Men and Osteoporosis

BY AMY CAMPBELL, MS, RD, LDN, CDCES | FEBRUARY 14, 2023

When it comes to bone health, you might think that only women need to pay attention. Many people think of osteoporosis, which is a disease that causes bones to weaken and break, as a “woman’s disease.” But men can have osteoporosis, too. And because people are living longer, even more men will get this disease.

Why healthy bones matter

Bones support us and allow us to grow; they also protect vital organs, such as the brain and the heart, from injury. And they store minerals like calcium and phosphorus that we need to keep bones strong.

If we don’t eat the right foods and don’t get enough physical activity, our bones can become weak, and they may break. Broken bones can lead to other long-term health problems.

Adults usually reach their peak bone mass (the greatest amount of bone you can attain) by around age 30. Bone “remodeling” (meaning, new bone is made, and old bone is broken down) continues after age 30, but we tend to lose more bone mass than we gain.

Osteoporosis in men

The Bone Health & Osteoporosis Foundation (BHOF) shares some interesting statistics about men and osteoporosis:

• Up to one in four men over age 50 will break a bone due to osteoporosis.
• Men older than 50 are more likely to break a bone due to osteoporosis than they are to get prostate cancer.
• Each year, about 800,000 men will break a hip.
• Men are more likely than women to die within a year of breaking a hip due to problems from the break.

Men in their fifties don’t lose bone as quickly as women following menopause, says the NIH Osteoporosis and Related Bone Diseases National Resource Center. But by the age of 65 or 70, men and women lose bone at the same rate, and absorption of calcium decreases.

Fractures from osteoporosis most commonly occur in the hip, spine, and wrist and can be permanently disabling. It’s a misconception, then, that men don’t get osteoporosis. It’s true that women are at risk for this disease earlier in life than men, but men over the age of 70 are equally at risk.

In addition to loss of bone mass, most men with osteoporosis have a secondary cause, such as:

• Use of corticosteroid medications (such as prednisone) and other immunosuppressive drugs
• Low levels of testosterone
• Excessive alcohol use
• Smoking
• Digestive disease
• Chronic obstructive pulmonary disease (COPD) and asthma
• Hypercalciuria (excess calcium in the urine)
• Lack of or not enough physical activity

There’s also some evidence that people with diabetes, especially type 1 diabetes, often have poorer bone quality and an increased risk of fractures. “Those with long-standing disease and poor blood sugar control, and who take insulin have the higher fracture risk,” says the NIH Osteoporosis and Related Bone Diseases National Resource Center.

Diagnosing and treating osteoporosis in men

Like women, men can get a bone mineral density test, which is a painless test called a central dual-energy x-ray absorptiometry, or central DXA test. It measures bone density at the hip and spine. Unfortunately, in men, a diagnosis of osteoporosis is not usually made until a fracture occurs or until a man complains of back pain to his doctor. (Tip: always let your health care provider know if you have sudden back pain, have a fracture, or are noticing a loss of height or change in posture).

Treatment of osteoporosis involves the use of medication approved by the FDA (for a list, visit the Bone Health & Osteoporosis Foundation website), as well as treating any underlying cause, and using lifestyle approaches, such as calcium and/or vitamin D supplements and regular physical activity.

How to boost bone health

Make sure you are getting enough calcium in your diet. Calcium is an essential mineral that helps build and maintain strong bones.

Men between the ages of 19 and 70 need 1,000 mg (milligrams) of calcium daily. Men over the age of 70 need 1,200 mg of calcium. Food sources of calcium include:

• Milk and yogurt (stick with lower-fat versions)
• Cheese
• Fortified plant-based milks
• Canned sardines and salmon with bones
• Some vegetables: e.g., kale, broccoli, Chinese cabbage, collards
• Some nuts and seeds: e.g., almonds, Brazil nuts, sunflower seeds
• Dried beans
• Fortified cereals and bread

The American Academy of Nutrition and Dietetics recommends looking at the Nutrition Facts label to see how much calcium is in the food that you eat. Calcium has a Daily Value (DV) of 1,300 mg a day. So, if the label says “20% DV of calcium”, for example, that means that there is 130 mg of calcium per serving of that food.

If you have having difficulty getting enough calcium, talk with your health care provider or dietitian about taking a calcium supplement.

Along with calcium, you need to get enough vitamin D, too. Vitamin D helps the body absorb calcium. Men under age 70 need 600 International Units (IU) of vitamin D daily and men over the age of 70 need 800 IU daily.

Vitamin D food sources include:

• Fatty fish, such as salmon, mackerel, and tuna
• Egg yolks
• Mushrooms grown in UV light
• Fortified milk
• Fortified cereal

You may need to take a vitamin D supplement to ensure that you meet the daily requirement.

Besides calcium and vitamin D, be sure to do both weight-bearing and muscle-strengthening exercises. Weight bearing exercises mean that your bones are supporting the weight of your body. These include:

• Walking
• Hiking
• Jogging
• Racquet sports

Aim to do 30 minutes, most days of the week.

Muscle-strengthening exercises are those in which you move your body, weights, or some other form of resistance. Do these two to three times per week. Examples include:

• Lifting weights
• Using weight machines
• Using exercise bands
• Lifting your own body weight

Always check with your health care provider before starting any kind of physical activity program.

Go easy with alcohol, and work with your health care team to make a plan to stop smoking, if you smoke.

For more information about osteoporosis in men, download “The Man’s Guide to Osteoporosis” from the National Osteoporosis Foundation.