Osteoporosis in Indian Males: Lumbar Spine DEXA Findings Among the Clinically Referred Cases: doi: 10.7417/CT.2026.2009

Background: Osteoporosis in males remains an underdiagnosed and underappreciated condition despite its association with substantial morbidity, especially following fragility fractures. In India, the limited availability of male-specific data and inadequate screening protocols have led to a poor recognition of bone mineral deficiencies in men. This study aimed to estimate the prevalence of osteoporosis in males using lumbar spine dual-energy X-ray absorptiometry (DEXA) and to examine the biochemical correlates of bone mineral density (BMD), particularly serum 25-hydroxyvitamin D [25(OH)D] and calcium levels. Methods: A retrospective cross-sectional study was conducted at a tertiary care center in Southern India over 12 months (January–December 2017). Ninety-four eligible male patients aged ≥20 years with contemporaneous DEXA scans and serum 25(OH)D and calcium measurements were included. Exclusion criteria excluded systemic comorbidities or medications that affect bone metabolism. BMD was assessed at the lumbar spine (L1–L4), and biochemical assays were performed using standardised electrochemiluminescence and photometric techniques. Statistical analyses included chi-square tests, Pearson’s correlation, and multiple linear regression. Results: Among the 94 male participants, osteoporosis was identified in 35.11% and osteopenia in 36.17%. Vitamin D deficiency (≤20 ng/mL) was observed in 67.02%, while 60.63% had hypocalcemia (lt;8.6 mg/dL). Although the association between age and BMD status was not statistically significant (p = 0.075), both younger (20–40 years: 73.68%) and older (≥60 years: 83.72%) males showed high prevalence of abnormal BMD. Pearson’s correlation showed significant positive associations between BMD and serum 25(OH)D (r = 0.5910, p lt; 0.0001) and calcium (r = 0.6366, p lt; 0.0001). In multivariate analysis, both serum 25(OH)D (β = 0.0091, p lt; 0.0001) and calcium (β = 0.0041, p lt; 0.0001) independently predicted BMD. Conclusion: The study indicates a high prevalence of osteoporosis and osteopenia among Indian males, including younger adults, with strong biochemical associations with serum vitamin D and calcium levels. These findings highlight the urgent need for gender-inclusive screening strategies, early biochemical profiling, and preventive interventions to mitigate the overlooked burden of male osteoporosis in India.