Men With Low Testosterone Often Have Low Bone Density Too

Pam Harrison

June 05, 2015

There is a high incidence of osteopenia in men with low levels of testosterone, and these patients are at significant risk for osteoporosis, new research suggests. And the longer they are hypogonadal, the greater the risk.

"Low testosterone is one of the more established risk factors for osteoporosis in men," said Joseph Ellen, MD, from the Albany Medical Center in New York.

However, "we were surprised that we found such a high incidence of osteopenia and osteoporosis in our clinic, especially because the average age of the men was only about 50 years," Dr Ellen said at the American Urological Association (AUA) 2015 Annual Meeting in New Orleans.

All patients had clinical and biochemical hypogonadism, defined as a testosterone level lower than 300 ng/dL, and all underwent dual-energy x-ray absorptiometry (DEXA) bone scans on the same machine.

Osteopenia was defined as a femoral neck, total hip, or total spine bone mineral density T-score of -1.0 to -2.5; osteoporosis was defined as a bone mineral density T-score of -2.5 or less.

The duration of hypogonadism was defined as the time from the first laboratory test indicating low testosterone to the time the patient underwent the DEXA scan.

Mean age in the cohort was 50.7 years.

Of 235 consecutive patients with clinical hypogonadism treated at the center, 56% had normal bone mineral density levels, 39% were osteopenic, and 5% had frank osteoporosis.

Furthermore, the longer the duration of hypogonadism, the greater the likelihood of normal bone mineral density levels.

"In our clinic, if a man has a testosterone of below 300 ng/dL, especially if he has risk factors for low BMD — including smoking, long-term steroid use, and diabetes — we think it's worthwhile to get a bone scan," said Dr Ellen.

Osteopenia Risk

"It's important to know if a man is osteopenic or not," Dr Ellen told Medscape Medical News. This is particularly true for younger men with years of life ahead of them, "because it's quite possible they will deteriorate into osteoporosis."

"But osteoporosis in men has not been well studied," he added. "There is no good prospective study to determine what the best treatment is."

"We try to get testosterone up to increase bone health, and we also use selective estrogen receptor modifiers, or SERMS, because they help too," said Dr Ellen. In addition, "we tell men to take vitamin D and calcium, then we notify their primary care providers and leave it up to them to start bisphosphonates if they feel it's appropriate."

 
This new study reaffirms the importance of testosterone for bone health in men Dr Abraham Morgentaler
 

The fact that testosterone deficiency causes symptoms that are troubling to men and is associated with significant general health concerns has been lost amid all the "recent senseless noise" regarding testosterone, said Abraham Morgentaler, MD, from Harvard Medical School and Men's Health Boston.

"This new study reaffirms the importance of testosterone for bone health in men," he told Medscape Medical News.

The high rates of osteopenia in men with testosterone deficiency seen in this study are consistent with rates in men younger than 50 years seen in a study Dr Morgentaler was involved in, in which 35% of hypogonadal men had osteopenia, and nearly 3% had frank osteoporosis ( J Sex Med. 2014;11:1898-902).

"In our practice at Men's Health Boston, we now routinely obtain DEXA imaging in these men because of the high rate of abnormal BMD, and we regularly see improvements in bone density with testosterone therapy," Dr Morgentaler reported.

"It is a shame that testosterone deficiency has become so politicized. This is a real condition affecting real men," he said.

Dr Ellen and Dr Morgentaler have disclosed no relevant financial relationships.

American Urological Association (AUA) 2015 Annual Meeting. Abstract PD37-09. Presented May 18, 2015.

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