Factors That Affect Bone Health in Aging Men

Many men older than 45 may be testosterone deficient. Low or deficient testosterone could result in:

• Erectile dysfunction
• Mood changes
• Reduced muscle mass and strength
• Metabolic changes
• Decreased bone mineral density (BMD).

While total testosterone (TT) helps form bones, estradiol (E2) helps maintain their strength. In men, some testosterone is naturally converted into estradiol. Both hormones help regulate the normal process in which old bone is broken down and replaced with new bone. When testosterone or estradiol levels are too low, this balance can be disrupted, and bone may weaken over time.

However, low bone mineral density does not necessarily mean a man has testosterone deficiency or needs testosterone replacement therapy (TRT). Testosterone deficiency should be diagnosed based on symptoms and appropriate hormone testing. Men concerned about low testosterone or bone health should speak with a healthcare provider about which tests may be appropriate.

Is Testosterone the Whole Story?

TRT may be prescribed to men with confirmed, symptomatic testosterone deficiency. Although TRT may improve bone mineral density in some men, it is not a primary treatment for osteoporosis and has not been shown to reduce fracture risk. However, there may be more factors at play than TT alone. Body mass index (BMI) and abdominal fat may also affect BMD. They do so through hormonal dysregulation and physical force exerted on bones (mechanical loading).

In a study of 327 men aged 60 or older, researchers found there was no significant association between BMD and the ratio of TT to E2.

• 5% of men with “normal” BMD were testosterone deficient.
• 2% of men with “reduced” BMD were testosterone deficient.
• 9% of men with “normal” BMD were within the normal E2 range.
• 8% of men with “reduced” BMD were within the normal E2 range.

Researchers say this means factors beyond hormones could affect bone health as men age.

Body Weight May Also Play a Role

Men with a lower TT/E2 ratio tended to have a higher BMI and greater abdominal circumference (AC). Researchers say this points to a change in the body’s hormone balance. As body fat increased, male-hormone activity appeared to decrease.

Men with “normal” BMD tended to have a higher BMI and AC. This may point to age-related weight loss being a contributing factor toward osteoporosis. Researchers suggest that moderate weight gain may help protect bone health.

Supporting Bone Health in Aging Men

Previous research on this subject has been inconsistent. Researchers say this highlights a broader approach to supporting bone health in aging men. TRT alone may not be enough to maintain bone strength. They recommend a combination of dietary changes, aerobic exercise, muscle-building strategies, vitamin D3 supplements, and TRT.

Key Takeaways

• Aging men may experience low testosterone or testosterone deficiency. This could lead to symptoms such as osteoporosis or bone weakness.
• TRT is a common treatment for testosterone deficiency. However, it may not fully improve bone health.
  • If this is the case, a wider approach may be needed. This could involve other areas of healthcare as well.
• Researchers recommend a broader approach to supporting bone health in aging men.
  • This includes hormone therapy, diet, exercise, and vitamin D3 supplementation as needed.
• Older men may want to speak with a healthcare provider about whether testosterone or bone-health testing may be needed.

Resources

Marquardt Filho, N., Da Ros, L. U., Da Ros, J. P., Carvalhal, G. F., Hallak, J., & Da Ros, C. T. (2026). Bone health in aging men: It’s not just about testosterone. The Journal of Sexual Medicine, 23(8). https://doi.org/10.1093/jsxmed/qdag220

Sizar O, Leslie SW, Schwartz J. Male Hypogonadism. [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532933/