Osteoporosis is most often seen in postmenopausal women, but in fact, osteoporosis is not uncommon in men, but is given less attention than in women. Men also have menopause, which is not easily detectable because of the gradual decline in male androgen levels. Menopause affects men’s health, including the development of osteoporosis. The age of onset of primary osteoporosis in men tends to be after 70 years of age, and the incidence is lower than in women, but the severity of the disease and mortality are higher than in women. In particular, mortality from osteoporotic hip fractures is significantly higher than in women. With the increase of per capita life expectancy, the incidence of osteoporosis in men has a tendency to increase significantly. There are no exact statistics on the incidence of osteoporosis in men. The lifetime risk of hip fracture in men is 13%-25%; at age 50, the risk of hip fracture in men is 13%, and at age 80, it is 20%. The mortality rate of hip fracture in men is 1.6-2.0 times higher than that in women, and the mortality rate within 1 year after fracture is 30% in men and 15% in women. The mortality rate within 5 years of vertebral fracture is also significantly higher in men than in women. The genetic mechanisms underlying the pathogenesis of osteoporosis in men are unclear. The vitamin D receptor (VDR) gene, estrogen receptor (ER) gene, type I collagen alpha chain (COLIAI) gene, transforming growth factor beta (TGF-β) gene, calcitonin receptor (CTR) gene, interleukin 1 (IL-1) receptor gene, cytochrome P450C19 gene, cytochrome P450C17 genes have been extensively studied, and these genes may be associated with BMD and fracture risk in men. Endocrine factors are closely related to the development of osteoporosis in men. Decreased active vitamin D, increased parathyroid hormone secretion, decreased calcitonin secretion, and changes in serum therapeutics concentrations all affect the development of osteoporosis in men. Androgens play a dominant role in peak bone formation and bone mass maintenance in men, but the effects of testosterone on bone are mediated in large part by estrogen. The role of estrogen in male bone metabolic surgery is perhaps even more important. Bone loss and changes in bone mineral density in men are more closely related to estrogen than to testosterone. Androgen deficiency, or androgen-estrogen co-deficiency is an important factor in the development of osteoporosis in men. Cytokines, nutritional factors, weight and exercise, and lifestyle habits all influence the development of osteoporosis in men. The technique for diagnosing BMD in men with osteoporosis has not been established and can be based on female criteria. Peak bone mass in men is greater than that in women, and when T ≤ -2.5 SD in men, their absolute BMD is still greater than that in women, and the absolute values of T and BMD in men with osteoporotic fractures are also higher than those in women. Accordingly, it is believed that it remains to be studied whether it is correct to use T ≤ -2.5 SD as a diagnostic criterion for men. Some studies have reported that the T value for diagnosing osteoporosis in men seems to be less than -2.5 SD or more. One third of men with osteoporotic fractures have reduced sexual function, so blood androgen level testing is needed for men with osteoporosis, which is related to the use of androgen replacement therapy. Twenty to 30% of the postmenopausal osteoporosis population in women and 50% of the osteoporosis population in men may have secondary osteoporosis, which should be differentiated from primary osteoporosis and their primary disease identified. As in women, the treatment strategy for osteoporosis in men includes basic treatment, pharmacological treatment and surgical treatment. Calcium and vitamin D supplementation are necessary. Bisphosphonates are preferred for the pharmacological treatment of osteoporosis in men, PTH (1-34) is considered, calcitonin is applied in case of hip fracture or acute vertebral fracture, and androgens are used in cases of reduced gonadal function. In men with osteoporosis who have low androgen levels, androgen replacement therapy has value, but its advantages and disadvantages are still controversial. androgens in men over 50 years of age should be examined before use, and changes in the prostate should be dynamically observed during use, including anal palpation of the prostate, ultrasonography, and serum prostate-specific antigen (PSA) measurement. Androgens should be used with caution in cases of prostate enlargement and are contraindicated in cases of prostate cancer. Androgen replacement therapy is only indicated for men with osteoporosis due to androgen deficiency. Those with normal gonadal function should not be treated with androgens. As in women, the treatment strategy for osteoporotic fractures in men should include aggressive correction of the osteoporosis.