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Osteoporosis in Men: Causes, Symptoms and Treatment
Osteoporosis in men is a frequently underestimated condition in which bone density decreases and fracture risk rises. Learn about causes, symptoms, and treatment options.
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Osteoporosis in men is a frequently underestimated condition in which bone density decreases and fracture risk rises. Learn about causes, symptoms, and treatment options.
What is Osteoporosis in Men?
Osteoporosis is a metabolic bone disease characterized by reduced bone mass and deterioration of bone microarchitecture, leading to increased fragility and fracture risk. Although often perceived as a condition primarily affecting women, approximately 20–25 % of all osteoporosis patients are men. In many countries, millions of men are affected, yet the condition is frequently diagnosed late due to lower public awareness and delayed medical attention.
Causes
Osteoporosis in men is classified as either primary or secondary.
Primary Osteoporosis
Primary osteoporosis develops as a result of the natural aging process. As men age, testosterone levels decline gradually – a process sometimes referred to as the andropause. Since testosterone plays a critical role in maintaining bone density, a significant decrease in this hormone leads to progressive bone loss over time.
Secondary Osteoporosis
Secondary osteoporosis is even more common in men than in women and is caused by underlying medical conditions or external factors, including:
- Hypogonadism: low testosterone due to insufficient testicular function
- Long-term corticosteroid therapy: prolonged use of cortisone (e.g., for rheumatoid arthritis or asthma)
- Alcohol abuse: inhibits bone formation and accelerates bone loss
- Chronic liver or kidney disease
- Malabsorption syndromes (e.g., celiac disease, Crohn's disease)
- Hyperparathyroidism: overactivity of the parathyroid glands
- Androgen deprivation therapy (ADT) for prostate cancer: one of the most significant risk factors for osteoporosis in men
- Immobilization: lack of weight-bearing physical activity
- Smoking: negatively affects hormonal metabolism and bone health
Symptoms
Osteoporosis in men is often asymptomatic for many years. Warning signs and symptoms may include:
- Back pain, especially in the thoracic or lumbar spine
- Loss of height due to vertebral compression fractures
- Development of a stooped posture (kyphosis)
- Fractures following minor trauma or occurring spontaneously – most commonly affecting the vertebral bodies, hip, and wrist
The hip fracture (proximal femur fracture) is particularly serious in men and is associated with higher mortality rates compared to women.
Diagnosis
Diagnosis involves multiple steps:
- Medical history: assessment of risk factors, pre-existing conditions, and medications
- Bone density measurement (DXA): Dual-energy X-ray absorptiometry is the gold standard. A T-score of −2.5 or below confirms the diagnosis of osteoporosis.
- Laboratory tests: calcium, vitamin D, testosterone, parathyroid hormone (PTH), and other relevant markers
- Fracture risk assessment: using validated tools such as the FRAX score
- X-ray imaging: to detect existing vertebral fractures
Treatment
General Measures
- Adequate calcium intake (1,000–1,200 mg per day through diet and supplementation if needed)
- Sufficient vitamin D levels (800–1,000 IU per day, higher doses if prescribed by a physician)
- Regular physical activity, especially weight-bearing exercises and balance training
- Fall prevention: physiotherapy and home hazard modification
- Avoidance of alcohol and smoking
Pharmacological Therapy
- Bisphosphonates (e.g., alendronate, zoledronic acid): first-line agents that inhibit bone resorption
- Denosumab: a monoclonal antibody that reduces bone breakdown; especially beneficial in men undergoing androgen deprivation therapy for prostate cancer
- Testosterone replacement therapy: indicated in men with confirmed hypogonadism to restore hormonal balance and improve bone density
- Teriparatide: a parathyroid hormone analogue that stimulates new bone formation; used in severe cases
- Romosozumab: a newer monoclonal antibody that simultaneously promotes bone formation and inhibits bone resorption
Prognosis and Prevention
With early diagnosis and consistent treatment, the progression of osteoporosis in men can be effectively managed. Adopting a bone-healthy lifestyle from middle age onward – including adequate calcium and vitamin D intake, regular weight-bearing exercise, and avoidance of smoking and excessive alcohol – represents the most important preventive strategy.
References
- Dachverband Osteologie (DVO): S3 Guideline Osteoporosis, 2023. Available at: https://www.dv-osteologie.org
- Khosla S, Amin S, Orwoll E. Osteoporosis in Men. Endocrine Reviews. 2008;29(4):441–464. PubMed PMID: 18451258.
- World Health Organization (WHO): Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical Report Series 843. Geneva: WHO, 1994.
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