Understanding Osteoporosis in Men: How to Keep Your Bones Healthy

While osteoporosis in women tends to get more attention, “osteoporosis in men is very real,” says Joey Loeb, PT, DPT, a physical therapist at Hinge Health. Bone health is an important component of men’s health and shouldn’t be ignored, he adds. 

“Osteoporosis is a bone disease that develops when bone mineral density decreases, which affects the structure and strength of bones,” says Dr. Loeb. The insides of your bones look more like a honeycomb than a solid white mass. In the case of osteoporosis, the spaces in this “honeycomb” become larger, indicating less bone density. This makes bones more susceptible to fractures (breaks).  

Osteoporosis is talked about more in the context of women’s health because it’s four times more common in women than in men, according to a review in the Journal of Clinical Medicine Research, and women tend to develop it at an earlier age. But men develop osteoporosis, too. 

Read on to learn about common causes of osteoporosis in men, risk factors, and ways to prevent bone loss — including PT-recommended exercises from Hinge Health physical therapists.

Osteoporosis in Men: Causes and Risk Factors

Osteoporosis affects one in five men, and even more have osteopenia (early bone loss). Many of the causes and risk factors for osteoporosis are similar for men and women, but some are unique to men. Here’s more on common causes of osteoporosis in men. 

• Low testosterone. Like in women, hormonal changes are a primary cause of osteoporosis, but the hormones and how they change differ. Men have some estrogen, which is a key factor in bone loss for women, but testosterone deficiency tends to be the problem for men. Testosterone, which helps to maintain bone, declines with age but at a slower pace than estrogen, which rapidly decreases in women at menopause. This is why men tend to develop osteoporosis later in life than women. 

• Medical conditions. When men under age 70 develop osteoporosis, it’s often related to an underlying health condition that affects bone density, or its treatment involves a medication that affects bone density, such as diabetes, chronic kidney disease, rheumatoid arthritis, and certain cancers. Conditions like celiac disease and inflammatory bowel disease can also impact bone health because they can impair calcium absorption in the gut, says Dr. Loeb. 

• Certain medications. Prolonged use of medications used to treat some conditions men face can contribute to weakened bones, such as androgen-reducing medications or gonadotropin-releasing hormone agonists that are used to treat prostate cancer. Other medications like glucocorticoids (e.g., to treat asthma or rheumatoid arthritis), antiseizure medications, and proton pump inhibitors to lower levels of stomach acid can also affect bone density. 

• Advancing age. Bone mass peaks around age 25 to 30 and then you start to lose bone as you age. While you can’t stop this decline entirely, there are many ways to slow it, especially with exercise. 

• Family history. Genetic factors significantly influence bone density. If a parent or sibling has osteoporosis or is prone to bone fractures, your risk is likely higher. 

• A diet low in calcium and vitamin D. Calcium and vitamin D are essential building blocks for bone. If you’re not getting enough of these nutrients from your diet or supplements, bone density can decline more rapidly with age than it otherwise would. And if your diet was lower in these nutrients when you were younger and building bone,  your bone density may remain lower through your later years.

• Smoking. Smokers lose bone faster and are more likely to have fractures than nonsmokers. Men are more likely to be smokers than women.

• Too much alcohol. Heavy drinking interferes with the ability of calcium and vitamin D to build strong bones. According to the World Health Organization, men tend to consume more alcohol than women, so this is another risk factor that applies more to men than women.

As you can see, some of these risk factors for osteoporosis in men are entirely outside of your control. But there are risk factors that you can modify. Lifestyle choices are responsible for 10%-50% of bone density. Even if you have unmodifiable risk factors for osteoporosis, there’s always something you can do to help keep your bones healthy, and it usually starts with staying active. The exercises below are a great place to start to build stronger bones.

The above exercises are recommended by Hinge Health physical therapists to target areas where osteoporosis tends to occur, such as the hips, spine, and wrists. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

8 Tips to Prevent Osteoporosis in Men

Osteoporosis is often referred to as a silent disease because it tends to progress without noticeable symptoms until a fracture occurs. But osteoporosis and broken bones aren’t inevitable. “You can improve your bone density at any age to prevent or delay the onset of osteoporosis,” says Dr. Loeb.

Here are some ways to keep your bones strong and reduce your risk of developing osteoporosis.

1. Stay active. Just like muscles atrophy when you’re not using them, bones also lose strength when you’re sedentary. The more you move, the lower your risk of developing osteoporosis. “Exercise helps stimulate your body to build stronger bones,” says Dr. Loeb. “Tendons connect muscles to bones, so when you contract a muscle, it exerts tension or force on the bone, signaling the body to make it stronger.” Weight-bearing exercises like walking, jogging, hiking, golfing, playing pickleball, and strength training are particularly effective at keeping your bones strong. They also help improve your balance to prevent a fall that could result in a fracture.

2. Do resistance training. Also known as strength training, resistance training is a type of exercise that utilizes some type of resistance (weights, resistance bands, or body weight) to improve muscular strength, which also strengthens bones. “It doesn't require a ton of time,” says Dr. Loeb. “If you work out two or three days a week for 30 minutes each time, you'll get a positive effect.” You can always start slow and gradually build up to that goal. If you’re a Hinge Health member, some of your exercises provide strength training. 

3. Eat enough protein. Dietary protein (found in dairy products, meat, fish, poultry, eggs, beans, nuts, and seeds) plays a critical role in bone health and helps prevent muscle and bone loss. Since muscle and bone loss happens more quickly as you age, getting adequate protein is especially important as you get older. 

4. Consider supplements. Men should consume at least 1,000 mg of calcium and 600 IU of vitamin D daily to keep your bones strong. If you’re over 70, your needs are even higher (1,200mg of calcium and 800 IU of vitamin D). If you’re unable to get enough of these nutrients through food, talk to your doctor about supplements.

5. Get screened. If you have multiple risk factors for osteoporosis, have lost height, or have had a fracture recently (especially a non-traumatic one), talk to your doctor about getting a bone density test. These can be early warning signs of low bone density, and men are often overlooked for testing. One study found that men are less likely to be screened for osteoporosis than women — 5% vs 12%, respectively.

6. Maintain a healthy weight for you. Weight loss affects your bones. As you lose weight, you also lose muscle. And the faster you lose the weight, the more muscle you lose. Less muscle means less tension is placed on your bones when you move, which can cause your bones to get weaker, too. If you are trying to lose weight, be sure to eat more protein and do weight-bearing exercise and strength training to help minimize muscle and bone loss. 

7. Stop smoking. Smoking can interfere with the absorption of calcium and increase bone loss. If you’re having trouble quitting on your own, seek help from a professional. 

8. Limit alcohol. More than two drinks a day can increase your risk of fractures. Opt for non-alcoholic beverages when you can.

PT Tip: Challenge Yourself

“As long as you're doing exercises that challenge your muscles, it will improve your bone density,” says Dr. Loeb. “The more load you’re putting on your muscles, the greater force they’ll put on the bones, and the stronger your bones will get.” To ensure that you’re working hard enough to strengthen your bones, pay attention to how you feel when exercising. “If you don’t feel any fatigue or like you could do the exercise in your sleep, it’s probably not challenging enough to strengthen your bones,” says Dr. Loeb. “You want to feel some fatigue, get your heart rate up some, and feel like you’re pushing yourself a bit. Then you know you’re getting stronger.”

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Alswat, K. A. (2017). Gender Disparities in Osteoporosis. Journal of Clinical Medicine Research, 9(5), 382–387. doi:10.14740/jocmr2970w

2. Epidemiology Across the World. (n.d.). International Osteoporosis Foundation. Retrieved from https://www.osteoporosis.foundation/health-professionals/about-osteoporosis/epidemiology

3. Office of the Surgeon General (US). (2010). Determinants of Bone Health. National Library of Medicine; Office of the Surgeon General (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK45503/

4. Syamlal, G., Mazurek, J. M., & Dube, S. R. (2014). Gender Differences in Smoking Among U.S. Working Adults. American Journal of Preventive Medicine, 47(4), 467–475. doi:10.1016/j.amepre.2014.06.013

5. Alcohol. (2024, June 28). World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/alcohol

6. Protein and other nutrients. (2024). Osteoporosis Foundation. Retrieved from https://www.osteoporosis.foundation/health-professionals/prevention/nutrition/protein-and-other-nutrients

7. Antonelli, M., Einstadter, D., & Magrey, M. (2014). Screening and Treatment of Osteoporosis After Hip Fracture: Comparison of Sex and Race. Journal of Clinical Densitometry, 17(4), 479–483. doi:10.1016/j.jocd.2014.01.009

8. Campbell, B. (2021, August). Healthy Bones at Every Age. American Academy of Orthopaedic Surgeons. Retrieved from https://orthoinfo.aaos.org/en/staying-healthy/healthy-bones-at-every-age/

9. Osteoporosis in Men. (2023, May 5). National Institute of Arthritis and Musculoskeletal and Skin Diseases. Retrieved from https://www.niams.nih.gov/health-topics/osteoporosis-men