Osteoporosis is not a women's disease. One in four Canadian men over 50 will suffer an osteoporosis-related fracture in their lifetime — the same odds as getting prostate cancer. Yet most men are never screened, and many are diagnosed only after a fracture has already happened.
The short answer is that osteoporosis research and clinical guidelines were built primarily around postmenopausal women. Doctors were trained to think of it as a women's health issue, and many still do. Men don't have a menopause — the hormonal cliff that triggers rapid bone loss in women — so there's no clear clinical trigger to start the conversation.
Men also tend to have larger, denser bones to start with, which delays the age at which osteoporosis appears. But when fractures do occur in men, they're often more severe. Men who sustain hip fractures have a 37% mortality rate within one year — higher than the rate in women. Men are also less likely to receive post-fracture osteoporosis treatment than women, even after a diagnosis should be obvious.
Both testosterone and estrogen play roles in male bone health. Testosterone is converted into estrogen in men's bodies via an enzyme called aromatase, and it's actually estrogen that does much of the heavy lifting for bone maintenance in men. When testosterone drops — due to age, hypogonadism, or androgen deprivation therapy (ADT) for prostate cancer — estrogen drops with it, and bone loss accelerates.
Men on ADT for prostate cancer are at extremely high risk for osteoporosis. ADT can cause a 2–8% bone density loss per year. If you or a family member is on goserelin (Zoladex), leuprolide (Lupron), or other GnRH agonists, a baseline DEXA scan and a conversation about bisphosphonate therapy are essential — not optional.
Age-related testosterone decline (sometimes called late-onset hypogonadism or "andropause") causes more gradual bone loss than ADT, but it accumulates over decades. Men who have had clinically low testosterone — confirmed by blood test, not just symptoms — should be assessed for bone density.
Many osteoporosis risk factors are shared between men and women (family history, low calcium intake, smoking, physical inactivity, excessive alcohol). But some are more specific to men or underappreciated in men:
Osteoporosis Canada recommends that all men over 65 receive a baseline DEXA scan (bone density test). For younger men — ages 50 to 64 — a DEXA scan is recommended if you have one or more risk factors listed above.
Your provincial health plan likely covers DEXA scans when referred by a physician. In Ontario, Alberta, and BC, DEXA scans are OHIP/MSP covered with a physician referral. In most provinces, you need to show a clinical indication — but if you're over 65, that's reason enough. Ask your family doctor directly. Many men have to push for this referral.
The DEXA scan measures bone mineral density at the hip and lumbar spine, and gives you a T-score — how your bone density compares to a young healthy adult's. A T-score of -2.5 or lower is defined as osteoporosis; between -1.0 and -2.5 is osteopenia (low bone density, not yet osteoporosis).
The reference population for T-scores in men has historically been based on male bone density data, but some older machines used female reference populations — which could misclassify men. The current standard, endorsed by Osteoporosis Canada and the International Society for Clinical Densitometry, uses a male reference database. If you're unsure, ask the imaging clinic which reference population their equipment uses.
For more detail on the DEXA process, see our DEXA scan guide for Canadians.
The same medications used to treat osteoporosis in women work in men, and are approved by Health Canada for male osteoporosis. Coverage and prescribing practices can differ, but the drugs are the same:
Alendronate (Fosamax) and risedronate (Actonel) are first-line options for most men with osteoporosis. They reduce fracture risk by 30–50% at the spine and 25–40% at the hip. Both are approved by Health Canada for male osteoporosis. Weekly dosing (70 mg alendronate or 35 mg risedronate) is the standard regimen.
Denosumab is a twice-yearly injection approved for men with osteoporosis, including those on ADT for prostate cancer. It's particularly useful for men who can't tolerate oral bisphosphonates. Coverage under provincial formularies varies — in Ontario, it's covered under the ODB program for high-risk patients; in BC, special authority is required. See our full medication guide for provincial coverage details.
If bone loss is driven by documented hypogonadism, testosterone replacement therapy (TRT) can improve bone density. However, TRT is not used as a primary osteoporosis treatment — it addresses the underlying cause, not the bone density directly. Most men on TRT for bone health also receive a bisphosphonate.
Men over 50 need 1,000 mg of calcium daily (1,200 mg over 70). Vitamin D deficiency is common across Canada, particularly in men who work indoors. Health Canada recommends 600 IU daily; Osteoporosis Canada recommends 800–2,000 IU for adults over 50. Supplementing both calcium and vitamin D is recommended alongside any pharmaceutical osteoporosis treatment.
See our calcium supplement guide and vitamin D guide for details.
The mortality statistics for men after hip fracture are sobering. Approximately 37% of Canadian men who sustain a hip fracture die within one year. This is consistently higher than the one-year mortality rate in women (about 20%). The reasons are complex — men tend to be older when they fracture, have more comorbidities, and are less likely to be in systems that proactively manage osteoporosis after a first fracture.
This is why secondary fracture prevention is so important. The Fracture Liaison Service (FLS) model — where patients who fracture are automatically assessed for osteoporosis and started on treatment — exists in many Canadian centres, including major hospitals in Toronto, Vancouver, and Calgary. But it's not universal. If you or a family member fractures a hip or vertebra, advocate for a bone health assessment before discharge.