EPISODE 81: Men and Osteoporosis: The Silent Risk Few Talk About
Osteoporosis is often viewed as a women’s health issue, but millions of men are living with the disease or are at risk of developing it. That misconception can have serious consequences, with men often being screened less frequently, diagnosed later, and missing opportunities to protect their bones before a fracture occurs.
On this episode of Bone Talk, Ami Patel talks with Jacqueline Kernaghan, a physician assistant specializing in osteoporosis, about why bone health deserves more attention among men and what patients and healthcare providers can do to recognize the risks earlier.
More than 2 million American men already have osteoporosis, with another 12 million at risk. Perhaps even more striking, one in four men over age 50 will break a bone because of osteoporosis during their lifetime.
Why osteoporosis in men often goes unnoticed
Osteoporosis is known as a silent disease because bone loss can progress without symptoms until a fracture happens. For men, Jacqueline explains, there’s an additional cultural barrier. Osteoporosis is still widely associated with women, and men may not realize that a fracture after a seemingly ordinary fall could indicate an underlying bone health problem.
A fracture resulting from a fall from standing height or less should raise concerns about osteoporosis, particularly in adults over 50. Yet these fractures are sometimes attributed simply to a bad fall or bad luck.
That can lead to a major gap in care. The fracture may be treated, but the osteoporosis that contributed to it may never be evaluated.
Understanding the risk factors for men
While aging itself contributes to bone loss, several other factors can increase a man’s osteoporosis risk. These include:
● Low testosterone levels
● Significant weight loss
● Physical inactivity
● Diabetes
● Corticosteroid use
● Tobacco use
● Excessive alcohol consumption
● Low calcium intake
● Vitamin D deficiency
● Certain medications and medical treatments, including androgen deprivation therapy for prostate cancer
For men diagnosed with osteoporosis at a younger age, Jacqueline says clinicians should also look for secondary causes of bone loss through appropriate laboratory testing.
When should men get a bone density test?
Jacqueline recommends that men have a bone density, or DEXA, scan at age 70. Men between ages 50 and 69 should be tested earlier when they have osteoporosis risk factors.
A low-trauma fracture after age 50 is an especially important reason to be evaluated.
Bone density testing can be combined with a fracture risk assessment tool to give clinicians a more complete picture. A DEXA scan measures bone quantity, while fracture risk assessment incorporates additional factors that may help determine whether someone whose results fall into a gray area would benefit from treatment.
A broken bone should start a bigger conversation
One of the biggest missed opportunities occurs after a fracture. Patients may assume their orthopedic specialist is addressing osteoporosis, while the orthopedic specialist may expect the patient’s primary care provider or another specialist to manage it.
As patients recover and begin to feel better, follow-up appointments may also seem less urgent. The underlying bone disease can then remain untreated.
Fracture liaison services can help close this gap by identifying people who experience fractures, connecting them with appropriate osteoporosis evaluation and treatment, and working to prevent the next fracture.
Osteoporosis treatment works for men
Another misconception is that osteoporosis medications haven’t been adequately studied in men. Jacqueline emphasizes that this isn’t true. Treatment options have been studied in men and include anti-resorptive therapies that slow bone loss as well as anabolic therapies that help build new bone.
Options include pills, injections, and infusions, with treatment decisions based on an individual’s fracture risk, medical history, and other factors.
While patients may worry about rare medication side effects, Jacqueline stresses the importance of comparing those risks with the much greater risk of experiencing an osteoporosis-related fracture.
Building stronger bones through everyday habits
Medication is only one part of protecting bone health. Jacqueline recommends that men make weight-bearing exercise, strength training, resistance exercise, and balance activities part of their routines.
Nutrition matters too. Men need adequate calcium throughout life, preferably from food sources such as low-fat dairy products, certain dark leafy greens, fish with bones, and calcium-fortified foods. Vitamin D is also essential because it helps the body absorb calcium and support bone mineralization.
She encourages men to talk with their healthcare providers about their individual calcium and vitamin D needs rather than assuming bone health recommendations apply only to women.
Don’t wait for a fracture to think about bone health
The biggest takeaway from this conversation is simple: osteoporosis can affect men, and a broken bone doesn’t have to be the first warning sign.
Men should understand their risk factors, discuss bone health with their healthcare providers, and ask about a DEXA scan when appropriate. Clinicians can also help close the osteoporosis care gap by recognizing fractures after age 50 as potential warning signs rather than isolated injuries.
Greater awareness can help shift osteoporosis care from reacting to fractures to preventing them in the first place.