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Association of Testosterone and Estradiol Deficiency with Osteoporosis and Rapid Bone Loss in Older Men

Geriatric Research Education and Clinical Center (H.A.F.) and Center for Chronic Disease Outcomes Research (H.A.F., K.E.E., B.C.T.), Veterans Affairs Medical Center, Minneapolis, Minnesota 55417; Department of Medicine (H.A.F., K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Department of Epidemiology and Biostatistics (S.K.E.), University of California, San Francisco, San Francisco, California 94143; University of California, San Diego (E.B.-C.), San Diego, California 92093; Division of Epidemiology (J.A.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15260; and Department of Medicine (E.S.O.), Oregon Health Sciences University, Portland, Oregon 97239

Address all correspondence and requests for reprints to: Howard A. Fink, M.D., M.P.H., Veterans Affairs Medical Center, One Veterans Drive, Box 11G, Minneapolis, Minnesota 55417. E-mail: howard.fink{at}med.va.gov.

Context: The clinical value of measuring testosterone and estradiol in older men with osteoporosis and of measuring bone mineral density (BMD) in older men with testosterone or estradiol deficiency is uncertain.

Objective: The objective of the study was to examine the association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men.

Design: This study was a cross-sectional and longitudinal analysis.

Setting: The study was conducted at six U.S. centers of the Osteoporotic Fractures in Men study.

Participants: The study population consisted of 2447 community-dwelling men aged 65 yr or older.

Main Outcome Measures: Total testosterone deficiency was defined as less than 200 ng/dl. Total estradiol deficiency was defined as less than 10 pg/ml. Osteoporosis was defined as femoral neck or total hip BMD T-score of –2.5 or less. Rapid bone loss was defined as 3%/yr or more.

Results: Prevalence of osteoporosis in men with deficient and normal total testosterone was 12.3 and 6.0% (P = 0.003) and 15.4 and 2.8% (P < 0.0001) in those with deficient and normal total estradiol. Among osteoporotic men and those with normal BMD, prevalence of total testosterone deficiency was 6.9 and 3.2% (P = 0.01), and prevalence of total estradiol deficiency was 9.2 and 2.4% (P = 0.0001). Incidence of rapid hip bone loss in men with deficient and normal total testosterone was 22.5 and 8.6% (P = 0.007) and in those with deficient and normal total estradiol was 14.3 and 6.3% (P = 0.08).

Conclusions: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency. BMD testing of older men with sex steroid deficiency may be clinically warranted.

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