Bone Health in Men: Important but Neglected

Bone health is not often as much of a priority for men as it is women, largely due to the fact that women are more prone to develop osteoporosis (50% by age 50 compared to 20% of men by age 50).¹ However, men are still vulnerable to the risk of fractures from low bone density, it’s only that their risk starts later then women because their peak bone density is greater to begin with, and the bone loss is slower for men.² Additionally, while men may statistically experience fewer fractures due to osteoporosis than women, those who suffer a major fracture, such as to the hip, are more likely to experience complications and die than women.¹ A contributing factor to the higher rate of mortality among men is delayed diagnosis since men are screened less than women and therefore are not receiving the same amount of treatment.³ Therefore men should be more proactive about screening for the disease as well as taking preventative measures, such as resistance exercise and nutritional supplementation.

Important Nutrients for Bone Health

The most prominent minerals in the bone mineral matrix are calcium and magnesium. Unfortunately, they are also often deficient in diets.¹ Age can exacerbate the effects of deficiency as older adults experience decreased intestinal calcium absorption. Vitamin D deficiencies further impact absorption of this crucial mineral. In fact, while there is inconsistent evidence that calcium supplementation alone reduces the risk of fracture, when combined with vitamin D, research shows that fracture risk can decrease by 5 to 15% for all fractures and 13 to 30% for hip fractures.¹ Magnesium, for its part, is associated with increased hip and femoral neck bone mineral density, though research has not found a relationship between magnesium consumption and reduced fracture risk.

In women, menopause is a major contributor to loss of bone mineral density and the development of osteoporosis. In men, testosterone plays an important role in maintaining bone mineral density, and therefore the loss of testosterone with age is associated with the loss of bone mineral density.⁴ Unfortunately, research linking low testosterone with osteoporosis is conflicting. That said, it remains a factor as men age. Interestingly, some research exists exploring the link between testosterone and minerals associated with bone health. For example, one study found that increases in testosterone levels following exercise were greater when accompanied with calcium supplementation.⁵ This improves performance, and offers a potential incentive to include calcium into sports nutrition formulas.

Cardiovascular disease is another important comorbidity to consider as men age which actually has a close relationship to bone health. The two conditions are closely linked, and research shows that one can be a predictor for the other. For example, research has shown that low phalangeal bone mineral density was a significant predictor for cardiovascular mortality in white men aged 45-74 years, while low bone density in the hip was a significant predictor for cardiovascular mortality in men aged 65-76 years.⁶ Deficiencies in certain nutrients highlight the interconnected nature of these two conditions. For example, vitamin K deficiency may be a common denominator for both atherosclerotic calcification and low bone mass. Researchers believe this is due to Gla-containing proteins such as matrix Gla protein and osteocalcin, due to the calcium-binding properties of Gla residues. The dual action of supporting bone and cardiovascular health could be attractive to consumers looking to reduce the amount of pills or capsules they consume.

There is also evidence to suggest that there is a relationship between protein and calcium with studies showing the addition of protein to calcium and vitamin D supplementation protocols may significantly reduce loss of bone mineral density, and reduce risk of fracture in those consuming high amounts of dietary protein.¹ When it comes to diet, dairy consumption may still be a good source of the necessary nutrients to support bone health. Milk in particular is rich in protein, calcium, and phosphorous. Research has shown that milk consumption offers a small but statistically significant impact on lumbar spine and total hip bone mineral density, compared to controls.¹ While research on the impacts of dairy on reducing fracture risk is inconsistent, some research does indicate that fermented dairy such as yogurt and cheese may reduce risk of hip fracture by 10-25% for every 200 g of yogurt or 20 g of cheese eaten.¹

Microbiome, Bone Health Connection

Emerging evidence suggests that there is a relationship between the gut microbiome and bone health. Most directly, the gut influences bone remodeling through microbial metabolites such as short chain fatty acids, which inhibit the production of osteoclasts, thus increasing bone mass. Propionate, butyrate, and acetate are the SCFAs behind these particular benefits.⁷ Diets such as the Mediterranean diet have been shown to increase the production of propionate and butyrate. When it comes to bone health, research has shown the combination of pre and probiotics, which is present in the Mediterranean diet, was associated with lower rates of hip fracture.¹ Some research has even found that specific microbial taxa whose abundance was associated with skeletal muscle health.⁸

Bone health is a relevant concern for both men and women as they age. While women become more vulnerable to developing bone diseases earlier in age, men are still likely to develop bone diseases later in life that makes them vulnerable to fractures. Complications related to fractures late in life are also more likely to cause death in men. As nutraceutical solutions become more targeted, it may be worth exploring how formulations marketed toward men can leverage bone health benefits for proactive supplementation that supports healthy aging and longevity.

References

1. Rizzoli R, Chevalley T. Nutrition and Osteoporosis Prevention. Curr Osteoporos Rep. 2024;22(6):515-522. doi: 10.1007/s11914-024-00892-0
2. NIH. Osteoporosis in Men. May 2023. Accessed March 22, 2026. https://www.niams.nih.gov/health-topics/osteoporosis-men
3. Built to Last: Protecting Men’s Bones for Life. Spine Health Foundation. June 6, 2025. Accessed March 22, 2026. https://spinehealth.org/article/built-to-last-protecting-mens-bones-for-life/
4. Shigehara K, Izumi K, Kadono Y, Mizokami A. Testosterone and Bone Health in Men: A Narrative Review. J Clin Med. 2021;10(3):530. doi: 10.3390/jcm10030530
5. Cinar V., Baltaci A.K., Mogulkoc R. et al. Testosterone Levels in Athletes at Rest and Exhaustion: Effects of Calcium Supplementation. Biol Trace Elem Res. 2009; 129, 65–69. doi: 10.1007/s12011-008-8294-5
6. Farhat GN, Cauley JA. The link between osteoporosis and cardiovascular disease. Clin Cases Miner Bone Metab. 2008;5(1):19-34. PMID: 22460842
7. Lyu Z, Hu Y, Guo Y, Liu, D. Modulation of bone remodeling by the gut microbiota: a new therapy for osteoporosis. Nature. 2023;11, 31. doi: 10.1038/s41413-023-00264-x
8. Okoro PC, Orwoll ES, Huttenhower C, Morgan X, Kuntz TM, McIver LJ, et al. A two-cohort study on the association between the gut microbiota and bone density, microarchitecture, and strength. Front Endocrinol (Lausanne). 2023;14:1237727. doi: 10.3389/fendo.2023.1237727