Medical research has found a direct positive correlation between low testosterone (hypogonadism) and reduced bone density (osteoporosis).  This simply means that the majority of studies have conclusively demonstrated low testosterone’s promotion of diminished bone mineral density.  Furthermore, numerous studies have also proved that the inverse is true, i.e. improved testosterone levels via testosterone replacement therapy reverses, or at least seriously diminishes, low bone density.  The following medical journal published studies, and additional commentary, clearly depicts both of the aforementioned positions.

In June of 2013 the British Journal of Medicine published ‘Hypogonadism and low bone mineral density in patients on long-term intrathecal opioid delivery therapy’ by RV. Duarte, et al from the Faculty of Health, Birmingham City University, Birmingham, UK.  The expressed aim of this study was to investigate the hypothalamic-pituitary-gonadal axis (HPTA) in a sample of male patients undertaking intrathecal opioid delivery for the management of chronic non-malignant pain, and the presence of osteopaenia and/or osteoporosis in those diagnosed with hypogonadism.  The study examined routinely collected health data from the Department of Pain Management, Russells Hall Hospital, Dudley, UK that was not specifically gathered for research purposes.  In its entirely the study consisted of twenty consecutive male patients attending follow-up clinics for intrathecal opioid therapy all of whom had the gonadal axis evaluated by measuring their serum sex hormone binding globulin, follicle stimulating hormone, luteinizing hormone, total testosterone, and free testosterone.  Also measured in those patients diagnosed with hypogonadism was their bone mineral density by means of Dual Energy X-ray Absorptiometry (DEXA) scanning.  A full 17 (85%) of patients had biochemical hypogonadism, and bone mineral density was assessed in 14 of these 17 patients after the exclusion of 3 patients.  Based on results from both DEXA and their analytical model, RV. Duarte, et al concluded that there as an association between hypogonadism and low bone mass density in patients undertaking intrathecal opioid delivery for the management of chronic non-malignant pain.

Rodriguez-Tolrà J, et al of the Department of Urology, Hospital Universitari de Bellvitge, L’Hospitalet, Spain published a July 2013 study in Andrology entitled, ‘Effects of testosterone treatment on bone mineral density in men with testosterone deficiency syndrome’.  The aim of this study was to examine the safety profile and efficacy of testosterone treatment on bone mineral density in patients with testosterone deficiency syndrome.  Comprised of 50 testosterone deficient men between the ages 50 and 65, this 2-year prospective open-label study administered 50 mg of testosterone gel daily (adjustable after 3 months up to 75-100 mg or down to 25 mg) for 12 months, followed by treatment with 1000 mg of testosterone undecanoate (also known the testosterone preparation Nebido) every 2-3 months from months 12-24.  Amid varying measurement instruments and findings, Rodriguez-Tolrà J, et al also concluded that testosterone replacement therapy in hypogonadal men with significantly improved (as assessed by the AMS questionnaire) symptomatic problems of the hip and lumbar spine, as well as improvements hip bone mineral density.

The list of conclusive, medical journal studies that support either the negative relationship between low testosterone and reduced bone density/osteoporosis, or the positive relationship between testosterone replacement therapy and improved bone density goes on and on.  For example, Aging Male published a June 2012 study by Bruzziches A. Aversa, et al of the Department of Experimental Medicine, Medical Pathophysiology, Food and Science and Endocrinology Section, Sapienza University of Rome, Rome, Italy entitled, ‘Effects of long-acting testosterone undecanoate on bone mineral density in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 36 months controlled study’.  Comprised of 60 (mean age 57 ± 10) men with low serum testosterone (T < 320 ng/dL), this study investigated the effects of long-term testosterone replacement therapy (TRT) on the bone mineral density (BMD) in obese patients with metabolic syndrome (MS) and late-onset hypogonadism (LOH).   Forty experimental subjects received intramuscular testosterone undecanoate (long-acting Nebido) four times per year for three years, while 20 age-matched hypogonadal subjects represented the control group.  Test subjects showed significant improvement of bone mass after 36 months (lumbar BMD=1.053 ± 0.145 g/cm(2)) with a direct relationship between serum testosterone levels and BMD increments.  More specifically the lumbar (r(2) = 0.66, p < 0.0001) and femoral (r(2) =0.52, p < 0.0001) sites both improved significantly.

In June of 2009 Osteoporosis International 2009 published a study by K. Venkat, et al of the National Institute for Research in Reproductive Health (ICMR), J.M. Street, Parel, Mumbai 400 012, India entitled, ‘Age-related changes in sex steroid levels influence bone mineral density in healthy Indian men’.  Their expressed aim was to assess the extent of changes in sex steroid (total testosterone, estradiol, and sex hormone-binding globulin) levels as related to age and bone mineral density in healthy Indian men.  This study was comprised of 330 men between the ages of 20-55, whose sex steroid levels were measured along with osteocalcin (a protein found in the extracellular matrix of bone and dentin and involved in regulating mineralization in the bones and teeth.), and c-terminal telopeptide (blood and urine tests used as an aid in monitoring bone loss in individuals with osteopenia).  Among their findings K. Venkat, et al concluded that there is in fact an age-related decrease in bioavailable testosterone levels which is directly associated with bone mineral density in healthy Indian men.

In July of 2009 RF. Lopes, et al of the Department of Internal Medicine, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil published a study in Osteoporosis International entitled, ‘Low body mass index and declining sex steroids explain most age-related bone loss in Brazilian men’.  This study investigated the association of sex hormones (testosterone and estradiol) and osteoporosis in 104 male subjects, between the ages 50 and 93.  While evaluating bone mineral density, bone turnover, testosterone, and estradiol levels using nonparametric analysis and Poisson regression models to measure the data, researchers found significant increases and decreases in observed variables.  After appropriately adjusting sequentially for Body Mass Index and bioavailable sex hormones attenuating the association between age and osteoporosis prevalence RF. Lopes, et al concluded that low Body Mass Index and declining testosterone levels sufficiently explain most of the association between aging, increased bone turnover, and osteoporosis in adult males.

A September 2008 study published in Mauritas by SR. Davis, et al of the Prince Henry’s Institute of Medical Research, 246 Clayton Road, Clayton, Victoria, Australia entitled, ‘Testosterone enhances estradiol’s effects on postmenopausal bone density and sexuality’ examined the effects of testosterone on women.  The expressed aim of this study was to examine the role of testosterone in increasing bone density and improving low libido in postmenopausal women.  This 2-year, single-blind, randomized trial was comprised of thirty-four postmenopausal female volunteers who were treated with either 50 mg of estradiol (implants) alone, or 50 mg of estradiol plus 50 mg of testosterone.  The treatments were administered every three months for a total of two years, and thirty-two of the initial group of women completed the study.  All sexual parameters (sexual activity, satisfaction, pleasure, orgasm, and relevancy) increased for both groups, with significantly greater improvement in the testosterone and estradiol group, as measured by the Sabbatsberg sexual self-rating scale.  Similarly, according to the DEXA, the bone mineral density of both group increased significantly within the lumbar vertebrae (L1-L4) and hip area increased significantly in both treatment groups.  However, the bone mineral density increased more rapidly in the testosterone and estradiol treated group at all sites, and produced substantially greater increase in total body (P < 0.008), vertebral L1-L4 (P < 0.001) and trochanteric (P < 0.005) measurements.

In May 2004, the Journal of Clinical Endocrinology and Metabolism published a study by C. Wang, et al of Departments of Medicine/Pediatrics, Harbor-University of California, Los Angeles Medical Center and Research and Education Institute, Torrance, CA entitled, ‘Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men’.  This study of 163 hypogonadal men (of whom 123 provided complete data) was conducted for 42 months.  Each subject applied the transdermal testosterone AndroGel at dosages of 5, 7.5, or 10 g (1%) per day.  Among the many cited changes (improved sexual function, improved mood parameters, increased lean body mass, and decreased fat mass), was increased serum bone markers suggestive of increased bone formation were followed by gradual and progressively significant increases in bone mineral density of the spine and the hip where measurements were taken.

The studies presented here represent only a fraction of the clinically tested, research proven, factual data that supports testosterone replacement therapy’s effectiveness in treating diminished bone density and osteoporosis.  Simply put, testosterone replacement therapy not only aids in reversing the hypogonadic symptoms of osteoporosis, but also literally improves bone mineral density for stronger healthier bones and joints, with is of the utmost importance in elderly populations.

REFERENCE LIST

• Hypogonadism and low bone mineral density in patients on long-term intrathecal opioid delivery therapy.
• Duarte RV, Raphael JH, Southall JL, Labib MH, Whallett AJ, Ashford RL.
• BMJ Open. 2013 Jun 20;3(6). doi:pii: e002856. 10.1136/bmjopen-2013-002856. Print 2013.
• Sublingual testosterone replacement improves muscle mass and strength, decreases bone resorption, and increases bone formation markers in hypogonadal men–a clinical research center study.
• Wang C, Eyre DR, Clark R, Kleinberg D, Newman C, Iranmanesh A, Veldhuis J, Dudley RE, Berman N, Davidson T, Barstow TJ, Sinow R, Alexander G, Swerdloff RS.
• J Clin Endocrinol Metab. 1996 Oct;81(10):3654-62.
• Effects of long-acting testosterone undecanoate on bone mineral density in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 36 months controlled study.
• Aversa A, Bruzziches R, Francomano D, Greco EA, Fornari R, Di Luigi L, Lenzi A, Migliaccio S.
• Aging Male. 2012 Jun;15(2):96-102. doi: 10.3109/13685538.2011.631230. Epub 2012 Mar 23.
• Low body mass index and declining sex steroids explain most age-related bone loss in Brazilian men.
• Lopes RF, Ferreira SA, Coeli CM, Farias ML.
• Osteoporos Int. 2009 Jul;20(7):1175-82. doi: 10.1007/s00198-008-0796-7. Epub 2008 Nov 20.
• Age-related changes in sex steroid levels influence bone mineral density in healthy Indian men.
• Venkat K, Desai M, Arora MM, Singh P, Khatkhatay MI.
• Osteoporos Int. 2009 Jun;20(6):955-62. doi: 10.1007/s00198-008-0765-1. Epub 2008 Oct 7.
• Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men.
• Wang C, Cunningham G, Dobs A, Iranmanesh A, Matsumoto AM, Snyder PJ, Weber T, Berman N, Hull L, Swerdloff RS.
• J Clin Endocrinol Metab. 2004 May;89(5):2085-98.
• Effects of testosterone treatment on bone mineral density in men with testosterone deficiency syndrome.
• Rodriguez-Tolrà J, Torremadé J, di Gregorio S, Del Rio L, Franco E.
• Andrology. 2013 Jul;1(4):570-5. doi: 10.1111/j.2047-2927.2013.00090.x. Epub 2013 May 20.
• Testosterone enhances estradiol’s effects on postmenopausal bone density and sexuality.
• Davis SR, McCloud P, Strauss BJ, Burger H.
• Maturitas. 2008 Sep-Oct;61(1-2):17-26.
• Testosterone treatment in elderly men with subnormal testosterone levels improves body composition and BMD in the hip.
• Svartberg J, Agledahl I, Figenschau Y, Sildnes T, Waterloo K, Jorde R.
• Int J Impot Res. 2008 Jul-Aug;20(4):378-87. doi: 10.1038/ijir.2008.19. Epub 2008 May 15.
• Adequacy of androgen replacement influences bone density response to testosterone in androgen-deficient men.
• Aminorroaya A, Kelleher S, Conway AJ, Ly LP, Handelsman DJ.
• Eur J Endocrinol. 2005 Jun;152(6):881-6.