Is androgen therapy indicated in men with osteoporosis?
Hoppé E, Bouvard B, Royer M, Chappard D, Audran M, Legrand E. Joint Bone Spine. 2013 Apr 12. pii: S1297-319X(13)00064-X. doi: 10.1016/j.jbspin.2013.03.002. [Epub ahead of print]

Source

Service de rhumatologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France; Groupe Etude sur le Remodelage Osseux et les bioMatériaux (GEROM), UPRES EA 4658, IRIS-IBS, Institut de Biologie en Santé, CHU d'Angers, Angers, France. Electronic address: emhoppe@chu-angers.fr.

Abstract

Male osteoporosis is not rare, and its management is a public health issue. The clinical evaluation must include investigations for one or more etiological factors such as hypogonadism, which is found in 5% to 15% of men with osteoporosis. Gradual development of moderate hypogonadism is the most common situation, and the prevalence of hypogonadism increases with advancing age. The wealth of scientific data establishing a major role for sex hormones in growth, bone turnover, and the osteoporotic fracture risk is in striking contrast to the paucity of therapeutic trials. Androgen therapy did not consistently produce bone mass gains, and no data on potential anti-fracture effects are available. Androgen therapy was not associated with significant increases in mortality, prostate disorders, or cardiovascular events, but few data were obtained in patients older than 75years. In practice, in a male patient with osteoporosis, a diagnosis of marked and persistent hypogonadism requires investigations for treatable causes. In patients younger than 75years of age, androgen replacement therapy should be started, in collaboration with an endocrinologist. A history of fractures indicates a need for additional osteoporosis pharmacotherapy. The risk/benefit ratio of androgen therapy is unclear in men older than 75years, in whom a reasonable option consists in combining fall-prevention measures, vitamin D supplementation, and a medication proven to decrease the risk of proximal femoral fractures.