New guidelines from the U.S. Preventive Services Task Force are reaffirming the importance of osteoporosis screening for women—but, once again, men are being left out.

Osteoporosis, a bone-thinning disease that can lead to serious, even fatal, fractures, is common among women who have gone through menopause. About one in five U.S. women over the age of 50 have the condition, with the risk rising in tandem with age. Osteoporosis has been dubbed a “silent” disease because it usually causes no symptoms until it leads to a broken bone (most often in the spine, hip, or wrist).

That’s why experts have long recommended that postmenopausal women get bone density testing to catch osteoporosis before it can cause a fracture. The testing is typically done using dual-energy X-ray absorptiometry, or DXA—a simple scan that takes a few minutes and uses low levels of radiation.

The U.S. Preventive Services Task Force is a government-funded panel that periodically reviews the latest scientific research and makes recommendations on preventive healthcare (like disease screenings). Its updated guidelines on osteoporosis screening, released earlier this year, reiterate what it previously advised in 2018:

• Women at average risk of osteoporosis should begin bone density testing at age 65.
• Postmenopausal women younger than 65 who are at higher-than-average risk of osteoporosis—due to factors like low body weight, smoking, heavy drinking, or having a parent who broke a hip—should be evaluated using a risk assessment tool to decide whether DXA screening is warranted.

There’s nothing controversial in that advice. But the update is notable for what’s left out. As in years past, the Task Force does not say “yea” or “nay” to osteoporosis screening for men, citing a lack of evidence. That longstanding omission has frustrated many experts, who worry that older men are being overlooked when it comes to bone health.

Here’s a closer look at the Task Force’s recommendations, what other medical groups say, and the takeaways for women and men.

Why is screening recommended for women only?

Both men and women lose bone density as they age. But women are more likely to develop osteoporosis because they typically have thinner bones to begin with, and their bone loss is often accelerated due to menopause (estrogen, which abruptly drops in menopause, helps keep bones strong). As a result, women account for 80 percent of all cases of osteoporosis.

Given that, most studies of osteoporosis have focused on postmenopausal women. At this point, several clinical trials have proven that screening women for osteoporosis and treating the condition with medication can lower the risk of broken bones—including potentially disabling or fatal hip fractures. In contrast, no clinical trials have tested the effects of routinely screening older men for osteoporosis. The Task Force requires that kind of clinical trial evidence in order to recommend screening.

Does this mean that men shouldn’t be screened?

No. As the Task Force expressly states, it’s not advising men to skip osteoporosis screening. It’s saying that it lacks the necessary evidence to recommend routine screening, and that men should decide after consulting their doctor. Meanwhile, some other medical groups do encourage routine screening for men. The Endocrine Society and the Bone Health & Osteoporosis Foundation (BHOF) both recommend bone density testing for all men starting at age 70 (or possibly earlier for some).

In diverging from the Task Force, those groups point to some basic facts around osteoporosis in men. For one, bone loss and its consequences do become bigger issues for men once they’re in their 70s. Around the ages of 65 to 70, men begin to lose bone density at the same clip as women do. And when men do break a bone due to osteoporosis, it’s typically after the age of 75—when poorer health and frailty may make recovery more difficult or impossible: Men are more likely to die following a hip or spinal fracture than women are.

Also, there’s an important caveat here for both men and women: The Task Force says its recommendations do not apply to people who have medical conditions or use medications that can cause bone loss. Those individuals, regardless of sex, may need bone density testing earlier, or more often, as advised by their doctor.

What should women do?

If you are 65 or older and haven’t been screened for osteoporosis, talk to your doctor. Medicare covers bone density testing for women every two years, or more often if your doctor thinks it’s necessary. If you are postmenopausal and younger than 65, talk to your doctor about whether you have any additional risk factors for osteoporosis that warrant bone density testing.

What should men do?

Remember that osteoporosis is not a “woman’s” disease. If you’re 70 or older, consider talking to your doctor about bone density testing. Some younger men might also want to have that conversation. The Endocrine Society and BHOF recommend bone density testing for men ages 50 to 69 who have certain risk factors, such as a history of fractures, heavy drinking, or smoking. Be aware, though, that your insurance (Medicare or private) may not cover routine screening, since the Task Force does not recommend that for men. (Medicare/Medicaid and most private insurers are required to cover preventive services endorsed by the Task Force.)

What happens if I am diagnosed with osteoporosis?

There are several types of medication that can treat osteoporosis by boosting bone density, including bisphosphonates (taken by pill or IV infusion) and the injection drugs denosumab and teriparatide. Those medications have all been better studied in women, but research suggests they are generally effective for men, too. In addition to medication, the following steps may help curb the risk of an osteoporosis-related fracture:

• Eat a healthful diet with enough calcium and vitamin D (take supplements, if necessary) and protein.
• Drink alcohol only in moderation, if at all.
• Get regular weight-bearing (walking, for example) and muscle-strengthening exercise, which helps preserve bone density and improves balance so you’re less likely to fall. (Talk to your doctor about the types of exercise that are safe for you.)
• Limit your fall risk in other ways, such as installing nightlights and grab bars in the bathroom.

On a side note, everything on that list is also helpful for older adults who haven’t been diagnosed with osteoporosis.

BOTTOM LINE: Bone health is critical for everyone as they age. Yet despite the availability of screening, osteoporosis remains underdiagnosed and undertreated in women and men alike. If you haven’t talked with your doctor about the state of your bone health and whether you need bone density testing, now is the time.