Osteoporosis is widely seen as a women's disease. But 1 in 5 Canadians with osteoporosis is male, and men who fracture a hip have worse outcomes than women — yet they're far less likely to be screened, diagnosed, or treated. Here's what every Canadian man needs to know about his bones.
Men generally start with higher bone density than women and don't experience the sharp hormonal drop at menopause — but they're not immune. Bone loss in men is gradual throughout adult life, and several factors accelerate it dramatically.
The most important is testosterone. Like estrogen in women, testosterone plays a key role in maintaining bone density in men. As testosterone levels naturally decline with age — and especially when testosterone is medically suppressed for prostate cancer treatment — bone loss accelerates significantly.
Men undergoing hormone therapy for prostate cancer (called androgen deprivation therapy, or ADT) are at very high risk of osteoporosis. ADT suppresses testosterone to near-zero levels, and bone density can drop by 2–3% per year during treatment — the same rate as in early menopause. Men on ADT should have a DEXA scan at baseline and annually, and most will need bone-protective medication.
Secondary osteoporosis — bone loss caused by another condition — accounts for a larger proportion of cases in men than in women. Common secondary causes include:
Canadian guidelines recommend bone density testing for men in these situations:
Provincial health plans generally cover DEXA scans when clinical criteria are met. Your doctor needs to provide a referral. Learn more about DEXA scans in Canada.
Testosterone promotes bone formation and slows bone breakdown. The relationship isn't perfectly linear — some of testosterone's bone-protective effects actually come via conversion to estradiol (yes, men have estrogen too) in bone tissue. This is why both hormones matter for men's bone health.
Low testosterone (below about 8 nmol/L) is a clear risk factor for osteoporosis. Whether testosterone replacement therapy (TRT) improves bone density is an active area of research — it appears to help in men with confirmed hypogonadism, but is not a substitute for osteoporosis medications in men with low bone density of other causes.
Two of the most modifiable risk factors for osteoporosis are more common in men than women: heavy alcohol use and smoking.
Alcohol: More than two drinks per day is independently associated with lower bone density. Heavy drinking suppresses osteoblast activity (bone formation), increases cortisol (which reduces calcium absorption), and in men, lowers testosterone. Reducing alcohol intake to moderate levels is one of the most impactful lifestyle changes a man at risk can make.
Smoking: Smokers have 10–15% lower bone density on average than non-smokers. Smoking impairs calcium absorption, reduces testosterone, and is associated with earlier menopause in women (earlier bone loss). The good news: bone density begins recovering within a few years of quitting.
Men typically have a head start in bone density, but they also tend to lose ground rapidly if physical activity drops off in middle age. The most effective exercises for bone health are weight-bearing and resistance-based:
Swimming and cycling, while excellent for cardiovascular health, are not weight-bearing and don't stimulate bone formation. If these are your primary activities, add 2–3 resistance training sessions per week. See our exercise and bone density guide for specific protocols.
Men over 50 need 1,000–1,200mg of calcium daily and 800–2,000 IU of vitamin D. Most Canadian men fall short of both. Vitamin D deficiency is especially prevalent — 40% of Canadian men have insufficient levels, with deficiency peaking in winter months. See our calcium guide and vitamin D guide.
The osteoporosis drugs that work for women — bisphosphonates, denosumab, teriparatide — work for men too. Alendronate, risedronate, and zoledronic acid are all Health Canada-approved for osteoporosis in men. Denosumab (Prolia) is approved specifically for men on ADT for prostate cancer.
Unfortunately, men are significantly undertreated. If you've been diagnosed with osteoporosis or have had a fragility fracture, ask your doctor directly whether osteoporosis medication is appropriate for you. See our full guide to osteoporosis medications in Canada.
Osteoporosis in men is common, serious, and frequently missed. The key steps: know your risk factors, ask for a DEXA scan when indicated, optimize calcium and vitamin D intake, stay active with weight-bearing exercise, minimize alcohol and avoid smoking, and work with your doctor on medication if needed. Men who fracture a hip have a higher chance of dying within a year than women — which means there's no good reason to wait.