title: Is androgen therapy indicated in men with osteoporosis?
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 75 years. In practice, in a male patient with osteoporosis, a diagnosis of marked and persistent hypogonadism requires investigations for treatable causes. In patients younger than 75 years 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 75 years, 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.
authors.affiliation: 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.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Hoppé
authors.forename: Béatrice
authors.initials: B
authors.lastname: Bouvard
authors.forename: Mathieu
authors.initials: M
authors.lastname: Royer
authors.forename: Daniel
authors.initials: D
authors.lastname: Chappard
authors.forename: Maurice
authors.initials: M
authors.lastname: Audran
authors.forename: Erick
authors.initials: E
authors.lastname: Legrand
mesh_terms: D000368:Aged; D000728:Androgens / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D020249:Hormone Replacement Therapy; D006801:Humans; D007006:Hypogonadism / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000728:Androgens
keywords: Bone mineral density; Fracture; Male osteoporosis; Replacement therapy; Testosterone