Testosterone Therapy in Men with Hypogonadism Does Not Reduce Fracture Risk

A recent study published in the The New England Journal of Medicine suggests that testosterone treatment did not lower the risk of fracture risk in middle-aged and older men with hypogonadism. This double-blind, randomized, placebo-controlled trial spanned over a median follow-up of 3.19 years and involved a total of 5204 participants who were aged 45 to 80 with cardiovascular disease risk and symptoms of hypogonadism. The participants were assigned randomly to either a testosterone or placebo gel, applied daily. This research team monitored fracture occurrences through regular inquiries and verified incidents by obtaining and adjudicating medical records.

This study found that testosterone treatment did not lower the incidence of clinical fractures when compared to the placebo. The full-analysis population revealed that after the 3.19-year period, clinical fractures occurred in 3.50% of the testosterone group (91 participants) and 2.46% of the placebo group (64 participants). The hazard ratio was 1.43 (95% confidence interval, 1.04 to 1.97) that suggests a higher fracture risk in the testosterone group. The findings of this research challenge the previous assumptions about the benefits of testosterone treatment in men with hypogonadism. While testosterone improved the bone density and quality, it did not translate into a reduced risk of fractures.

In summary, this study emphasize the importance of more extensive trials with larger sample sizes and longer durations to comprehensively understand the effects of testosterone on fracture incidence. The outcomes boost hope towards future investigations that highlight the complex relationship between testosterone treatment, bone health, and the overall well-being in middle-aged and older men with hypogonadism.

Reference:

Snyder, P. J., Bauer, D. C., Ellenberg, S. S., Cauley, J. A., Buhr, K. A., Bhasin, S., Miller, M. G., Khan, N. S., Li, X., & Nissen, S. E. (2024). Testosterone treatment and fractures in men with hypogonadism. The New England Journal of Medicine, 390(3), 203–211. https://doi.org/10.1056/nejmoa2308836