Also called: Male osteoporosis
Exercise is the main treatment
Strength
Balance
The same disease as osteoporosis in women, routinely missed because it is thought of as a women's condition. Men have worse outcomes after a hip fracture and are far less likely to be assessed or treated.
How common: Around 5% of men over 50 have osteoporosis and 33% have low bone mass; hugely underdiagnosed
What it is
Osteoporosis in men is common - roughly one in five men over fifty will have an osteoporotic fracture - and it is substantially under-diagnosed and under-treated. The mechanism is the same as in women: bone resorption outpacing formation, with reduced mechanical loading as the largest modifiable factor.
The differences are in the risk factors and the outcomes. Secondary causes are more common in men - low testosterone, steroids, alcohol, hypogonadism - and should be actively looked for. And mortality in the year after a hip fracture is higher in men than in women, which makes the under-diagnosis particularly costly.
What it feels like
- Nothing at all, until something breaks
- A fracture from a fall that should not have caused one
- Height loss over years
- An increasing forward curve of the upper back
- Sudden severe back pain, which may be a vertebral compression fracture
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Reduced mechanical loading
- Bone maintains density in response to strain. Without resistance or impact loading it has no reason to, and this is the largest modifiable factor in both sexes.
- Low testosterone
- Testosterone maintains bone density in men. Hypogonadism from any cause, including androgen deprivation therapy for prostate cancer, produces rapid bone loss.
- Corticosteroids
- One of the most common secondary causes. Bone loss is fastest in the first months of treatment, and long-term or repeated courses accumulate substantial loss.
- Alcohol
- A more common contributor in men than in women. Heavy regular drinking reduces bone formation directly and increases fall risk.
- Smoking
- Reduces bone density independently and is associated with fracture risk in both sexes.
- Age
- Bone formation slows from midlife in men as in women, though without the abrupt acceleration that menopause produces. Men lose bone more gradually and start from a higher peak.
- Medical conditions
- Coeliac disease, inflammatory bowel disease, chronic kidney disease, chronic liver disease, rheumatoid arthritis and overactive thyroid all contribute. Secondary causes are identifiable in a majority of men with osteoporosis.
- Low body weight
- A consistent risk factor, and low body weight combined with low activity is a particularly poor combination for bone.
- Family history
- A parent with a hip fracture roughly doubles risk in men as in women.
- Not being assessed
- The single biggest problem. Men who fracture are far less likely than women to be investigated for osteoporosis or started on treatment, despite worse outcomes.
Who tends to get it
- Men over seventy, and men over fifty with any risk factor
- Anyone who has had a fracture from a fall from standing height after fifty
- Men on long-term steroids or androgen deprivation therapy
- Heavy drinkers and smokers
- Men with coeliac disease, inflammatory bowel disease or chronic kidney or liver disease
What makes it worse, and what settles it
Makes it worse
- Not being assessed after a low-trauma fracture, which is the norm for men
- Long periods of inactivity or bed rest
- Doing only swimming or cycling, which do very little for bone
- Heavy alcohol intake and smoking
- Assuming osteoporosis is a women's condition, which is what produces the under-diagnosis
Settles it
- Progressive resistance training, heavy enough to be a genuine stimulus - the intervention that builds bone
- Impact loading where safe, which bone responds to specifically
- Getting assessed after any low-trauma fracture, which men frequently are not
- Checking for secondary causes, particularly testosterone, coeliac disease and vitamin D
- Balance training, since preventing the fall prevents the fracture
What actually helps
The short version: Same mechanism as Osteoporosis and osteopenia but routinely missed because it is thought of as a women's condition
Strength work: Heavy compound lifting plus impact work - identical protocol to Osteoporosis and osteopenia
Stretching: Avoid loaded end-range spinal flexion
Massage: Not primary
Also worth doing: Impact loading; balance work; vitamin D and calcium
What the evidence says: Men account for a third of hip fractures and have higher post-fracture mortality than women. Worth a separate routine purely because nobody offers them one.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
The qFIT routine for this
Ready-made routineStrength & Bone for Aging
qFIT already has this one built. It runs massage first, then stretching, then
strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
them.
Have more than one problem? Tick yours under My Problems on
My Profile and your Checklist's Routine list gains
Recommended for my problems — every routine for the problems you picked, merged
into one. Your picks stay private; that filter is the only thing they feed.
Get it checked if…
Any fragility fracture in a man over 50 should trigger a bone density scan - it usually does not
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Bone density responds to resistance and impact training over six to twelve months, and the fracture risk reduction is greater than the density change suggests because strength and balance prevent the falls. Medical treatment is as effective in men as in women. The most valuable thing on this page is the prompt to be assessed: a man who fractures a wrist, hip or vertebra from a minor fall after fifty should have his bone density measured and secondary causes looked for, and usually will not be offered it unless he asks.
Prevalence basis: Bone density population data
Others the same routine covers
These share the Strength & Bone for Aging routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.