Increasing Bone Mineral Density in Older Men

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Larger and longer trials are needed to confirm an association between testosterone and reduced fracture risk.
Larger and longer trials are needed to confirm an association between testosterone and reduced fracture risk.

Men with low testosterone who received testosterone treatments for 1 year showed greater volumetric bone mineral density (BMD) compared with a control group, according to recent research published in JAMA Internal Medicine.

“Testosterone treatment for 1 year of older men with low testosterone concentrations improved all aspects of sexual function and improved somewhat mood and depressive symptoms,” Peter J. Snyder, MD, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues wrote in the study. “The results reported here show that testosterone treatment of these men also significantly increased the [volumetric bone mineral density] and estimated bone strength, more so in the spine than the hip and more so in trabecular bone than cortical-rich peripheral bone.”

Dr Snyder and colleagues evaluated 211 patients enrolled in the Testosterone Trials between December 2011 and June 2014 who had 2 testosterone concentrations of <275 ng/L. Patients in the cohort were a mean 72.3±5.9 years old, had a mean body mass index (BMI) of 31.2±3.4 kg/m2, and were 86% white.

The researchers found that patients who received testosterone treatments for 1 year had a 7.5% increase (95% CI, 4.8%-10.3%) in spine trabecular volumetric bone mineral density (vBMD) compared with the control group who received placebo (0.8%; 95% CI, −1.9%-3.4%) with a treatment effect of 6.8% (95% CI, 4.8%-8.7%; P <.001). There was also a 10.8% increase in spine peripheral vBMD (95% CI, 7.4%-14.3%) compared with the control group (2.4%; 95% CI, −1.0%-5.7%) with a treatment effect of 8.5% (95% CI, 6.0%-10.9%; P <.001) as well as increases in peripheral vBMD spine trabecular bone, and hip trabecular bone.

Compared with the control group, patients who received testosterone had higher mean areal BMD (3.3%; 95% CI, 2.01%-4.56% vs 2.1%; 95% CI, 0.87%-3.36%; P =.01), mean increase in the total hip (1.2%; 95% CI, 0.19%-2.17% vs 0.5%; 95% CI, −0.45%-1.46%; P =.052), and mean increase in the femoral neck (1.5%; 95% CI, 0.02%-2.97% vs 0.9%; 95% CI, −0.49%-2.35%; P =.27).

Summary & Clinical Applicability

The researchers noted larger and longer trials are needed to find an association between testosterone and reduced fracture risk.

“The clinical significance of the effect of testosterone treatment on vBMD and estimated bone strength in these men will depend on whether testosterone treatment also reduces fracture risk,” Dr Snyder and colleagues wrote in the study. “Some evidence suggests that it might. Bone strength, as estimated by [finite element analysis] of [quantitative computer tomography] data, does correlate well with physical strength of human vertebrae and is associated with prevalent bone fractures and incident spine and hip fractures.”

Limitations & Disclosures

The study design did not allow for the researchers to determine testosterone's effect on bone.

The researchers report various financial disclosures. Please see the full study for a complete list of disclosures.

Reference

Snyder PJ, Kopperdahl DL, Stephens-Shields AJ, et al. Effect of testosterone treatment on volumetric bone density and strength in older men with low testosterone: a controlled clinical trial. JAMA Intern Med. 2017;177(4):471-479. doi:10.1001/jamainternmed.2016.9539

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