Late‐onset Hypogonadism: Bone health

Abstract

Background Bone health is underdiagnosed and undermanaged in men. Bone loss occurs in men with hypogonadism and in aging men. Thus, patients with a diagnosis of late‐onset hypogonadism (LOH) are at risk of osteoporosis and osteoporotic fractures. Objectives To provide an update on research data and clinical implications regarding bone health in men with LOH by reviewing literature articles on this issue. Materials and Methods A thorough search of listed publications in PubMed on bone health in older men with hypogonadism was performed, and other articles derived from these publications were further identified. Results Late‐onset Hypogonadism may be associated with reduced bone mineral density (BMD). In a pathophysiological perspective, the detrimental effects of testosterone (T) deficiency on BMD are partly ascribed to relative estrogen deficiency and both serum T and serum estradiol (E2) need to be above 200 ng/dL and 20 pg/mL to prevent bone loss. The effects of exogenous T on BMD are controversial, but most of the studies confirm that testosterone replacement therapy (TRT) increases BMD and prevents further bone loss in men with hypogonadism. No data are available on TRT and the prevention of fractures. Discussion and Conclusion In men with documented LOH, a specific clinical workup should be addressed to the diagnosis of osteoporosis in order to program subsequent follow‐up and consider specific bone active therapy. TRT should be started according to guidelines of male hypogonadism while keeping in mind that it may also have positive effects also on bone health in men with LOH.

Risk factors for endocrine complications in transfusion-dependent thalassemia patients on chelation therapy with deferasirox: a risk assessment study from a multi-center nation-wide cohort

“…This has been previously shown for bone metabolism disorders, metabolic syndrome, and glucose and lipid metabolism disorders after treatment for hypothyroidism and hypogonadism. [34][35][36] Furthermore, endocrine glands are not equally vulnerable to the iron toxicity, and patients with more endocrinopathies have already wiped out the most endangered endocrine glands.…”

Late‐onset hypogonadism a challenging task for the andrology field

“…Similarly, despite the fact that reduced T levels have been associated with worse metabolic profiles as well as with a higher cardiovascular (CV) risk, the current data only partially support the use of TRT for improving the latter conditions 9,13 . Finally, while TRT can contribute to the improvement of bone mineral density in osteoporotic subjects, its specific role in preventing bone fracture is unknown 10 …”

“…9,13 Finally, while TRT can contribute to the improvement of bone mineral density in osteoporotic subjects, its specific role in preventing bone fracture is unknown . 10 Prostate safety has been considered among the most risky side effects related to TRT. 14…”

“…5 Specific papers included in this special issue analyzed all evidence-based data supporting the role of TRT on several outcomes. [5][6][7][8][9][10] In addition, available on-label and off-label TRT options have been specifically addressed and critically discussed. 11,12 Current evidence supports the role of TRT in improving sexual function in patients with a milder form of ED, whereas the effect of TRT in more complicated ED patients is less effective.…”

“…9,13 Finally, while TRT can contribute to the improvement of bone mineral density in osteoporotic subjects, its specific role in preventing bone fracture is unknown . 10 Prostate safety has been considered among the most risky side effects related to TRT. 14 Substantial clinical and experimental data have clarified that androgens are not only involved in the stimulation of prostate cell proliferation but also contribute to the regulation of prostate cell differentiation.…”