Presentation Authors: Alexandra Berger*, Valary Raup, Ramy Abou Ghadya, Paul Bain, Martin Kathrins, Boston, MA
Introduction: Men with testosterone deficiency (TD) are at an increased risk of developing osteoporosis, defined by low bone mineral density (BMD). Testosterone supplementation therapy (TST) has the potential to improve patientsâ€™ BMD, preventing fractures. However, there is limited high-quality data to suggest TST measurably improves BMD in these men. We performed a meta-analysis of randomized, placebo-controlled trials (RCTs) to determine if TST is associated with significant increases in BMD.
Methods: A systematic review using MEDLINE, Embase, Web of Science and Cochrane Central was performed. Search terms and methods are depicted in the PRISMA protocol flow diagram (Figure 1). Only placebo-controlled RCTs of TST in men with TD were included. TD was defined as morning T
Results: TST formulation was heterogenous and included gel (3, n=252), intramuscular (2, n=82), capsule (1, n=126) and patch (1, n=39). Patients received TST for a mean 33.17 weeks. There were 6 RCTs for femoral neck (n=461), 7 RCTs for lumbar (n=498) and 5 RCTs for total hip BMD (n=455) meeting our inclusion criteria. There was a significant association of TST with increase in femoral neck BMD compared to placebo (Standardized mean difference [SMD] 0.24, 95% CI 0.06-0.43) (Figure 2). There was no significant association of TST with total hip BMD (SMD 0.18, 95% CI 0.00-0.37) or lumbar BMD (SMD 0.18, CI 0.00-0.36) compared to placebo.
Conclusions: This meta-analysis of RCTs suggests that TST for men with TD improves femoral neck, but not total hip or lumbar BMD. Additional RCTs with longer TST exposure and follow-up are necessary to determine whether this modest improvement in BMD leads to a decrease in fracture risk and morbidity.