Testosterone Treatment and Fractures in Men with Hypogonadism
Subtrial (n=5204) of an RCT found among middle-aged and older men with hypogonadism after median follow-up of 3.19 years, testosterone treatment did not result in a lower incidence of clinical fracture than placebo (3.50% vs 2.46%, respectively, HR 1.43; 95% CI, 1.04 to 1.97).
Source:
New England Journal of Medicine
SPS commentary:
The analysis also found that fracture incidence appeared to be higher in the testosterone group for all other fracture end points.
An editorial discusses the clinical implications of the trial, highlighting that the findings do not apply to men with hypogonadism due to identifiable disease of the hypothalamic–pituitary–testicular axis, who need testosterone for normal function. It notes that a potential increase in fracture risk should be considered in the decision making about testosterone therapy for men with low serum testosterone concentrations due to aging or obesity. It also suggests that men at high risk for fragility fracture should receive osteoporotic drug therapy with proven anti-fracture benefit independent of any consideration of testosterone therapy.