Osteoporosis in Men and Women: When to Start Screening

Osteoporosis in Men and Women: When to Start Screening

Osteoporosis is often thought of as a “women’s disease,” but it affects both men and women—and often goes undetected until a fracture occurs. In reality, osteoporosis is a silent condition that weakens bones over time, making them fragile and more likely to break. Since it rarely causes symptoms until a fracture happens, screening plays a vital role in early detection and prevention.

As a direct primary care physician in St. Augustine, FL, Dr. Bryant Wilson sees many patients who are unsure when to start screening for osteoporosis. Let’s break down what you need to know about this condition, who is at risk, and most importantly—when you should start screening.

What Is Osteoporosis?

Osteoporosis is a condition where bones become porous, weak, and brittle due to a loss of bone density and strength. Bone is a living tissue that is constantly being broken down and rebuilt. When this balance tips—more bone is broken down than rebuilt—the skeleton loses mass and resilience.

Fractures related to osteoporosis often occur in the hip, spine, and wrist. These can lead to chronic pain, disability, loss of independence, and in the case of hip fractures, even increased risk of death in older adults.

Why Screening Matters

The tricky part about osteoporosis is that you don’t “feel” your bones getting weaker. By the time a fracture occurs, significant bone loss has already taken place. That’s why screening is so important.

Early detection allows for:

• Lifestyle modifications (nutrition, exercise, reducing alcohol and tobacco use)

• Medication when appropriate to strengthen bones

• Fall-prevention strategies to avoid fractures

How Osteoporosis Affects Women vs. Men

Women

• Estrogen loss after menopause accelerates bone loss.

• Women generally start with lower peak bone mass compared to men, giving them less “reserve.”

• Nearly 1 in 2 women over 50 will experience an osteoporosis-related fracture in their lifetime.

Men

• Osteoporosis is less common in men, but often more severe when it occurs.

• Men tend to be diagnosed later, sometimes only after a fracture.

• Nearly 1 in 4 men over 50 will break a bone due to osteoporosis.

• Men who fracture a hip have a higher mortality rate compared to women.

Risk Factors for Osteoporosis

Certain factors increase the risk of osteoporosis in both men and women:

• Age: Risk rises after 50, accelerating in later decades.

• Family history: Having a parent with osteoporosis or hip fracture.

• Low body weight: Smaller, thinner individuals are more vulnerable.

• Hormonal changes: Menopause in women; low testosterone in men.

• Medical conditions: Thyroid disease, rheumatoid arthritis, celiac disease, kidney disease.

• Medications: Long-term use of corticosteroids, some cancer treatments, and certain seizure medications.

• Lifestyle factors: Smoking, heavy alcohol use, poor nutrition, and lack of weight-bearing exercise.

Screening Guidelines: When to Start

The gold standard for screening is a DEXA (dual-energy X-ray absorptiometry) scan, a painless test that measures bone density in the hip and spine.

Women

• All women age 65 and older should have a bone density test.

• Younger postmenopausal women (under 65) should be screened if they have risk factors (low body weight, prior fracture, long-term steroid use, family history, smoking, etc.).

Men

• All men age 70 and older should be screened, regardless of risk factors.

• Men age 50–69 with risk factors (low testosterone, prior fracture, smoking, alcohol use, certain medical conditions or medications) should also be screened.

After a Fracture

Anyone—man or woman—over the age of 50 who suffers a low-trauma fracture (a break from a fall at standing height or less) should be evaluated for osteoporosis.

How Often Should Screening Be Repeated?

• If bone density is normal, repeat testing may be done every 5–10 years.

• If low bone density (osteopenia) is detected, testing may be repeated every 2–5 years, depending on risk.

• Patients on medication for osteoporosis usually have a repeat scan every 1–2 years to monitor response.

Preventing Osteoporosis: Start Early

Screening tells you where your bone health currently stands, but prevention should begin decades earlier. Here are key strategies:

Nutrition

• Calcium: Aim for 1,000 mg per day (men up to 70, women up to 50). After those ages, increase to 1,200 mg daily.

• Vitamin D: Needed for calcium absorption. Most adults require 600–800 IU daily, though some may need more based on blood levels.

• Balanced diet: Adequate protein, fruits, and vegetables support bone health.

Exercise

• Weight-bearing exercise: Walking, running, dancing, hiking.

• Resistance training: Lifting weights or using resistance bands.

• Balance training: Yoga or tai chi can help prevent falls.

Lifestyle

• Quit smoking—it accelerates bone loss.

• Limit alcohol—more than 2 drinks a day increases fracture risk.

• Maintain a healthy weight—being underweight increases risk.

Addressing Common Myths

• “Only women get osteoporosis.”
  False. Men are underdiagnosed and undertreated.

• “I drink milk, so I’m fine.”
  Calcium is important, but vitamin D, exercise, and overall health habits matter just as much.

• “I don’t have symptoms, so I don’t need screening.”
  False. Osteoporosis is silent until a fracture happens.

Final Thoughts

Osteoporosis doesn’t discriminate—it affects both men and women. While women are more likely to develop it earlier due to menopause, men are often diagnosed later, when fractures have already occurred. Screening is the only way to catch osteoporosis early.

• Women: Start at age 65 (earlier with risk factors).

• Men: Start at age 70 (earlier with risk factors).

• Anyone with a fracture over 50: Needs evaluation.

If you’re approaching these ages—or have risk factors—talk to your doctor about whether it’s time for a bone density test. Strong bones are the foundation of a healthy, active life.

If you’re interested in learning more about osteoporosis including treatment options, check out this other blog article titled Osteoporosis Explained: Who’s At Risk and What You Can Do About It

Florida Direct Primary Care in St. Augustine

Dr. Bryant Wilson is a board certified internal medicine physician at Florida Direct Primary Care who develops individualized treatment plans that promote overall health and wellness, tailored to each patient’s unique health needs and goals. If you’re in the St. Augustine area and looking for a primary care doctor, contact us to learn more about our practice. Visit FloridaDPC.com, email us at info@FloridaDPC.com, or call 904-650-2882.

This web site is provided for educational and informational purposes only and does not constitute the provision of medical advice or professional services. The information provided should not be used for diagnosing or treating individual health problems or diseases. Those seeking medical advice should consult with a licensed physician.

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