Testosterone supplementation fails to increase BMD, reduce falls among men with deficiency
The effect of testosterone supplements on bone mineral density and the risk for fracture or falling among men with testosterone deficiency remains inconclusive, according to findings published in BMC Endocrine Disorders.
“Aging is associated with a 1% decline in testosterone levels in males, though the causes remain unclear,” Hongjun Li, PhD, professor in the urological department at Peking Union Medical College Hospital and Peking Union Medical College in China, and colleagues wrote. “Androgen deficiency may lead to dysfunctions of the skeletal, reproductive and cardiovascular systems. ... Given that the evidence to date is both conflicting and insufficient, this systematic review aims to evaluate the effect of testosterone supplementation on BMD.”
In a systematic review and meta-analysis, researchers analyzes data from 52 randomized controlled trials with 5,067 men aged at least 40 years who had a diagnosis of testosterone deficiency who were prescribed testosterone therapy. Studies compared testosterone supplementation with placebo, and the primary outcome was total BMD. Secondary outcomes included incidence rate of fracture and falling, all-cause mortality, risk for cardiovascular events and quality of life.
Among the studies included in the analysis, 10 reported no increase in total BMD in the short term (eight randomized controlled trials; 1,081 participants; mean difference, 0.01 g/cm2; 95% CI, 0.02 to 0.01) or long term (two randomized controlled trials; 156 participants; mean difference, 0.04 g/cm2; 95% CI, 0.07 to 0.14) with testosterone supplementation. One study reported incidence rate of fracture was reduced among those who assigned testosterone (211 participants; RR = 0.92; 95% CI, 0.31-2.76), and one reported a lower incidence rate of falling in the testosterone group (262 participants; RR = 0.7; 95% CI, 0.34-1.45).
Five studies reported that testosterone supplementation decreased the risk for all-cause mortality both short term and long term (729 participants; RR = 0.55; 95% CI, 0.29-1.04). CV event incidence was similar between testosterone and placebo groups in the 10 studies in which it was reported (1,374 participants; RR = 1.28; 95% CI, 0.62-2.64). Quality of life as assessed by the Aging Males’ Symptoms scale was improved in the eight studies reporting that outcome (1,328 participants; mean difference, –1.32; 95% CI, 2.11 to 0.52).
The researchers concluded that when compared with placebo, testosterone supplementation did not increase total BMD or risks for CV events or all-cause mortality and did not decrease risks for falling or fracture.
“Clinical practitioners should pay more attention to the problem and make necessary management of the testosterone deficiency in aging males,” Li told Healio. “Even though the effect of testosterone supplementation on BMD and the risk of falls or fracture remains inconclusive, supplementation may benefit patients in many aspects and require further research.” – by Kate Burba
Disclosure: One of the authors reports funding from MSD China.