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

Background and objectives Perceived as a disease of postmenopausal women, osteoporosis is an underrecognised problem in males, as well. In India, available evidence on osteoporosis prevalence in healthy men is limited and heterogeneous, and many studies rely on non-gold-standard assessment tools. This systematic review and meta-analysis aimed to synthesise dual-energy-X-ray absorptiometry (DXA)-based evidence on osteoporosis prevalence and bone mineral density (BMD) in otherwise healthy adult Indian men. Methods We conducted this systematic review and meta-analysis in accordance with PRISMA guidelines. The protocol was registered in PROSPERO (CRD420251145491). PubMed, Scopus, Web of Science, and Central were searched for studies reporting DXA-measured osteoporosis prevalence or BMD in apparently healthy Indian men aged ≥18 y. Data were pooled using random-effects models. Heterogeneity was assessed using the I2 statistic. Publication bias was evaluated using funnel plots and Egger's and Begg's tests, where sufficient studies were available. Results Twenty-one studies were included. Six studies (n=1,569) contributed to the osteoporosis prevalence meta-analysis, yielding a pooled prevalence of 14.6% [95% confidence interval (CI): 8.31-24.45], with substantial heterogeneity (I2=89.9%). Seven studies (n=1,585) reported osteopenia prevalence, with a pooled estimate of 50.3% (95% CI: 40.87-59.79). The pooled mean lumbar spine BMD was 0.99 g/cm2 (95% CI: 0.95-1.04), and femoral neck BMD was 0.87 g/cm2 (95% CI: 0.82-0.92). No significant publication bias was detected for major continuous outcomes. Interpretation and conclusions DXA-based evidence shows a considerable burden of osteoporosis and osteopenia among healthy adult Indian men; however, the evidence is heterogeneous and limited.