 It has been proposed that men with fragility
fractures and a bone density T-score at or less
than -1.0 with risk factors, and men with a
bone density T-score of -2 or less regardless
of risk factors, should be considered for therapy.26
Testosterone Therapy
The risk of osteoporosis increases as a consequence
of declining testosterone levels that occur
with increasing age, and the coincident decrease
in BMD. In men with hypogonadism, BMD is generally
low, and can be improved with testosterone
replacement therapy. However, there are no
prospective studies on fracture prevention
with testosterone supplementation either in
patients with established hypogonadism, or
the broader group of elderly male patients
without diagnosed hypogonadism.27 In
one randomized study of changes in BMD of
the lumbar spine
among 108 men over the age of 65 years, who
were randomized to receive either a testosterone
or placebo patch for 36 months, BMD did not
increase among those men with normal pretreatment
testosterone levels (400 ng/dL), while among
those with a low pretreatment testosterone
level (200 ng/dL or less), the testosterone
therapy was associated with an increase in
BMD.28
Testosterone therapy is usually not appropriate
in elderly men due to the high incidence of
undiagnosed prostate cancer in that group.
Management of this potential risk was addressed
in a recent study.29
Read this study
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