Prevalence of osteoporosis in healthy adult males in India measured by dual-energy-X-ray absorptiometry: A systematic review and meta-analysis.

TL;DR

Healthy adult men in India show a pooled osteoporosis prevalence of 14.6% and osteopenia prevalence of 50.3%, based on gold-standard DXA imaging. The evidence is heterogeneous and limited, but suggests bone health screening in men is an overlooked clinical priority in India.

What the Study Found

Osteoporosis has long been framed as a women's health issue, particularly affecting postmenopausal women. This systematic review and meta-analysis challenges that narrative by synthesizing DXA-based bone mineral density data from Indian men. The findings reveal a clinically significant burden of bone disease in a population where the condition remains underdiagnosed and undertreated.

The meta-analysis pooled data from 21 studies, with 1,569 healthy adult men contributing to the osteoporosis prevalence analysis. The result: a pooled osteoporosis prevalence of 14.6% (95% CI: 8.31-24.45). To put this in context, approximately 1 in 7 ostensibly healthy Indian men meet the diagnostic criteria for osteoporosis based on bone mineral density measurements. Beyond frank osteoporosis, the picture grows more concerning. Seven studies with 1,585 participants reported osteopenia prevalence, yielding a pooled estimate of 50.3% (95% CI: 40.87-59.79). This means roughly half of healthy Indian men have suboptimal bone density that falls short of osteoporotic thresholds but exceeds normal ranges.

The researchers also quantified absolute bone mineral density values. Lumbar spine BMD averaged 0.99 g/cm2 (95% CI: 0.95-1.04), while femoral neck BMD was 0.87 g/cm2 (95% CI: 0.82-0.92). These measurements matter because lower BMD correlates with increased fracture risk, though absolute fracture risk depends on multiple additional factors including age, prior fractures, and falls history.

A critical limitation tempers these findings: substantial heterogeneity marked the osteoporosis prevalence estimate (I2 = 89.9%), indicating that the underlying studies differed substantially in their populations, methods, or results. The authors explicitly note this limitation, describing the evidence base as "heterogeneous and limited." Publication bias testing suggested the data were reasonably robust for major outcomes, but the heterogeneity raises questions about whether a single pooled estimate fully captures the variation across Indian populations and study designs.

What This Means for You

This research does not establish new mechanisms or identify modifiable risk factors specific to Indian men. Instead, it documents an epidemiological reality: bone health screening in men remains inconsistently applied, even when prevalence justifies it.

If you are an adult male in India, this study provides a rationale for discussing bone health screening with your physician, especially if you have risk factors for osteoporosis (family history, low body weight, sedentary lifestyle, low vitamin-d status, or chronic conditions affecting bone metabolism). DXA screening is the diagnostic standard referenced throughout this analysis.

The high prevalence of osteopenia is particularly noteworthy because it identifies a window for prevention. Osteopenia does not yet constitute osteoporosis, but it signals compromised bone density that may progress. Evidence-based approaches to bone health in men with suboptimal BMD include resistance training, adequate protein intake, and ensuring sufficient vitamin-d status (typically assessed via serum 25-hydroxyvitamin D measurement). Vitamin-k and calcium-containing foods feature prominently in observational studies of bone health, though the supplement literature on bone outcomes remains modest compared to other tissues.

For clinicians, the data support case-finding conversations about bone health in male patients, moving beyond the assumption that osteoporosis is a women's disease. The heterogeneity in the evidence base also highlights the need for standardized, prospective studies on bone health determinants in Indian men.

Study Details

Sources

Prevalence of osteoporosis in healthy adult males in India measured by dual-energy-X-ray absorptiometry: A systematic review and meta-analysis. The Indian Journal of Medical Research. PubMed: 42851224