Presentation Authors: Carolyn A. Salter*, Elizabeth Schofield, Nicole Benfante, John P. Mulhall, New York, NY
Introduction: Low testosterone (T) levels are associated with bone mineral density (BMD) loss. Guidelines have suggested 300 ng/dl as a reasonable cut-off for diagnosing T deficiency (TD). Clinical experience suggests that some men with T levels in the 300-400 range are symptomatic and may have signs of TD such as BMD loss. This study compares BMD in men with low versus equivocal T levels.
Methods: The study population included men â‰¥ 50 years old who had a baseline DEXA scan and T levels between 200-399 ng/dL. The patients were divided into two groups based on a morning total T level: low T (200-299 ng/dL) and equivocal T (300-399 ng/dL). Men using chronic proton pump inhibitors (PPI) and corticosteroids were excluded. BMD was measure using dual-energy x-ray absorptionometry (DEXA). Comparison between T groups was conducted using a series of t-tests and Chi-square tests.
Results: 307 men with DEXA scans and T levels within the range of interest constituted the study population. Mean age was 63.6 Â± 8.0 years. Hyperlipidemia was present in 51%, hypertension in 49%, diabetes in 19%, sleep apnea in 17%, coronary artery disease in 5% and prior stroke in 2% of patients. Eleven percent of men were excluded due to PPI or corticosteroid use. Sleep apnea was more common in the low T group compared to equivocal T (22% vs 11%; p=0.012) whereas there were no differences between the groups with respect to other comorbidities. There was no statistically significant difference in mean DEXA scores between the 2 groups. The mean lowest T-score was -0.65 in the low T group and -0.85 in the equivocal T group; p=0.225. Overall, 55% of men had normal bone density, 39% had osteopenia and 5% had osteoporosis. These rates did not differ between the 2 groups; p=0.249.
Conclusions: The rates of BMD loss are as high in men with equivocal T levels when compared to men with low T.