Dear Editor,

We wholeheartedly support these comments from Sirufo et al. [1] regarding the osteoporosis care chiasm that exists among men, which dwarfs the widely publicized care gap in women [2]. Although men develop osteoporosis and related fractures less frequently than women, men still contribute substantially to the osteoporotic fracture burden at the population level—more than one-quarter of all hip fractures occur in men and age-specific hip fracture rates are approximately half those of women [3]. Moreover, men more commonly experience adverse outcomes following fracture including greater death and institutionalization [4, 5]. Although not the focus of our study, the authors correctly highlight that only 13% of the individuals over age 65 undergoing baseline DXA testing were men, which is significantly smaller than their relative contribution to fractures in the population [6]. This low testing rate among men reflects current practice patterns and should not be construed as in any way optimal or supported by the authors. Guidelines, which still frequently target postmenopausal women, need to acknowledge and address this serious shortcoming [7, 8].