title: Bone mineral density and response to treatment in men younger than 50 years with testosterone deficiency and sexual dysfunction or infertility.
abstract: OBJECTIVE
  Testosterone deficiency is a known risk factor for osteopenia and osteoporosis in older men. Less is known about the impact of testosterone deficiency on bone mineral density in younger men.
  
  
  METHODS
  We retrospectively reviewed the charts at an andrology/infertility clinic and identified 399 men younger than 50 years who underwent baseline dual energy x-ray absorptiometry and had total testosterone less than 350 ng/dl or free testosterone less than 1.5 ng/dl. Additional analysis was done in a subgroup of 75 men (18.8%) in whom dual energy x-ray absorptiometry was repeated after treatment at a mean ± SD of 30.4 ± 16.2 months. The determination of osteoporosis or osteopenia was based on T-scores (osteopenia less than -1.0 and osteoporosis less than -2.5) of the lumbar spine and left hip.
  
  
  RESULTS
  Of all 399 men 141 (35.3%) had bone mineral density consistent with osteopenia at the lumbar spine (137) and/or the total hip (19). In 11 men (2.75%) bone mineral density was consistent with osteoporosis at the lumbar spine. On multivariate analysis higher body mass index was independently associated with increased bone mineral density at the spine (p <0.0001) as well as the hip (p <0.001). Testosterone treatment in 43 men increased spine bone mineral density (p <0.001). Significant decreases in spine bone mineral density developed in 21 men treated with clomiphene citrate or anastrazole (p = 0.003). No significant change was noted in hip bone mineral density for any treatment.
  
  
  CONCLUSIONS
  More than a third of men younger than 50 years with testosterone deficiency and infertility or sexual dysfunction had decreased bone mineral density. Testosterone treatment increased bone mineral density while estrogen modulators such as clomiphene citrate or aromatase inhibitors decreased bone mineral density. These results suggest that dual energy x-ray absorptiometry may be warranted in young men with testosterone deficiency.
authors.affiliation: Men's Health Boston, Brookline, Massachusetts, and New York Medical College (JZ), Valhalla, New York.
authors.forename: Ravi
authors.initials: R
authors.lastname: Kacker
authors.affiliation: Men's Health Boston, Brookline, Massachusetts, and New York Medical College (JZ), Valhalla, New York.
authors.forename: William
authors.initials: W
authors.lastname: Conners
authors.affiliation: Men's Health Boston, Brookline, Massachusetts, and New York Medical College (JZ), Valhalla, New York.
authors.forename: John
authors.initials: J
authors.lastname: Zade
authors.affiliation: Men's Health Boston, Brookline, Massachusetts, and New York Medical College (JZ), Valhalla, New York.
authors.forename: Abraham
authors.initials: A
authors.lastname: Morgentaler
mesh_terms: D000367:Age Factors; D000077384:Anastrozole; D000728:Androgens / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects*; D002996:Clomiphene / Q000627:therapeutic use*; D003677:Deficiency Diseases / Q000150:complications / Q000188:drug therapy; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D006801:Humans; D007248:Infertility, Male / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use*; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000150:complications* / Q000188:drug therapy*; D013739:Testosterone / Q000172:deficiency* / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D000728:Androgens; D047072:Aromatase Inhibitors; D004965:Estrogen Antagonists; D009570:Nitriles; D014230:Triazoles; D002996:Clomiphene; D000077384:Anastrozole; D013739:Testosterone
keywords: age groups; bone density; infertility; male; testis; testosterone