Testosterone Replacement Therapy for Treatment of Osteoporosis in Men

Osteoporosis and osteoporotic fractures are associated with significant morbidity and mortality in older men. Declining testosterone levels may occur with aging, and hypogonadism can develop secondary to different pathological disorders. Both testosterone and estrogen play an essential role in maintaining bone mineral density in men. Recent studies have added to the data showing that testosterone replacement therapy (TRT) can increase bone mineral density (BMD); however, long-term studies examining the effect on fracture risk are still lacking. Thus, current evidence does not support the use of TRT solely to treat osteoporosis in hypogonadal men at high risk for fracture. However, TRT may have a role in men at lower risk for fracture or as an adjunct to other pharmacological agents.