 "Osteoporosis in Men: How declining testosterone fuels fragile bones")
In the minds of many, osteoporosis is seen as a condition that primarily affects women, but experts say the truth is far more complex. Men face significant and often overlooked risks, and one major driver of bone loss is falling testosterone. Understanding how hormonal decline weakens bones can help men take action long before a fracture becomes the wake-up call.
Testosterone’s role in bone health
Bones are living tissue that constantly renew themselves. For men, testosterone is essential for more than muscle and metabolism; it directly supports bone density.
According to Dr Ashis Acharya, Orthopaedic Specialist at Sir Ganga Ram Hospital, New Delhi, testosterone plays a key role in maintaining bone strength, and falling levels can contribute to weakened bones and increased osteoporosis risk.
Dr Nikhil Jadhav, Consultant, Orthopaedics at Sahyadri Super Speciality Hospital, Pune, explains, “Declining testosterone disrupts the balance of bone remodelling by weakening osteoblast activity and reducing the conversion of testosterone to estradiol, which normally slows bone loss.”
Here’s how the hormone protects bone:
- Testosterone converts into estradiol (a form of oestrogen hormone), activating oestrogen receptors in bones that slow deterioration.
- It is closely linked with vitamin D, which regulates calcium absorption and bone metabolism.
- Studies show a strong association between vitamin D levels and free testosterone, even after adjusting for age and body weight.
When testosterone declines naturally with age, bone formation slows, bone loss increases, and bones become more porous and fragile.
Who is most at risk, and when changes begin
Testosterone-linked bone loss usually begins earlier than most men expect. Dr Jadhav notes that:
- Bone changes typically start in the mid-40s, as testosterone gradually declines.
- The impact becomes more pronounced after 50.
Men at highest risk include:
- Those with hypogonadism
- Long-term steroid users
- Men with chronic illnesses like kidney diseases, diabetes
- Heavy smokers or alcohol users
- Those with a family history of osteoporosis
He adds that bone loss is often early and accelerated in men with genuine hypogonadism, especially in the spine and hip.
Subtle signs men should not ignore
Osteoporosis is known as a silent condition, but early clues do exist. Dr Jadhav says, “Most men realise they have osteoporosis only after a fracture because the disease progresses quietly.” Subtle warning signs may include:
- Gradual height loss
- Back discomfort or stiffness
- Reduced physical strength
- General decline in stamina or resilience
Low testosterone itself may bring fatigue, low libido, or muscle loss — symptoms often dismissed or unrecognised.
Screening and treatment
For men with suspected low testosterone or unexplained bone loss, doctors may advise:
- Serum testosterone test (₹ 500 to ₹ 1,500)
- DXA scan for bone mineral density (₹ 1,800 to ₹ 8,500)
- Vitamin D and calcium assessment (₹ 800 to ₹ 1,500)
When it comes to treatment, Dr Jadhav explains, “Testosterone therapy can improve bone mineral density in men with confirmed hypogonadism, especially in the spine and hip, but evidence does not yet show a clear reduction in fracture risk.” Testosterone therapy, if recommended, must be carefully monitored because of its potential effects on cardiovascular and prostate health.
Long-term protection requires a comprehensive plan that includes:
- Getting enough calcium and vitamin D to support bone formation and strengthen mineral density.
- Staying active with weight-bearing and resistance exercises, which help stimulate bone growth and maintain muscle mass.
- Cutting down on smoking and alcohol, both of which accelerate hormonal decline and worsen bone loss.
- Taking prescribed osteoporosis medications such as bisphosphonates or denosumab when recommended, especially for men at high fracture risk.
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This report is for informational purposes only and is not a substitute for professional medical advice.