Androgen Therapy

Abstract

Male osteoporosis is a health problem of multifactorial origin. Bone mineral density evaluation by X-ray densitometry allows diagnosis, while stratification of risk fracture is usually done through useful diagnostic tools, i.e., FRAXc. Observational studies demonstrate that sex hormones are important regulators of bone turnover in men. Serum estradiol levels are consistent predictors of bone turnover in men. Although correlation data do not prove causality, interventional studies underline that estradiol appears to be the dominant sex hormone regulating bone resorption, while both testosterone and estradiol may be important in maintaining bone formation in male population. It remains to be elucidated to what extent sex hormones and, more specifically, inadequate testosterone levels, i.e., late-onset hypogonadism, may contribute to increased risk of osteoporotic fractures. Measurements of serum testosterone levels are routinely indicated to exclude secondary causes of male osteoporosis and to designate appropriately all candidates for testosterone treatment. The association with other anti-resorption drugs is somehow indicated in association with testosterone treatment in all cases of severe fracture risk.