Prevalence of Osteoporosis in Elderly Men: Large Real-World Data Addressing the Current Screening Evidence Gap

Evidence supporting osteoporosis screening in older men remains limited. In a large real-world cohort of 29,906 men aged ≥ 70 undergoing DXA screening, osteoporosis was identified in 16.5% and osteopenia in 51.3%, with prevalence increasing with age. These findings indicate that a substantial proportion of older men have low bone mass and are therefore at increased risk of fracture. PURPOSE: Evidence supporting routine osteoporosis screening in older men remains limited. We aimed to evaluate the prevalence and skeletal distribution of low bone mineral density (BMD) in elderly men within a large healthcare system where an age-based DXA screening recommendation has been implemented. METHODS: We conducted a retrospective cohort study of DXA examinations performed between 2014 and 2024 at Assuta Medical Centers within Maccabi Health Services (MHS). MHS implemented a computerized clinical recommendation within the electronic medical record supporting DXA screening in men aged ≥ 70 years approximately a decade ago. To approximate primary age-based screening conditions, individuals with prior DXA examinations before age 70, oncologic disease, prior fracture, chemotherapy or radiotherapy exposure, and other causes of secondary osteoporosis were excluded. Additional exclusions for inflammatory disease, chronic glucocorticoid therapy, and endocrine disorders were applied using structured diagnostic fields and referral free-text data. Participants were required to have at least two valid skeletal site-groups available for analysis. RESULTS: Among a total of 29,906 eligible individuals who underwent DXA, osteoporosis prevalence was 15.0% at the femoral neck, 6.1% at the total hip, and 3.8% at the lumbar spine. Using the lowest T-score definition, overall osteoporosis prevalence was 16.5% and 51.3% of participants demonstrated osteopenia. Femoral neck osteoporosis increased from 12.4% in men aged 70-74 years to 26.1% in men aged ≥ 80 years. CONCLUSION: In a large real-world cohort approximating systematic screening conditions, nearly one in six older men met diagnostic criteria for osteoporosis. These data help address the current evidence gap regarding osteoporosis screening in men.