Why Osteoporosis is Underdiagnosed in Men

Greater bone mass

Osteoporosis is more commonly diagnosed in women, and women are at greater risk than men. However, men really have only temporary protection against osteoporosis. The temporary protection is related to the size of men’s skeletons, which are generally larger than women’s bones. This means that men have larger reserves of bone mass to draw from as they age, so their bone loss progresses more slowly. Also, men do not experience the same rapid bone loss that occurs in women during and after menopause. See What is Bone Loss? for more information.

Because bone loss is delayed and osteoporosis does not have any symptoms, men do not usually know they have osteoporosis until a fracture occurs. Increasing awareness about the true frequency of osteoporosis in men is essential for prevention and long-term health.

Screening standards for osteoporosis

Osteoporosis is diagnosed using bone mineral density (BMD) tests to measure the solidness and mass (bone density) usually in the spine, hip, and/or wrist (the most common sites of fractures due to osteoporosis). These tests are performed like x-rays, and they are the only reliable way to determine loss of bone mass. They are painless, noninvasive, and safe. See Bone Mineral Density Tests for more information.

The results of a bone mineral density test are compared to standards, or norms, determined from a large average population. One of the problems with measuring the bone mineral density of men is that many of the standards used for comparison are from young women rather than men. The average bone mass in healthy young women is always lower than that observed in healthy young men. This means that a man may have low bone mass (osteopenia) compared to healthy men, but the comparison with the norm (from young women) will not show that they are at risk for osteoporosis. Consequently, few men are classified as osteoporotic based on the normal data from young women.