Although it is significantly more common in older women, the bone-thinning disease osteoporosis also affects older men. Women precipitously lose bone after menopause. Bone loss continues at a slower rate for both women and men after age 65.
While routine bone density screening is recommended for women age 65 and older, there is controversy about screening men for osteoporosis. Studies have shown improved bone density and decreased vertebral fractures when certain men were treated with bisphosphonate drugs, which inhibit the process of natural bone loss that occurs as we age. However, a recent study suggests that many older men at high risk for fracture have not been screened or treated for osteoporosis. That’s a significant issue, given that elderly men are at greater risk of disability and death than women are following osteoporosis-related fractures.
Undertreatment in Men
Researchers writing in the April issue of the Journal of Investigative Medicine compared the screening and treatment of osteoporosis in 13,704 men and women age 70 and older at one Veterans Affairs medical center from January 2000 to August 2010. The researchers used a validated risk assessment tool to calculate the participants’ risk of an osteoporotic hip fracture over the next 10 years.
The threshold risk for osteoporosis treatment is a 10-year hip fracture risk of 3 percent or greater, and men who meet this criteria should have a bone density test to screen for osteoporosis. Among the study participants, about half of 75- to 79-year-old men and 88 percent of men age 80 and older met this criteria due to age alone, yet only 12 percent had undergone bone density testing compared with 63 percent of similar-age women, and only 5 percent received prescriptions for bisphosphonates compared with 44 percent of the women.
Men were also classified as high risk based on risk factors other than age. These included a previous hip fracture, or treatment with drugs that raise the risk of osteoporosis and bone fractures—specifically corticosteroids such as prednisone (Cortone®, Deltasone®, Sterapred®), which are used to treat arthritis, chronic obstructive pulmonary disease and other inflammatory conditions; and androgen deprivation therapy, which is used to treat prostate cancer. Depending on their risk factor, 69 to 95 percent of men met the criteria for osteoporosis treatment, yet only 27 to 36 percent had bone density screening, and 13 to 24 percent received a bisphosphonate prescription. Of concern, the testing and treatment of osteoporosis among men who had already had sustained a hip fracture was strikingly low.
Osteoporosis Screening Debate
Mount Sinai geriatrician Patricia Bloom, MD, says it isn’t clear why men are falling through the cracks when it comes to osteoporosis. “It’s possible doctor visits in this age group may focus on other health issues, such as cardiovascular problems and pain,” she observes. “Doctors also may be unaware of osteoporosis screening guidelines for men. That said, there is some debate about who benefits most from screening, and it has been several years since guidelines for men were published.”
The National Endocrine Society, National Osteoporosis Foundation, and International Osteoporosis Foundation recommend that all men age 70 and older should have their bone density checked. However, the U.S. Preventive Services Task Force (USPSTF) concludes that current evidence is insufficient to assess the balance of benefits and harms of screening to prevent osteoporotic fractures in men.
Know Your Risk Factors
Dr. Bloom says the best thing you can do for your bone health is to get 
informed about what makes you vulnerable to osteoporosis, and discuss with your doctor whether you should be screened for the disease. “Men and women share many of the risk factors for osteoporosis,” she explains. “These include low body mass, excessive alcohol consumption, smoking, long-term corticosteroid use, low calcium intake or gastrointestinal conditions that impact calcium absorption, low vitamin D levels, a sedentary lifestyle, previous fractures, and a history of falls. Men also may develop osteoporosis due to low testosterone levels—as men age, testosterone decreases, although the drop is much more gradual than the equivalent drop in estrogen levels that women experience during menopause.”
Osteoporosis Management
If you are diagnosed with osteoporosis, your doctor will likely recommend you follow nutrition, exercise, and lifestyle strategies that can help prevent bone loss (see What You Can Do). He or she also may prescribe bisphosphonate drugs, which include alendronate (Fosamax®), ibandronate (Boniva®), risedronate (Actonel®), and zoledronic acid (Reclast®), or other osteoporosis treatments such as denosumab (Prolia®), or teriparatide (Forteo®). “While there is substantial evidence that these drugs reduce osteoporotic fractures in women, there is less evidence that they have the same benefit for men, though one 2013 study did point to a reduction in vertebral fractures in men taking bisphosphonates,” Dr. Bloom says. “Much of the research on bisphosphonate use in men has focused not on the drugs’ anti-fracture efficacy but rather on how they affect age-related bone loss—and the data have shown that they do improve bone density in men.”
If you are advised to take bisphosphonates, you will likely be advised to have repeat bone density scans and bone-health evaluations every few years. Keep in mind that studies have identified a slight risk of atypical fractures of the femur (thigh bone) in people who take bisphosphonates on a long-term basis, though the benefits of the drugs are generally considered to outweigh the possible harms. “To reduce the risk of atypical fractures, many experts recommend that people who take bisphosphonates have a break from the drugs at least every five years,” Dr. Bloom says. “While off the drugs, you should have your bone health reassessed annually to gauge whether you should resume treatment.”
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