When people think of osteoporosis, elderly women often come to mind first. However, this insidious disease can also seriously affect men. In my clinical practice, I frequently see male patients who only learn they have osteoporosis after presenting with fractures. Osteoporosis in men is often overlooked and, if diagnosed late, can lead to significant health problems.
What is Osteoporosis?
Osteoporosis is a systemic skeletal disease characterized by reduced bone mineral density, making bones brittle and fragile. Tiny holes and structural weakness develop in the bones, increasing the risk of fractures from even minor traumas. The most common fracture sites are the hip, spine, and wrist.
How Does Osteoporosis Progress Differently in Men?
In women, declining estrogen levels after menopause accelerate bone loss. In men, bone loss occurs more slowly and subtly, largely because testosterone remains active longer. However, this doesn’t mean men are protected; on the contrary, because osteoporosis often goes undiagnosed in men, fractures tend to have more severe consequences. For example, mortality rates within one year of a hip fracture are twice as high in men compared to women.
The Role of Genetics
Family history of osteoporosis, especially fractures in the father or male relatives, increases the risk of osteoporosis in men. Genetic factors involve mutations that affect bone mineral density and the expression levels of proteins involved in bone metabolism.
Ethnicity also plays a role: Asian and white men have a higher risk of osteoporosis, while African men tend to have genetically higher bone density.
Hormonal Disorders and Osteoporosis
Low testosterone (hypogonadism) is one of the leading causes of osteoporosis in men. As men age, testosterone levels naturally decline, a condition known as “age-related hypogonadism,” which increases osteoporosis risk. Endocrine disorders like thyroid diseases, adrenal disorders such as Cushing’s syndrome, and elevated parathyroid hormone (hyperparathyroidism) can also accelerate bone loss.
Risk Factors for Osteoporosis in Men
- Genetic predisposition
- Low testosterone levels
- Sedentary lifestyle
- Excessive alcohol and tobacco use
- Long-term corticosteroid use
- Chronic illnesses (e.g., kidney, liver, or intestinal diseases)
- Insufficient calcium and vitamin D intake
How is Osteoporosis Diagnosed?
The gold standard for osteoporosis diagnosis is measuring bone mineral density (BMD) with DEXA (Dual-Energy X-ray Absorptiometry). Screening is recommended for men over 70; however, in the presence of risk factors, screening should begin earlier.
Helpful blood tests include:
- Testosterone levels
- Calcium and phosphorus levels
- Vitamin D levels
- Thyroid and parathyroid hormones
Treatment Options
Treatment starts with identifying and addressing underlying causes. If low testosterone is diagnosed, hormonal therapy should be considered in consultation with an endocrinologist. Main treatment approaches include:
Medical Treatment
- Bisphosphonates (e.g., alendronate) to slow bone resorption
- Denosumab, especially in patients with high fracture risk
- Teriparatide to stimulate bone formation in advanced cases
- Testosterone replacement therapy if hypogonadism is confirmed
Exercise and Rehabilitation
- Resistance and balance exercises to strengthen bones and prevent falls
- Comprehensive physical therapy programs to build musculoskeletal strength and reduce fracture risk
Nutrition
- Daily intake of 1000-1200 mg calcium and 800-1000 IU vitamin D
- Limiting alcohol and caffeine consumption
Strategies for Osteoporosis Prevention
✔ Regular physical activity
✔ Quitting smoking and limiting alcohol
✔ Getting sufficient sunlight exposure
✔ Maintaining a calcium-rich, balanced diet
✔ Reducing fall risks at home and in daily life
Conclusion: Don’t Neglect Bone Health
Osteoporosis in men is often diagnosed late but can have serious consequences. Considering individual risk factors like genetic predisposition and hormonal imbalances, early screening, conscious lifestyle changes, and comprehensive treatment approaches are crucial. We cannot see our bones, but their health directly affects our quality of life.
Dr. Lecturer Elif BERBER
