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Peer-reviewedCC BY 4.0Archives of Osteoporosis

The osteoporosis–fracture paradox in older Taiwanese men: lower osteoporosis prevalence but comparable fragility fracture burden

  • Yi-Yen Lee1,2
  • Yi-Chieh Huang1,2
  • Sheng-Wen Kao1,2
  • Yi-Chou Chen2,3
  • Ming-Te Cheng1,2,4,5
5 affiliations
  1. 1Sinwu Branch, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan, ROC
  2. 2Department of Orthopaedic Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan, ROC
  3. 3National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei City, Taiwan, ROC
  4. 4Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan City, Taiwan, ROC
  5. 5Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan, ROC
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Abstract

Despite a substantially lower prevalence of osteoporosis than age-matched women, older men experienced a relatively comparable burden of fragility fractures, demonstrating a marked dissociation between osteoporosis prevalence and fracture burden.

Purpose: Although osteoporosis is less common in men than in women, male fragility fractures carry substantial morbidity and post-fracture mortality. Whether the lower prevalence of osteoporosis translates into a proportionally lower fracture burden remains unclear. We compared the prevalence of osteoporosis and fragility fractures between age-matched Taiwanese men and women.

Methods: This retrospective cohort study evaluated 2093 men undergoing clinical dual-energy X-ray absorptiometry (DXA) between 2021 and 2023, of whom 2031 met eligibility criteria and were compared with 2031 age-matched women selected via 1:1 nearest-neighbor matching. Osteoporosis was defined as a T-score ≤−2.5 at the lumbar spine, femoral neck and/or total hip. Vertebral and hip fractures were identified from radiographs and electronic medical records. Multivariable logistic regression identified independent predictors of fracture.

Results: The prevalence of osteoporosis in men was approximately half that in women (32.4% vs. 51.4%; P < 0.001). Conversely, vertebral fracture prevalence was comparable between the sexes (22.7% vs. 22.8%; P = 0.940), and hip fracture prevalence did not differ significantly between the sexes (6.1% vs. 5.0%; P = 0.150). In sensitivity analyses, men had a significantly higher prevalence of moderate-to-severe (Genant grade ≥2) vertebral fractures (16.9% vs. 12.3%; P < 0.001). After adjustment for age, body mass index, and osteoporosis, male sex remained independently associated with both vertebral and hip fractures.

Conclusions: Older Taiwanese men exhibited a substantially lower prevalence of osteoporosis than age-matched women but experienced a relatively comparable burden of fragility fractures. These findings demonstrate a marked dissociation between osteoporosis prevalence and fragility fracture burden in older men and reinforce the importance of comprehensive fracture risk assessment integrating BMD with clinical risk factors.

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Cite

BibTeXRIS
BibTeX
@article{lee2026osteoporosisfracture,
  title = {{The osteoporosis–fracture paradox in older Taiwanese men: lower osteoporosis prevalence but comparable fragility fracture burden}},
  author = {Yi-Yen Lee and Yi-Chieh Huang and Sheng-Wen Kao and Yi-Chou Chen and Ming-Te Cheng},
  journal = {Archives of Osteoporosis},
  year = {2026},
  month = oct,
  doi = {10.1007/s11657-026-01782-x},
  url = {https://doi.org/10.1007/s11657-026-01782-x},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The osteoporosis–fracture paradox in older Taiwanese men: lower osteoporosis prevalence but comparable fragility fracture burden
AU  - Yi-Yen Lee
AU  - Yi-Chieh Huang
AU  - Sheng-Wen Kao
AU  - Yi-Chou Chen
AU  - Ming-Te Cheng
PY  - 2026
DA  - 2026/10/31
JO  - Archives of Osteoporosis
DO  - 10.1007/s11657-026-01782-x
UR  - https://doi.org/10.1007/s11657-026-01782-x
AB  - Despite a substantially lower prevalence of osteoporosis than age-matched women, older men experienced a relatively comparable burden of fragility fractures, demonstrating a marked dissociation between osteoporosis prevalence and fracture burden.  Purpose: Although osteoporosis is less common in men than in women, male fragility fractures carry substantial morbidity and post-fracture mortality. Whether the lower prevalence of osteoporosis translates into a proportionally lower fracture burden remains unclear. We compared the prevalence of osteoporosis and fragility fractures between age-matched Taiwanese men and women.  Methods: This retrospective cohort study evaluated 2093 men undergoing clinical dual-energy X-ray absorptiometry (DXA) between 2021 and 2023, of whom 2031 met eligibility criteria and were compared with 2031 age-matched women selected via 1:1 nearest-neighbor matching. Osteoporosis was defined as a T-score ≤−2.5 at the lumbar spine, femoral neck and/or total hip. Vertebral and hip fractures were identified from radiographs and electronic medical records. Multivariable logistic regression identified independent predictors of fracture.  Results: The prevalence of osteoporosis in men was approximately half that in women (32.4% vs. 51.4%; P < 0.001). Conversely, vertebral fracture prevalence was comparable between the sexes (22.7% vs. 22.8%; P = 0.940), and hip fracture prevalence did not differ significantly between the sexes (6.1% vs. 5.0%; P = 0.150). In sensitivity analyses, men had a significantly higher prevalence of moderate-to-severe (Genant grade ≥2) vertebral fractures (16.9% vs. 12.3%; P < 0.001). After adjustment for age, body mass index, and osteoporosis, male sex remained independently associated with both vertebral and hip fractures.  Conclusions: Older Taiwanese men exhibited a substantially lower prevalence of osteoporosis than age-matched women but experienced a relatively comparable burden of fragility fractures. These findings demonstrate a marked dissociation between osteoporosis prevalence and fragility fracture burden in older men and reinforce the importance of comprehensive fracture risk assessment integrating BMD with clinical risk factors.
SN  - 1862-3522
SN  - 1862-3514
ER  -