Testosterone Deficiency and Osteoporosis

As men age, and especially around age 70, their bone density decreases. Unlike women, men do not generally go through periods or rapid hormonal change. However, men can develop osteoporosis as a result of low hormone levels in the body, especially low testosterone levels.

Testosterone deficiency can be caused by one or more of the following:

Age. While the reduction in hormone levels experienced by aging men is not as pronounced as that which postmenopausal women experience, it can be significant enough to impact bone mineral density.

Cancer treatments. Prostate cancer is sensitive to and feeds off of testosterone, and treatment often includes hormone therapy.

Glucocorticoids. This type of steroid is used to treat asthma and rheumatoid arthritis. If taken on a long-term basis, it can reduce testosterone levels.

Hypogonadism. If the male body does not produce sufficient testosterone, this is called hypogonadism. Men may be born with this condition, or it may develop later in life due to injury or illness.

Primary vs. Secondary Osteoporosis

There are two types of osteoporosis: primary and secondary. Primary osteoporosis may be the result of old age (senile osteoporosis) or an unknown non-secondary cause (idiopathic osteoporosis).

See Types and Causes of Osteoporosis

Secondary osteoporosis, which includes osteoporosis in men caused by low testosterone, is osteoporotic bone loss due to one or more secondary causes. Typical causes of secondary osteoporosis in men include: ¹ Osteoporosis in Men. NIH Osteoporosis and Related Bone Diseases National Resource Center. January 2012. Available at http://www.niams.nih.gov/health_info/bone/osteoporosis/men.asp. Accessed February 2015.

• Certain medications, including steroids, immunosuppressants, and anticonvulsants
• Excessive drug or alcohol use
• Smoking
• Hypothyroidism
• Some gastrointestinal diseases
• Some musculoskeletal diseases, including ankylosing spondylitis and rheumatoid arthritis
• Immobilization

Men with the above secondary testosterone causes, combined with other typical risk factors, are encouraged to talk to their doctors about preventative measures they may take to reduce the likelihood of developing osteoporosis and whether or not they are candidates for DXA scans or other tests.

Estrogen and Osteoporosis in Men

Estrogen is important for creating and protecting bone density in both men and women. Research suggests that estrogen deficiency may play a role in men developing osteoporosis as it does for women. ¹ Osteoporosis in Men. NIH Osteoporosis and Related Bone Diseases National Resource Center. January 2012. Available at http://www.niams.nih.gov/health_info/bone/osteoporosis/men.asp. Accessed February 2015. Lack of estrogen, which is present in men in small amounts, may result in low bone mineral density. ² Ebeling PR. Osteoporosis in men. New insights into aetiology, pathogenesis, prevention and management. Drugs Aging. 1998;13(6):421-34. It is currently unclear, however, if estrogen level monitoring and/or maintenance should play a role in the treatment of osteoporosis in men. ³ Kung, Annie WC. Androgen and bone mass in men. Asian Journal of Andrology. 2003 Jun; 5. Available at http://www.asiaandro.com/archive/1008-682x/5/148.htm Accessed February 2015.