Osteoporosis in Men: Are Men at Risk?

Can men get osteoporosis?

Yes — men get osteoporosis, and it is far more common than most people assume. Although the condition is usually pictured as something that affects women after the menopause, the Royal Osteoporosis Society is clear that osteoporosis is commonly perceived as a women's disease but is common in men too, and that around 1 in 5 men over the age of 50 will break a bone because of osteoporosis (Royal Osteoporosis Society).

Men of all ages can be affected. The Royal Osteoporosis Society specifically advises that younger men should see a specialist who understands the condition, because osteoporosis at a younger age often points to an underlying cause that needs investigating (Royal Osteoporosis Society). The bones weaken silently — usually the first sign is a fracture — so, as with women, the condition is easy to miss until a break happens. Our guide to the early signs of osteoporosis covers what (little) there is to watch for.

Why is osteoporosis so often missed in men?

It is missed largely because it is still seen as a "women's disease" — so men are simply not assessed. In 2024, an evidence-based guideline highlighted by the International Osteoporosis Foundation stated that osteoporosis is still often viewed as a women's condition and that underdiagnosis and undertreatment of the disease in men is even more prevalent than in women (International Osteoporosis Foundation, 2024).

That gap matters because the stakes are high. The same guidance notes that osteoporosis in men carries substantial morbidity and mortality, comparable to or exceeding that in women (International Osteoporosis Foundation, 2024). Men also tend to break bones later in life than women — a review in Bone Research found men suffer osteoporotic fractures about 10 years later than women — which can reinforce the false impression that a fracture in an older man is "just bad luck" rather than a treatable bone problem (Adler, Bone Research, 2014).

What are the risk factors for osteoporosis in men?

In men, osteoporosis very often has an identifiable underlying cause — up to 60% of cases do. StatPearls reports that secondary causes account for as much as 60% of male osteoporosis, a much larger share than in postmenopausal women, where age and oestrogen loss dominate (StatPearls, 2025). That makes finding the cause a central part of assessing a man's bone health.

The best-recognised contributors include:

• Low testosterone (hypogonadism). About 20% of older men with osteoporosis have hypogonadism (StatPearls, 2025) — more on how testosterone protects bone below.
• Long-term steroid (glucocorticoid) tablets, a well-established cause of bone loss in both sexes (StatPearls, 2025).
• Heavy alcohol intake — StatPearls flags intake above 3 units a day as a risk factor (StatPearls, 2025).
• Smoking, associated with a relative risk of fracture of about 1.37 (StatPearls, 2025).
• Increasing age, and generally low body weight, which is a recognised fracture risk factor and a variable in fracture-risk tools.

Some causes are shared with women. The Royal Osteoporosis Society lists coeliac disease, steroids and eating disorders among conditions that raise osteoporosis risk in men as well (Royal Osteoporosis Society). Because so many of these are treatable in their own right, understanding what causes osteoporosis is often the first step to protecting a man's bones.

How does low testosterone affect a man's bones?

Testosterone is important for male bone strength — and low levels are linked to more fractures. The Royal Osteoporosis Society notes that testosterone matters for bone, and that conditions causing low testosterone raise the risk of osteoporosis (Royal Osteoporosis Society). Research in the International Journal of Endocrinology likewise reports that hypogonadal states accelerate bone loss and that low testosterone is associated with fracture risk in older men (International Journal of Endocrinology, 2017).

The mechanism is subtler than it first appears. Much of testosterone's benefit to the male skeleton comes not from testosterone directly but from its conversion — aromatisation — to oestradiol, a form of oestrogen; men with aromatase deficiency (who cannot make this conversion) almost universally develop osteopenia or osteoporosis (International Journal of Endocrinology, 2017).

Are hip fractures in men more dangerous than in women?

When men break a hip, the consequences tend to be more serious than for women. Nearly one-third of hip fractures occur in men, and men have about twice the one-year fatality rate after a hip fracture compared with women (Adler, Bone Research, 2014). The International Osteoporosis Foundation frames the share slightly differently — putting men at roughly a quarter of hip fractures in the over-50s — but both point to a substantial male burden that is easy to overlook (International Osteoporosis Foundation). These figures refer specifically to hip fractures, not to all fragility fractures.

The mortality picture reinforces the point. The International Osteoporosis Foundation reports overall mortality of around 20% in the first 12 months after a hip fracture, higher in men than in women, and notes that over the first six months male mortality is approximately double that of similarly aged women (International Osteoporosis Foundation). The Foundation also projects that male hip fractures could rise by roughly 310% worldwide between 1990 and 2050 as populations age (International Osteoporosis Foundation).

When should a man be assessed for osteoporosis — and how is it diagnosed?

In the UK, a man should be assessed when he is 50 or older and has a clinical risk factor, or after any fragility fracture. The National Osteoporosis Guideline Group's 2024 UK guideline applies to men aged 50 years or older (as well as postmenopausal women) and recommends that a FRAX fracture-risk assessment is carried out in anyone with a clinical risk factor for fragility fracture (National Osteoporosis Guideline Group, 2024). FRAX combines factors such as age, prior fracture, smoking, alcohol intake above 3 units a day and oral glucocorticoid use to estimate 10-year fracture risk (Adler, Bone Research, 2014).

A DXA bone-density scan then refines the picture. NOGG advises that BMD measured by DXA is used to refine intermediate risk and to guide drug choice in those at high or very high risk (National Osteoporosis Guideline Group, 2024). On the scan itself, the thresholds differ by age: in men aged 50 and over, osteoporosis is defined by a T-score of −2.5 or lower (or a prior fragility fracture), whereas in men under 50 a Z-score of −2.0 or lower plus a major risk factor is used instead (StatPearls, 2025). One nuance worth knowing: the ISCD and WHO endorse a young-adult female reference database for calculating T-scores even in men, though many centres use sex-specific databases (StatPearls, 2025). If you want to understand what these numbers mean, our guide to DXA scan results and T-scores breaks them down.

For context, US guidance differs from the UK pathway: the Endocrine Society (a US body) recommends screening men aged 70 and over, and men 50–69 with risk factors (StatPearls, 2025). In the UK, the NOGG/FRAX route above is the one to follow.

How can men reduce their risk of osteoporosis?

Much of a man's fracture risk can be lowered by tackling the causes above — and by knowing where you stand before a fracture happens. Several of the strongest risk factors are modifiable: stopping smoking, keeping alcohol within sensible limits, and staying active with weight-bearing and resistance exercise all support the skeleton, and each maps onto a recognised risk factor for men (StatPearls, 2025). Because so much male osteoporosis is secondary, it is also worth reviewing — with your GP — whether any condition or long-term medication, such as steroids, might be affecting your bones (Royal Osteoporosis Society).

The single most useful move is to stop guessing and measure. A bone-density scan gives you a baseline and, combined with your risk factors, shows whether you need to act now or simply keep an eye on things over time. If you are a man over 50, have had a fracture from a minor fall, take long-term steroids, or have a condition linked to low testosterone, a baseline assessment is a sensible step — you can book a bone health assessment to find out where your bones stand.

The bottom line on osteoporosis in men

Osteoporosis is real, common and under-recognised in men. Around 1 in 5 UK men over 50 will break a bone because of it, men account for a substantial share of hip fractures, and their outcomes afterwards are often worse than women's — yet the condition remains under-diagnosed and under-treated, partly because it is still thought of as a women's disease. The encouraging part is that much male osteoporosis has a treatable underlying cause, and that fracture risk can be assessed with FRAX and DXA long before a bone breaks. If you are a man with any of the risk factors here, the smartest step is to move from guessing to knowing.

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This article is part of our bone health series. To make sense of a scan result, read our guide to DXA scan results and T-scores.