Bone loss and low testosterone: 5 ways to reduce your risk

When most people think about testosterone, they picture muscle, mood, and libido. Bone health rarely makes the list.

Osteoporosis is usually seen as something that affects women after menopause, but it's far from a female-only issue. Around one in five men over 50 will break a bone linked to osteoporosis, and when men do fracture, the consequences tend to be more severe: more hospital stays, more complications, and a higher risk of death.¹

Behind much of this is a gradual fall in testosterone that creeps in with age.

Osteoporosis is not just a women's disease

Osteoporosis is a condition where bones become weaker and more likely to break. It happens because the body loses too much bone, builds too little new bone, or both, leaving bones fragile enough to fracture from a minor bump or fall.²

Millions of people are affected by osteoporosis worldwide. Hip, spine, and wrist fractures are among the most common, and the most dangerous. In men, the problem often goes unnoticed, yet research shows the risk of dying after a hip fracture is higher in men than in women. One study found men in their 60s were nearly twice as likely to die within five years of a fracture as women the same age.³

The role of testosterone in bone strength

Testosterone keeps bones strong in several ways. It boosts the activity of the cells that build bone (osteoblasts), slows the cells that break bone down (osteoclasts), and converts into oestrogen in the body. Oestrogen is usually associated with women, but it's just as vital for men's bone health, and much of testosterone's bone-preserving effect comes from this conversion.^1,3

Testosterone levels drop as men age. That's natural. But in some men, levels fall far enough to cause real problems, a condition known as hypogonadism. Alongside low energy, reduced libido, and muscle loss, one of the lesser-known effects is loss of bone density.⁴

The lower the testosterone, the greater the risk.

How big is the risk?

By the time men reach their 70s and 80s, the risk of osteoporosis and fractures rises sharply, right around when testosterone tends to be at its lowest.^1-4 Men over 80 are just as likely to develop osteoporosis as women, yet far less likely to be tested or treated for it.³

Osteoporosis doesn't cause symptoms until something breaks. Bone loss happens quietly, in the background, and often the first sign is a fractured wrist, spine, or hip after a fall.¹

Can testosterone therapy help?

Testosterone replacement therapy (TRT) is often used to treat symptoms of low testosterone, and some studies suggest it can improve bone mineral density, particularly in the spine and hips.

A 2020 study found TRT increased spinal bone density by around 4% compared to placebo.⁵ It hasn't been proven to prevent fractures, though, the outcome that matters most.³ It also carries potential risks: raised red blood cell counts, prostate side effects, and questions around heart health.

Because of this, TRT isn't routinely recommended just to treat osteoporosis. But in men with both low testosterone and bone loss, it can be one part of a broader strategy to strengthen bones.

5 ways to protect your bones

You don't need testosterone therapy to start protecting your bones. Here's where to begin:^1,3

1. Get a bone density test (DEXA scan) if you're over 70, have low testosterone, or a history of fractures.

2. Exercise regularly, especially resistance and weight-bearing activities.

3. Get enough calcium and vitamin D, through food or supplements.

4. Cut down on alcohol and stop smoking. Both speed up bone loss.

5. Get a blood test to check whether your testosterone levels could be behind it.

The numan take

We talk about testosterone mostly in terms of how men feel. It's just as much about how well their bodies hold together. Paying attention to it now could help prevent the kind of injuries that change lives, and shorten them.

See if low testosterone could be affecting your bones →

References

1. ^{Mohamad NV, Soelaiman IN, Chin KY. A concise review of testosterone and bone health. Clinical interventions in aging. 2016;11: 1317–1324.}

2. ^{Vilaca T, Eastell R, Schini M. Osteoporosis in men. The lancet. Diabetes & endocrinology. 2022;10(4): 273–283.}

3. ^{Shigehara K, Izumi K, Kadono Y, Mizokami A. Testosterone and bone health in men: A narrative review. Journal of clinical medicine. 2021;10(3): 530.}

4. ^{Nassar GN, Leslie SW. Physiology, testosterone. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.}

5. ^{Isidori AM, Giannetta E, Greco EA, Gianfrilli D, Bonifacio V, Isidori A, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clinical endocrinology. 2005;63(3): 280–293.}