Identifying Predictors of Bone Density Loss in Men With Low Testosterone

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Identifying Predictors of Bone Density Loss in Men With Low Testosterone


Ljubetic, BM1; Liso, N2; Mulhall, JP2; Flores, JM2

1 - MSKCC
2 - Memorial Sloan Kettering Cancer Center


Introduction

Bone density loss (BDL), is associated with low testosterone (T).


Objective


We aimed to identify predictors of BDL in this cohort of patients.


Methods


The sample included (i) men ≥50 years old (ii) with low total T levels (<300 ng/dL using LCMS on 2 early morning blood draws) (iii) who had dual-energy X-ray absorptiometry (DEXA) within 6 months of T measurement. Men with prior T therapy were excluded. On DEXA, osteopenia was defined as a T score -1.1 to -2.5, osteoporosis T score lower than -2.5. Additionally, demographics and comorbidity data, diabetes, sleep apnea, coronary artery disease (CAD), hypertension, dyslipidemia and smoking status were collected. We report rates and attempt to define predictors of any BDL using multivariable analysis (MVA), including age, comorbidities ≥ 3 (yes), and total T levels ≤ 100 ng/dL (yes).


Results

512 men were analyzed, mean age of 65 ± 5 years. Median total T was 223 (175, 262) ng/dL, free T 4.5 (2.8, 7.9) ng/dL, and estradiol 17 (13, 23) pg/mL. 6% had a total T ≤ 100 ng/dL. Median number of comorbidities was 2 (1, 3). 57% hypertension, 57% dyslipidemia, 40% reported OSA, 24% had diabetes, and 8% reported CAD. 34% of the men had ≥ 3 comorbidities. 44% were former or current smokers. BDL was present in 36% of the patients. 91% had osteopenia, and 9% had osteoporosis. On MVA, significant predictors of BDL were older age, presence of ≥ 3 comorbidities and the presence of total T ≤100 ng/dL (Table 1).


Conclusions

In our cohort of men with low T, one third had BDL, and we have identified key predictors of this occurrence, older age, higher number of comorbidities and profoundly low T.


Disclosure


No




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Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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