resistance bands) all stimulate bone to stay strong. Aim for at least 150 minutes of moderate activity per week, and include some strength training two or more days a week. Even small amounts of regular activity help; a man who walks 30 minutes most days is doing his bones a favor.

Get enough calcium and vitamin D. Dairy products, leafy greens, fortified plant milks, and canned fish with bones are good sources of calcium. Vitamin D comes from sunlight exposure (10 to 30 minutes most days), fatty fish, egg yolks, and fortified milk. If you can't get enough from food, a supplement is reasonable. Limit alcohol to no more than two drinks per day, and if you smoke, talk to your doctor about quitting—it affects bone health as well as everything else.

Frequently Asked Questions

Can a man in his 50s get osteoporosis?

Yes, though it's less common than in women the same age. Men with risk factors—low testosterone, long-term corticosteroid use, COPD, or a history of fractures—can develop osteoporosis in their 50s or even earlier. If you have any of these risk factors, ask your doctor about bone screening.

Does low testosterone always cause bone loss?

Low testosterone increases bone-loss risk significantly, but it's not the only factor. A man with low testosterone who exercises regularly, gets adequate calcium and vitamin D, and doesn't smoke may maintain reasonable bone density. But the risk is real, and if you have symptoms of low testosterone (fatigue, reduced muscle, mood changes), talk to your doctor about testing.

What's the difference between osteopenia and osteoporosis in men?

Osteopenia means low bone density but not yet osteoporosis—it's a middle ground. Not all men with osteopenia will develop osteoporosis, especially if they address risk factors. Your doctor will use your T-score, age, and fracture risk to decide whether you need treatment or just monitoring and lifestyle changes.

If I break a bone, does that mean I have osteoporosis?

Not necessarily, but a fracture from a minor fall (like tripping on a step or falling from standing height) is a red flag. A break from significant trauma—a car accident or fall from height—can happen to anyone. But if you broke a bone easily, get a bone density test. You may have osteoporosis, or you may have another condition affecting bone strength.

Are there medications for osteoporosis in men besides bisphosphonates?

Yes. Denosumab (an injection given twice yearly) and teriparatide (a daily injection) are alternatives. Hormone therapy is sometimes used for men with very low testosterone, though it carries its own risks and benefits. Your doctor will choose based on your bone density, fracture risk, other health conditions, and how well you tolerate the medication.