Osteoporosis in Women

Why Osteoporosis is More Common in Women

Women are more likely to have osteoporosis than men — but are these statistics actually putting men at a diagnostic disadvantage?

By Madeline Vann, MPH

Medically reviewed by Lindsey Marcellin, MD, MPH

It may not be fair, but it’s true: If you're a woman, you're automatically at greater risk for osteoporosis than men. The International Osteoporosis Foundation estimates that osteoporosis affects about 200 million women worldwide.

Why the gender gap? Women start with lower bone density than their male peers and they lose bone mass more quickly as they age, which leads to osteoporosis in some women. Between the ages of 20 and 80, the average white woman loses one-third of her hip bone density, compared to a bone density loss of only one-fourth in men.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, osteoporosis statistics show a greater burden for women in the following ways:

• 68 percent of the 44 million people at risk for osteoporosis are women.
• One of every two women over age 50 will likely have an osteoporosis-related fracture in their lifetime. That’s twice the rate of fractures in men — one in four.
• 75 percent of all cases of hip osteoporosis affect women

Building Better Bones

Osteoporosis may have its roots in childhood and adolescence, which is the period when your body does the most bone building. Women reach their peak bone mass at about age 18 while men reach theirs at 20. After that, both women and men continue to build small amounts of bone mass, but men add more than women. By 30, your bones are fully stocked, and although your body will continue to replace old bone cells, there will be no increase in bone mass past that point. 

Osteoporosis and Estrogen

Add osteoporosis to the long list of health issues, like mood swings and migraines, that you can blame on your hormones. Although there are other possible genetic and environmental factors behind bone loss, your body's changing levels of estrogen remains the most culpable suspect.

Estrogen is a hormone that helps regulate a woman’s reproductive cycle. At the same time, it plays a role in keeping bones strong and healthy, in both men and women. While premenopausal women have more estrogen than men, they will experience dramatic drops in estrogen production due to menopause, and are more likely to experience bone loss and osteoporosis at that time.

Women are at increased osteoporosis risk related to estrogen levels if they:

• Experience irregular or infrequent periods, or began having their periods at a later than normal age
• Have had their ovaries removed (at any age)
• Are going through menopause, with those undergoing menopause at an early age having an even higher risk

Women lose bone mass much more quickly in the years immediately after menopause than they do at any other time in their lives.

In contrast, data suggests that women who have more estrogen than their peers, such as women who began their menstrual cycles earlier than normal or who have used estrogen containing contraceptives, are likely to have higher bone density. 

Osteoporosis: Underdiagnosed in Men

Because osteoporosis occurs more frequently in women than men, less attention is paid to bone health in men, and those who have osteoporosis may go undiagnosed and untreated. A study of 895 nursing home residents over age 50 revealed that doctors were less likely to consider osteoporosis diagnosis and treatment for men than women, even when the men had recently experienced a fracture, a widely recognized red flag for osteoporosis. The reality is that 80,000 men experience osteoporosis-related fractures every year, and close to 23,000 die as a result of fracture-related complications.

Bone loss is a normal part of aging in both men and women; by about age 75, men and women lose bone at the same rate and both genders are less able to absorb calcium. However, when men get osteoporosis, it is usually related to another health condition, a lifestyle choice (smoking or alcohol abuse), or medication that has bone loss as a side effect.

Osteoporosis risk is different for men and women, but the disease is dangerous for anyone who gets it. Talk to your doctor about getting an osteoporosis screening if you know you have risk factors.