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Being female puts you at greater risk for broken bones. Osteoporosis can strike males and females of any race at any age, but the majority of cases occur in women after menopause. Here are some of the reasons why.

Being a woman puts you at higher risk for developing osteoporosis and suffering broken bones.

These figures from the (US) National Osteoporosis Foundation are for the United States but approximate the reality in much of the world:

  • Of the 9.9 million people in the USA who have been diagnosed with osteoporosis, approximately 8 million are women.
  • Of the 43.1 million people in the USA who could be diagnosed with osteopenia (low bone mineral density), approximately 33 million are women.
  • After the age of 50, approximately 50 percent of women will experience a bone fracture. Only 21 percent of men will have a fracture. Before age 50, more fractures occur in men, but most of these broken bones are due to sports injuries or trauma.
  • 25 percent of women will eventually develop an osteoporosis-related deformity of the spine.
  • 15 percent of women will eventually experience a broken hip — and 80 percent of hip fractures occur in women.
  • Women are twice as likely as men to experience "fragility fractures", broken bones that occur after minimal trauma (sometimes as little as a sneeze or picking up the pet cat).
  • The rate of new fractures begins to accelerate every year after a woman turns 55. The rate of fractures begins to accelerate every year after a man turns 65.
  • Two-thirds of women diagnosed with type 2 diabetes have low bone mineral density.
  • Of the 2 million bone fractures treated by American doctors every year, approximately 1.4 million occur in women.
  • Of the 180,000 Americans every year who have to enter nursing home care because of broken bones, approximately 120,000 are women.
  • A woman's risk of breaking a hip is greater than her combined risk of breast cancer, uterine cancer, and coronary artery disease.
Women need to be aware of the strong likelihood of developing primary osteoporosis. Women tend to be diagnosed with primary osteoporosis, brittle bones that are due to metabolic errors in the bone itself.

Men tend to be diagnosed with secondary osteoporosis, deterioration of bone that is caused by low testosterone levels, alcoholism, or the use of certain prescription medications. The reasons women are so much more likely to develop primary osteoporosis than men include:

  • Women usually have thinner bones than men.
  • Women develop less bone mass for their body weight than men. Teenage girls usually stop gaining new bone mass at age 15. Teenage boys continue to develop new bone mass until age 18.
  • Women lose bone mineral content at an accelerated pace in their sixties. Men also lose bone minerals at an accelerated rate in old age, but not until their seventies.
  • Men's bodies produce relatively more parathyroid hormone (which directs the deposit of calcium into bone) for their size than women.
  • Women's bodies break down the collagen that holds bone minerals together faster than men.
  • Women's estrogen levels plummet after menopause. Estrogen is important for making new bone. Men's bodies also produce tiny amounts of estrogen that are important to bone health, making it from testosterone, but their estrogen levels do not vary as much.

But there are ways that women have a better experience of osteoporosis than men. Women are far more likely than men to be tested for osteoporosis when they have a fracture. Even in the United States, emergency room physicians and orthopedic surgeons tend to neglect long-term for bone mineral loss. Just 23.2 percent of women who have already had a bone fracture due to the disease and a mere eight percent of men who have already had a bone fracture due to the disease are evaluated at the time they experience the broken bone. During the one to five years after a fracture due to osteoporosis, just 48 percent of men and nine percent of men get the indicated treatment for osteoporosis. In the United States, osteoporosis treatment is hit-or-miss for women, and scandalously neglected for men.

Women are more likely to break a hip than men, but men are more likely to die as a result of a hip fracture than women. About 10 percent of men over the age of 65 who break a hip die in the first 30 days. About 21 percent die within a year. For about 75 percent of men, a hip fracture is the beginning of the end, and mortality occurs within seven years. The stated cause of death is likely to be infection, cardiovascular disease, or dementia, but all of these disease processes are accelerated by the disability caused by breaking a hip.

Women are also far more likely than men to get appropriate medication for osteoporosis. All of the bisphosphonate drugs are approved for treating bone demineralization in women. Only alendronate (Fosamax, Binosto), risendronate (Actonel, Atelvia), and zoledronic acid (Reclast) are commonly used in men. About 61 percent of women for whom bisphosphonate treatment is indicated are prescribed it. This number falls to 39 percent for men. Orthopedic surgeons and emergency room physicians are especially unlikely to make referrals to osteoporosis specialists for older men who experience osteroporosis-related fractures of the wrist or forearm.

What is the bottom line on gender disparities in osteoporosis? Women are more likely to get the disease, but they are also more likely to get appropriate treatment. Treatment of osteoporosis for both sexes in the United States is inadequate, and patients and their advocates need to insist on appropriate care.

  • Alswat KA.Gender Disparities in Osteoporosis. J Clin Med Res. 2017 May.9(5):382-387. doi: 10.14740/jocmr2970w. Epub 2017 Apr 1. Review. PMID: 28392857.
  • Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002.162(19):2217–2222. doi: 10.1001/archinte.162.19.2217.
  • Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, Finkelstein JS. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012.97(6):1802–1822. doi: 10.1210/jc.2011-3045.
  • Photo courtesy of SteadyHealth

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