Diagnosing Osteoporosis in Men

Women and their doctors commonly begin watching for signs of bone loss around menopause. Doctors typically confirm medical and family history and evaluate the patient’s risk factors before deciding to conduct one or a series of tests, including:

• DXA scan for bone density
• Vertebral spine fracture assessment
• FRAX scoring
• 5-hydroxyvitamin D test
• Blood calcium level test
• Testing for biochemical markers of bone turnover

In men, however, these test are often only completed when a fracture has already occurred and/or he has complained of back pain during a visit to his doctor.

See Signs and Complications of Osteoporosis

It is not known if the standard World Health Organization guidelines used to diagnose osteoporosis in women are appropriate for male patients. The International Society for Clinical Densitometry, an independent organization, suggests using a different set of guidelines, though this is controversial.¹

Men and Osteoporotic Fractures

A bone fracture is typically the first symptom of osteoporosis. Men usually suffer fractures from osteoporosis later in life than women do, though this does not mean the fractures do not carry significant risk. In fact, men are more likely to die from complications following an osteoporosis-related hip fracture than women are. About 80,000 men break a hip each year. After a fracture, 60% of surviving men have a higher chance of suffering a second fracture. Men are also more susceptible to rib fractures due to osteoporosis than women.²

Because osteoporosis does not cause pain unless a fracture occurs and men are less likely to undergo osteoporosis testing at midlife, male patients will benefit from being aware of their bone health, especially if they are at risk for osteoporosis. Men who have experienced a loss in height greater than 2 inches or who are known to have low levels of testosterone are often advised to undergo diagnostic testing for osteoporosis.

Other Indications for Osteoporosis Testing

For male patients over 50, a DXA scan is highly recommended if they have any of the following risk factors or indications of decreased bone mineral density:

• Significant height loss
• Drop in hormone levels
• Taking medicines or having diseases that cause bone loss
• Family history of osteoporosis or fractures

Cultivating healthy habits and visiting the doctor regularly are important steps toward preventing osteoporosis development and getting a correct diagnosis prior to painful fractures.