Do only women develop osteoporosis?

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People of any sex or gender can develop osteoporosis. This means that it is not only females who can develop the condition. However, the rates of osteoporosis are higher among females, which is why the condition has a reputation for affecting females more often than males.

It is still possible for males to get osteoporosis. Because the bones naturally weaken with age, the risk of osteoporosis increases over time for all adults.

Estimates suggest that around 10 million people in the United States over the age of 50 have osteoporosis. Of these, 2 million are males, while the remaining 8 million are females. This means that the majority of people with osteoporosis are female, but that around 1 in 5 of all cases affect males.

The rates also differ by race and ethnicity. For example, a 2022 article estimates that more than 50% of older white women and 20% of white men will have a fracture related to osteoporosis. The risk is lower in both Black males and females.

Data from the Centers for Disease Control and Prevention (CDC) also suggest that osteoporosis rates in females increased from 2007–2008 and 2017–2018, but not in males. It is unclear why this is.

Females tend to develop osteoporosis earlier in life than males. This is because females:

• have faster age-related bone loss than males
• typically have smaller, thinner bones
• typically have smaller bodies overall

These factors make a person more likely to develop osteoporosis if their bone density decreases.

The Framingham Osteoporosis Study looked at hip bone mineral density in males and females with an average age of 74. After 4 years, the bone loss at all the sites scientists measured was 0.2–3.6% for males but 3.4– 4.8% for females.

The risk of fractures in people with osteoporosis varies greatly from person to person, as many factors influence the likelihood. However, the risk is higher in females than males overall.

A 2021 analysis estimates that the risk of a hip fracture in older males is 5–6%, compared to 16–18% for older females.

The risk also varies by location. For example, a 2021 research article states that in Sweden, the lifetime risk of a hip fracture among females over 50 is 22.8%, while in Germany, France, Spain, and the United Kingdom, the figure ranges from 10–17%.

This may be because people in parts of the world that get less sunlight may get less vitamin D, which is important for bone health.

Although more females with osteoporosis have fractures in comparison to males, some research suggests that males who do have fractures are more likely to have complications.

A 2017 review of prior research suggests that men have a 70% higher mortality rate after hip fractures than females. This may be because of surgical complications, such as infections and sepsis.

The risk factors for osteoporosis are similar across genders, but how frequently they occur varies by sex, lifestyle, and other factors.

The risk factors include:

• older age
• a lack of nutrition, particularly low calcium or vitamin D intake
• a lack of physical activity
• low body weight
• being white or Asian
• having low estrogen
• menopause or early menopause
• a family history of osteoporosis
• a personal history of fractures
• smoking
• drinking alcohol
• taking certain medications, such as corticosteroids

Osteoporosis is more common in females than in males because some of the risk factors for the disease affect females more often.

For example, most females will experience hormonal changes that increase the risk of osteoporosis, such as menopause. Early menopause or low estrogen levels can also elevate the risk.

However, low estrogen also increases the risk in males, along with low testosterone. Estimates suggest that 20% of older males have hypogonadism, which is when the testes do not make enough sex hormones.

Other causes include:

• Body size: A lower body weight is a risk factor for osteoporosis. On average, females have a smaller body size than males.
• Smaller bones: Similarly, females usually have smaller bones than men. This increases the risk of more rapid bone loss.
• Eating disorders: Some eating disorders cause a person to severely limit the foods they eat, which may result in low calcium or vitamin D levels. Women are more likely to develop eating disorders than men.
• Pregnancy and lactation: Rarely, breastfeeding and pregnancy can deplete bone minerals, causing pregnancy-induced osteoporosis. This is more likely to occur in older females with lower body mass.

It is not only women who develop osteoporosis — people of all sexes and genders can have the condition. However, more females than males get osteoporosis due to a range of factors, such as menopause and smaller bones. They also tend to develop osteoporosis earlier in life.

Dietary and lifestyle changes can reduce the risk of osteoporosis in males and females. Because the disease causes no symptoms until a bone breaks, screening can also help to detect it early.

Males ages 70 and above and females ages 65 or above should seek bone density testing. If a person has osteoporosis risk factors, they may benefit from screening from 50 years of age.