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Male Osteoporosis: Bone Mass Matters

20% of people with osteoporosis are men. What causes it, and what can you do about it?
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WebMD Feature

Real men get osteoporosis, too.

As many as 2 million American men already have osteoporosis, the bone thinning that makes bones brittle and porous and at likely to fracture. Twelve million men are at risk, and may have early signs of bone loss and low bone density, called osteopenia. But given that four times as many women have osteoporosis, men are less likely to end up with thin bones than women.

Recommended Related to Osteoporosis

Knowing and Treating Osteoporosis

Osteoporosis is sometimes diagnosed incidentally after an X-ray has been taken for a fracture or an illness. If your health care provider suspects you have osteoporosis, he or she may measure you to check for a loss of height. The vertebrae are often the first bones affected, causing a loss in height of half an inch or more. Your health care provider may also recommend that your bone density be measured.  Diagnostic tools more likely to catch osteoporosis at an early stage include various forms...

Read the Knowing and Treating Osteoporosis article > >

Why this lower risk?

"Women live longer, so they're more likely to get osteoporosis," says Paul Mystkowski, MD, an endocrinologist at Virginia Mason Medical Center in Seattle and clinical faculty member of the University of Washington in Seattle. And because men are generally more physically active over the course of their lives, he says, men are less likely to lose bone mass, since exercise has been shown to protect bone density.

But there's an even bigger difference with male osteoporosis.

"In general, osteoporosis in men is considered a symptom of something else," says Mystkowski, "whereas in older women, it's almost always postmenopausal."

And for many men, that "something" is hormonal.

Causes of Male Osteoporosis: Testosterone Deficiency

The most common cause of male osteoporosis is testosterone deficiency, says Mystkowski. "There's a clear consensus that when you're evaluating men with osteoporosis, you always evaluate for testosterone deficiency," he says.

For low-testosterone men, doctors may advise testosterone replacement to build bone mass. The dilemma is that science hasn't yet shown how much of the bone-building benefit is a direct testosterone effect -- or the result of turning testosterone into estrogen. "Probably the bulk of the benefit is the testosterone," Mystkowski says, "but it's important not to minimize the role of testosterone to estrogen conversion."

Men also need a small amount of estrogen, says Mystkowski. Estrogen preserves bone density -- in both men and women. In fact, all men normally convert testosterone to estrogen to build bone mass.

"If you look at men who lack an enzyme to make even small amounts of estrogen because they were genetically born that way," says Mystkowski, "they get osteoporosis. If you give them estrogen, their osteoporosis improves. So even though estrogen doesn't circulate in very high concentrations in men, it's a critical factor for bone health."

Causes of Male Osteoporosis: Low Calcium and Vitamin D

Bones continually grow over your lifetime, in a natural process called remodeling, with old bone cells sloughing off and new bone cells growing in to replace them. But to make new bone, your body needs plenty of calcium and vitamin D.

"It's a giant construction project," says Mystkowski. But without enough calcium and vitamin D, you can't build the scaffolding for new bone and replace bone density solidly with calcium and other minerals.

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Osteoporosis Glossary

  • Bone Mineral Density - A measurement of the amount of calcium and minerals in bone tissue.
  • Calcium - A mineral in (and vital to) your bones. If your body lacks calcium, it takes it from bones.
  • DEXA (dual energy X-ray absorptiometry) - a test used to measure bone mineral density.
  • Osteoporosis - A decrease in bone density, which increase the risk of fractures.
  • Vitamin D - A vitamin that helps your body absorb calcium.
  • View All Terms

How do you exercise for strong bones?