When you think of a heart disease sufferer, what comes to mind? Chances are, you are visualizing an overweight, middle aged male struggling with his metabolic woes and fighting an uphill battle with stress, diet, exercise, and inflammation. You wouldn’t be wrong- this is the profile for many at high risk of heart disease. But women get heart disease, too, and that’s not an image we conjure up as readily.
Of course women get heart disease, you might think, just not as often. But would you be surprised to learn that this “man’s” disease is the leading cause of death for men and the leading cause of death for women in the United States- 1 in 4? Or that only about half of women even know heart disease is their primary disease threat? Or that two-thirds of women who die of coronary heart disease have no previous symptoms? What these statistics imply is that with less awareness, there may also be less screening and timely treatment options for the gender that is at a lesser- but still very significant- risk.
Now, compare heart disease to another less fatal but very common disease- osteoporosis. Again, we encounter this gender-lensed problem. Osteoporosis is thought of more as a “woman’s” disease. Statistically, osteoporosis strikes more women just as heart disease threatens more men. However, just as heart disease is a risk women ignore at their peril, research shows that men too must pay attention to their bone health or suffer the consequences.
Let’s further examine differences in osteoporosis risk between men and women, and look at some hot-off-the-press research comparing the way clinicians screen and care for men and women’s bone density. We guarantee you, you don’t want to skip out on regular bone density check-ups once you have reached an age of increased risk, so read on to learn more!
Prevalence of Osteoporosis in Men
Yes, the statistics show that there are definite gender differences. Between 2005 and 2010, 16.2% of adults over 65 had osteoporosis at the lumbar spine or femur neck: nearly 5 times more women than men. Interestingly, 48.3% of these adults were affected with low bone mass at the lumbar spine or femur neck, the prelude to osteoporosis, and here the gender gap narrowed to nearly a 1:1 ratio (52% women vs. 44% men). The bottom line is that men, like women, increase their fracture risk as they age.
Now that you are aware that men do indeed suffer from low bone density, just like women, you might not be surprised to learn that osteoporosis in men is a relatively common problem. Men frequently suffer fractures of the hip and vertebra (spine) associated with a high risk of disability or death.
Risk Factors for Osteoporosis in Men
In men, bone loss usually starts at middle age and proceeds both slowly and gradually. Unlike women, whose risk of fracture increases steadily throughout life and dramatically after menopause, men uncommonly suffer hip fractures until after 75 years old, with higher rates among white men in northern European countries and the lowest incidence rates between blacks and Asians. As noted above, most experts recommend screening after age 70 in accord with this data. While younger men break more bones than younger women, these are usually related to distinct incidents and not bone density- think arms and hands, not spine and hips.
Although age, stress, exercise, inflammation, smoking, alcohol, other toxic exposures, malnutrition, and more are known and often modifiable risk factors for osteoporosis shared by men and women, let’s further explore a few key gender-based differences.
- Estrogen and Testosterone Levels. The role of male sex (steroid) hormones such as testosterone in bone density cannot be ignored. Because men do not experience menopause, they do not enter their midlife period with a crash in the sex hormone production responsible for maintaining bone density. With aging, men actually resorb less inner (endocortical) bone and produce more outer (periosteal) bone compared to women, boosting bone size. Like women, men use estrogen, made from testosterone, to fuel bone-building and reduce bone-resorption. Testosterone also helps maintain bone mass, but to a far lesser extent. As men age and make less testosterone, they also can make less estrogen, both of which negatively affect bone health.
- Sex Hormone Transport. Just because estrogen doesn’t crash hard and fast in men as it does in women during menopause doesn't mean that sex hormone activity can’t be reduced undesirably. Aging correlates with an increase in sex hormone binding globulin (SHBG), the taxicab that takes your sex hormones around your body. While they are being chauffeured by SHBG, they cannot do work- including maintaining your bone density- so high SHBG is not desirable.
- Other Hormone Production. Aging men make less growth hormone and insulin-like growth factor I, both of which stimulate the growth of muscle and bone. This is associated with a decline in the thickness and number of trabeculae that comprise the inner scaffolding of bone.
Should we Screen Men for Osteoporosis?
There is a lack of comprehensive research to guide gender-specific treatment and screening of osteoporosis in men. Many experts in the field don’t recommend screening until age 70 and after. However, as we saw above, nearly the same percentage of men as women age 65 and over were already being affected by low bone density – the precurser to osteoporosis. Many medical and nutritional specialist, like ourselves, believe bone density testing should be recommended for men and women at a much younger age. By testing early, perhaps in ones 20’s or 30’s, we could catch and/or rule out low bone density early and establish a personal baseline to compare with,as we age. a 2016 study in the Journal of Bone Mineral Research investigating cost-effectiveness of screening strategies in men concluded that every type of screening was more effective than no screening at all, and no screening at all was by far the most expensive option for the healthcare industry. 
Current Screening for Osteoporosis in Men
In a study published in 2019 in the Journal of Investigative Medicine, Dr. Radhika Narla’s team from the University of Washington compared screening and treatment for osteoporosis among more than 13,700 men and women. The differences in screening methods and techniques were woefully lacking.
- Less than 15 percent of men had their bone density measured, 4 times less than women.
- Less than 19 percent of men had their vitamin D levels measured, 2 times less than women. 
- Only 20 percent of men were given basic calcium and vitamin D supplementation, 3 times less than women.
- Men with previous fractures were overlooked. Men at higher hip fracture risk due to a previously broken hip were often overlooked for both diagnosis and treatment. As noted above, this is a huge risk factor to miss.
While osteoporosis is still considered a predominately “womans” disease, reason for this may be – we simply aren’t looking. Over the last 15 years since we reversed Mira’s advanced osteoporosis using our three step approach to micronutrient sufficiency (food, lifestyle and supplementation) and our patented multivitamin – nutreince, we have received thousands of emails from people asking us for help with their osteoporosis. Many of these letters are from women, but over the last 5 years, an increasing number of them have been from men and in some cases young men. We are honored and touched to be able to share with you one such letter we received on January 3, 2019 from Kevin E., who was able to rebuild his bones and change his life with the power of nutrition, lifestyle, supplementation, and true perseverance.
A Story of Grit – One Man’s Triumph Over Osteoporosis
Dr. Calton & Mira,
When I first reached out to Mira and Jayson the first time, it was purely out of desperation. My email was a cry for help:
“After reading the article you wrote in MindBodyGreen about your osteoporosis diagnosis at 30, I felt the need to reach out. After a celiac disease diagnosis in 2013, I’ve had an ongoing struggle with gut health and other autoimmune related issues. I don’t eat junk food and I consider myself a healthy eater of paleo, gluten-free foods. Still, this past year has been especially challenging as I burned out in my corporate job, suffered extreme fatigue, and felt my health was spiraling out of control.
“Two weeks ago, I received the same diagnosis as you…the worst case of osteoporosis my doctor had seen in someone my age (32). With a young daughter, and another on the way in 2 months, I couldn’t help but breakdown in tears. I want to be there for them. I want to dance with my daughter at her wedding. But with this diagnosis it’s hard for me to think past a few years.
Your article has given me hope to build back my bone density. I’d like to just talk to you and hear how you worked through this and how you got back on track to reverse osteoporosis after being diagnosed.”
The correspondence that followed brought nothing but positivity, hope, and the recommendation to read their new book “Beating Osteoporosis.” This book has been a catalyst not only for rebuilding my bone density but also helping restore my energy and heal my body.
For the first time in many years, I actually feel healthy. I have energy to play with my kids. My gut health has been restored. I no longer worry whether or not I’ll be there for our family. I’m going to be there. And you better believe I’m going to be there to dance
with my daughter on her wedding day.
The Caltons truly are amazing, caring people that put out great information backed by research. Even better is that they’ve built a company around quality products that actually work…They actually help people like me heal their bones, their guts, and their bodies. For that, I’m incredibly grateful.
Bone Up, Boys!
We hope that you saw Kevin’s joy in finding a sustainable, effective, micronutrient-based solution to his bone-building challenges, and noted that advanced age isn’t necessarily a requirement for low bone density. We are here doing what we do everyday as proof of that. Whether you are a man or a women concerned about osteoporosis we will share with you the newest, cutting edge research, clinically proven to naturally increase bone density in our new book, Beating Osteoporosis – A 12-Week Plan to Stronger Bones, when it is released in September! (Click Here to Learn More) It’s the culmination of our life’s work on this topic, and we