Osteoporosis International

, Volume 20, Issue 4, pp 507–518 | Cite as

Risk factors for low BMD in healthy men age 50 years or older: a systematic review

  • A. Papaioannou
  • C. C. Kennedy
  • A. Cranney
  • G. Hawker
  • J. P. Brown
  • S. M. Kaiser
  • W. D. Leslie
  • C. J. M. O’Brien
  • A. M. Sawka
  • A. Khan
  • K. Siminoski
  • G. Tarulli
  • D. Webster
  • J. McGowan
  • J. D. Adachi



In this systematic review, we summarize risk factors for low bone mineral density and bone loss in healthy men age 50 years or older. Consistent risk factors were: age, smoking, low weight, physical/functional limitations, and previous fracture. Data specific to men has clinical and policy implications.


Osteoporosis is a significant health care problem in men as well as women, yet the majority of evidence on diagnosis and management of osteoporosis is focused on postmenopausal women. The objective of this systematic review is to examine risk factors for low bone mineral density (BMD) and bone loss in healthy men age 50 years or older.

Materials and methods

A systematic search for observational studies was conducted in MEDLINE, Cochrane Database of Systematic Reviews, DARE, CENTRAL, CINAHL and Embase, Health STAR. The three main search concepts were bone density, densitometry, and risk factors. Trained reviewers assessed articles using a priori criteria.


Of 642 screened abstracts, 299 articles required a full review, and 25 remained in the final assessment. Consistent risk factors for low BMD/bone loss were: advancing age, smoking, and low weight/weight loss. Although less evidence was available, physical/functional limitations and prevalent fracture (after age 50) were also associated with low BMD/bone loss. The evidence was inconsistent or weak for physical activity, alcohol consumption, calcium intake, muscle strength, family history of fracture/osteoporosis, and height/height loss.


In this systematic review, we identified several risk factors for low BMD/bone loss in men that are measurable in primary practice.


Bone density DXA Men Osteoporosis Risk factors Systematic review 



We thank Chistina Lachetti, Kristina Szabo, and Nicole Zytaruk for data abstraction, and Lois Wyndham for literature review and library assistance.

This project was funded by the Ontario Ministry of Health and Long-Term Care, Ontario Osteoporosis Strategy.

Conflicts of interest

Alexandra Papaioannou, MD, FRCPC, MSc

Consulting and Advisory Role: Amgen, Eli Lilly, Merck Frosst, Novartis, Proctor & Gamble, Sanofi-aventis, Servier

Clinical Trials: Amgen, Eli Lilly, Merck, Novartis, Proctor & Gamble, Sanofi-aventis

Ann Cranney, MD, FRCPC, MSc has received honoraria for educational lectures from Merck Frosst, Alliance for Bone Health and Novartis; and consultant fees from Amgen Canada and Research funding from Hofmann La Roche.

Jacques P. Brown, MD, FRCPC has received honoraria for lecturing, consultancies, grants and research support for clinical trials: Abbott, Alpharx, Amgen, Arthrolab, Sanofi-aventis Canada, Boehringer Ingelheim/Roche, Bristol-Myers Squibb, Celltech, Eli Lilly Canada, Genizon, Glaxosmithkline, Merck Frosst, Nicox, Novartis, NPS Pharma, Pfizer, Proctor & Gamble, Quintiles, Rhône-Poulenc Rorer, Servier, Wyeth, Zelos.

Stephanie M Kaiser, MD, FRCPC

Advisory Boards: Amgen, Eli Lilly, Novartis, Wyeth-Ayerst, Servier

Speaker for: Amgen, Eli Lilly, Novartis, Merck, Procter & Gamble/Sanofi-aventis, AstraZeneca, Servier

William D. Leslie, MD, FRCPC, MSc

Speaker fees, research honoraria, and unrestricted research grants: Merck Frosst Canada Ltd; research honoraria and unrestricted educational grants from The Alliance for Better Bone Health: Sanofi-aventis and Procter & Gamble Pharmaceuticals Canada, Inc.; unrestricted research grants from Novartis Pharmaceuticals Canada, Inc.; unrestricted educational grants from Genzyme Canada

Aliya Khan

Consulting Role: Proctor & Gamble, Merck Frosst, Novartis

Research: Proctor & Gamble, Merck Frosst, Servier, Amgen, Eli Lilly

Jonathan D. Adachi, MD

Consulting Role: Amgen; Astra Zeneca, Eli Lilly; GlaxoSmithKline; Merck Frosst; Novartis; Proctor & Gamble; Roche; Sanofi-aventis; Servier

Clinical Trials: Eli Lilly; GlaxoSmithKline; Merck; Novartis; Pfizer; Proctor & Gamble; Sanofi-aventis; Servier; Wyeth-Ayerst

Courtney C. Kennedy, MSc; Gillian Hawker MD, MSc, FRCPC; Anna M. Sawka MD, FRCPC, PhD; Kerry Siminoski, MD, FRCPC; David Webster, MD, FRCP; Jessie McGowan MLIS: No competing interests to declare.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • A. Papaioannou
    • 1
    • 16
  • C. C. Kennedy
    • 2
  • A. Cranney
    • 3
  • G. Hawker
    • 4
  • J. P. Brown
    • 5
  • S. M. Kaiser
    • 6
  • W. D. Leslie
    • 7
  • C. J. M. O’Brien
    • 8
  • A. M. Sawka
    • 9
  • A. Khan
    • 10
  • K. Siminoski
    • 11
  • G. Tarulli
    • 12
  • D. Webster
    • 13
  • J. McGowan
    • 14
  • J. D. Adachi
    • 15
  1. 1.Division of Geriatric Medicine, Department of MedicineMcMaster UniversityHamiltonCanada
  2. 2.Department of MedicineMcMaster UniversityHamiltonCanada
  3. 3.Division of RheumatologyUniversity of Ottawa, Scientist, Clinical Epidemiology, Ottawa Health Research InstituteOttawaCanada
  4. 4.Women’s College Hospital, Departments of Medicine and Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  5. 5.Department of MedicineUniversité Laval and Head of the Division of Rheumatology at Le Centre Hospitalier Universitaire de QuébecQuebecCanada
  6. 6.Division of Endocrinology, Department of MedicineDalhousie UniversityHalifaxCanada
  7. 7.Department of RadiologyUniversity of ManitobaWinnipegCanada
  8. 8.Department of Nuclear Medicine, Brantford General HospitalBrantfordCanada
  9. 9.Division of Endocrinology, Department of MedicineUniversity Health Network, University of TorontoTorontoCanada
  10. 10.Division of Endocrinology and Geriatrics, Department of MedicineMcMaster UniversityHamiltonCanada
  11. 11.Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of AlbertaEdmontonCanada
  12. 12.Department of Medical ImagingHumber Regional HospitalTorontoCanada
  13. 13.Department of Nuclear MedicineSudbury Regional HospitalSudburyCanada
  14. 14.Institute of Population Health, Adjunct Professor, Department of MedicineUniversity of OttawaOttawaCanada
  15. 15.Alliance for Better Bone Health Chair in Rheumatology, Department of MedicineMcMaster UniversityHamiltonCanada
  16. 16.McMaster University, Hamilton Health SciencesHamiltonCanada

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