OBJECTIVES: Male osteoporosis is traditionally under-diagnosed. In the US, two-million men have osteoporosis and another 3.6 million are at an increased risk. In men over 64 years of age, 80% of hip fractures are attributed to osteoporosis, costing a national direct expenditure of $13.8 billion in 2000. Earliest diagnosis is through a bone density test, which could help in prevention of hip fractures and significant savings in health care costs. This study examines the various physician and patient factors, which influence the bone density test prescribing for osteoporosis in male ambulatory patients. METHODS: Patient factors such as age, race, geographical location and payment source, and Physician factors such as specialty and referral status were used to determine their influence on the number of bone density tests prescribed. Data from the National Ambulatory Medical Care Survey (NAMCS) 2002 were utilized. Male patients with principal diagnosis of osteoporosis (ICD-9-CM code 733.00) with age more than or equal to 50 years were analyzed using multiple linear and binomial logit regression models. RESULTS: The number of bone density tests performed were independent of patients' geographic region (R2 = 0.111). White patients were prescribed more bone density tests compared to other races (R2 = 0.436). Patients above 75 years of age and patients with Federal source of payments were prescribed more bone density tests than other patients (R2 = 0.345). Numbers of bone density tests were not influenced by whether the patient was referred (R2 = 0.027). Family Practice physicians prescribed more bone density tests compared to other specialties (R2 = 0.326). CONCLUSIONS: The numbers of bone density tests prescribed are significantly influenced by patients' race, age and source of payments, and physician's specialty. Bone density screening for men over 50 years of age appears to be an optimal approach to manage osteoporosis in men.