Osteoporosis in men is under-recognised, and the deadliest fractures fall on them

Osteoporosis is usually thought of as a women's disease, but it causes significant morbidity and mortality in men too — and men who break a hip are more likely to die of it than women are [s1][s3]. Yet no major body recommends screening every older man the way it does older women: when the US Preventive Services Task Force reviewed the question in 2025, it concluded that the evidence is insufficient to say whether screening men helps at all [s2].

That combination — real harm, weak evidence for what to do about it — is why bone loss in men is one of the more neglected problems in men's health.

The disease is not rare in men

Osteoporosis thins and weakens bone until it fractures under loads a healthy skeleton would shrug off. It is more common in women, largely because the fall in oestrogen at menopause accelerates bone loss, but men lose bone with age as well, and the Endocrine Society's clinical practice guideline on osteoporosis in men states plainly that the disease causes "significant morbidity and mortality" in them [s1].

The guideline recommends testing higher-risk men rather than all men. It advises central dual-energy x-ray absorptiometry — a DXA scan — for men aged 70 and older, and for men aged 50 to 69 who carry risk factors such as low body weight, a prior fracture as an adult, or smoking [s1]. It also recommends laboratory testing to look for contributing causes, because bone loss in men more often traces to a treatable secondary cause — low testosterone, excess alcohol, steroid use, or another condition — than it does in postmenopausal women [s1].

On treatment, the guideline is specific: drug therapy is recommended for men aged 50 or older who have already had a spine or hip fracture, for those with a DXA T-score of −2.5 or below, and for men judged to be at high fracture risk on the basis of low bone density and clinical risk factors [s1]. Adequate calcium and vitamin D, weight-bearing exercise, and avoiding smoking and heavy drinking round out the advice [s1].

The hip fracture is where it turns lethal

The reason osteoporosis matters is the fractures, and the hip fracture is the one that kills. A meta-analysis of prospective cohort studies — 17 cohorts of men and 22 of women — found that in the first three months after a hip fracture the relative hazard for death from any cause was 7.95 in men (95% confidence interval 6.13 to 10.30), against 5.75 in women (95% CI 4.94 to 6.67) [s3]. Put more simply, older adults face a five- to eight-fold increase in the risk of dying in the three months after breaking a hip [s3].

That excess does not fully resolve. Using life-table methods, the same analysis estimated that a man who fractures a hip at age 80 carries excess annual mortality — over and above men of the same age who did not fracture — of 18%, 22%, 26% and 20% at one, two, five and ten years afterwards [s3]. For a woman fracturing at 80 the corresponding figures were 8%, 11%, 18% and 22% [s3]. The authors' conclusion is the one worth remembering: at any given age, the excess annual mortality after a hip fracture is higher in men than in women [s3].

Men break fewer bones, in other words, but pay more heavily when they do. Part of that is that men tend to fracture at older ages and with more other illness; part of it is that the disease that set up the fracture was more often missed beforehand.

Why there is no "screen every man" rule

Against that backdrop it seems obvious that men should be screened — but the evidence to justify it is not there. The USPSTF commissioned a systematic review of screening in adults aged 40 or older with no known osteoporosis or prior fragility fracture [s2]. It came out with a B recommendation to screen women aged 65 and older, and a B recommendation to screen postmenopausal women younger than 65 who are at increased risk [s2]. For men, it issued an I statement: "the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men" [s2].

An I statement is not a recommendation against screening. It means the trials needed to weigh benefit against harm in men have not been done — screening trials have overwhelmingly enrolled women, so the question of whether finding low bone density in an asymptomatic man leads to fewer fractures down the line is genuinely unresolved [s2]. That is a gap in the research base, not a verdict that men's bones do not matter.

The practical upshot is a two-track situation the popular framing usually misses. There is no evidence-backed programme of universal screening for men, as there is for older women — see our account of what the 2025 task force actually recommended. But for a man who already carries risk factors, or a treatable cause of bone loss such as low testosterone, specialty guidance does support targeted testing and, where indicated, treatment [s1]. Bone loss is a recognised long-term consequence of untreated hypogonadism, including in Klinefelter syndrome and other causes of low testosterone, which is one reason the Endocrine Society folds laboratory work-up into its approach [s1].

The everyday levers — calcium and vitamin D adequacy, weight-bearing activity, not smoking, moderate drinking — apply to men and women alike, and are covered in our reviews of diet and bone health and of testosterone therapy's effects on bone [s1].

This article is informational and is not medical advice. Decisions about bone-density testing or treatment should be made with a clinician who can weigh an individual's risk factors.