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* Hypogonadism was more common in men with osteoporosis than with osteopenia, yet testosterone testing remains limited, with osteoporosis patients tested more frequently than those with osteopenia, suggesting a care gap. Of those tested, about half had low testosterone (<300 ng/mL) in both groups, and over 60% with hypogonadism received TRT. These findings underscore the need for routine testosterone screening in men with low bone density, especially in those with osteoporosis, to enhance hypogonadism diagnosis and management
PREVALENCE OF HYPOGONADISM AND TESTOSTERONE SCREENING PRACTICES IN MEN WITH OSTEOPENIA AND OSTEOPOROSIS: A RETROSPECTIVE COHORT STUDY
Anael S. Rizzo*, Joseph A. Borrell, Thiago P. Furtado, Nancy Ye,Jennifer M. Amis, Sriram V. Eleswarapu, Jesse N. Mills, Los Angeles, CA
INTRODUCTION AND OBJECTIVE
Hypogonadism and osteoporosis are rising health concerns in aging men worldwide. Defined by testosterone levels below 300 ng/mL, hypogonadism is a major risk factor for low bone mineral density and accounts for 16–30% of secondary osteoporosis cases in men. Despite this, routine testosterone screening in men with osteopenia or osteoporosis remains uncommon. This study examined hypogonadism prevalence and testosterone screening and treatment practices in male patients with osteopenia and osteoporosis at a tertiary academic health center.
METHODS
Retrospective data were obtained from a single high-volume academic institution using ICD-10 codes from October 2015 to September 2024. The population for this cohort study consisted of 15,634 patients with hypogonadism, 10,159 with osteopenia, and 7,249 with osteoporosis. Demographic characteristics and clinical risk factors including sleep apnea, diabetes, anemia, obesity, and metabolic syndrome were also collected.
RESULTS
In this cohort (mean age 54, 64.4% white), hypogonadism was found in 8% of patients with osteopenia and 11% with osteoporosis. Patients with osteoporosis had 1.37 times higher odds of hypogonadism than those with osteopenia (OR 1.37, 95% CI: 1.24–1.51, p<0.001). Testosterone testing occurred in 23.9% of patients with osteopenia and 31.7% with osteoporosis, with osteoporosis patients being 47% more likely to be tested (OR 1.47, 95% CI: 1.37–1.57, p<0.00001). Low testosterone (<300 ng/mL) was present in about half of both groups. Testosterone replacement therapy was more common in patients with diagnoses of osteoporosis and hypogonadism (65.8%) than in osteopenia and hypogonadism (63.5%). Sleep apnea was the most common comorbidity (27%), followed by diabetes (20.6%) and anemia (13.1%).
CONCLUSIONS
This study highlights key links between hypogonadism, reduced bone density, and testosterone screening practices in men. Hypogonadism was more common in men with osteoporosis than with osteopenia, yet testosterone testing remains limited, with osteoporosis patients tested more frequently than those with osteopenia, suggesting a care gap. Of those tested, about half had low testosterone (<300 ng/mL) in both groups, and over 60% with hypogonadism received TRT. These findings underscore the need for routine testosterone screening in men with low bone density, especially in those with osteoporosis, to enhance hypogonadism diagnosis and management.
PREVALENCE OF HYPOGONADISM AND TESTOSTERONE SCREENING PRACTICES IN MEN WITH OSTEOPENIA AND OSTEOPOROSIS: A RETROSPECTIVE COHORT STUDY
Anael S. Rizzo*, Joseph A. Borrell, Thiago P. Furtado, Nancy Ye,Jennifer M. Amis, Sriram V. Eleswarapu, Jesse N. Mills, Los Angeles, CA
INTRODUCTION AND OBJECTIVE
Hypogonadism and osteoporosis are rising health concerns in aging men worldwide. Defined by testosterone levels below 300 ng/mL, hypogonadism is a major risk factor for low bone mineral density and accounts for 16–30% of secondary osteoporosis cases in men. Despite this, routine testosterone screening in men with osteopenia or osteoporosis remains uncommon. This study examined hypogonadism prevalence and testosterone screening and treatment practices in male patients with osteopenia and osteoporosis at a tertiary academic health center.
METHODS
Retrospective data were obtained from a single high-volume academic institution using ICD-10 codes from October 2015 to September 2024. The population for this cohort study consisted of 15,634 patients with hypogonadism, 10,159 with osteopenia, and 7,249 with osteoporosis. Demographic characteristics and clinical risk factors including sleep apnea, diabetes, anemia, obesity, and metabolic syndrome were also collected.
RESULTS
In this cohort (mean age 54, 64.4% white), hypogonadism was found in 8% of patients with osteopenia and 11% with osteoporosis. Patients with osteoporosis had 1.37 times higher odds of hypogonadism than those with osteopenia (OR 1.37, 95% CI: 1.24–1.51, p<0.001). Testosterone testing occurred in 23.9% of patients with osteopenia and 31.7% with osteoporosis, with osteoporosis patients being 47% more likely to be tested (OR 1.47, 95% CI: 1.37–1.57, p<0.00001). Low testosterone (<300 ng/mL) was present in about half of both groups. Testosterone replacement therapy was more common in patients with diagnoses of osteoporosis and hypogonadism (65.8%) than in osteopenia and hypogonadism (63.5%). Sleep apnea was the most common comorbidity (27%), followed by diabetes (20.6%) and anemia (13.1%).
CONCLUSIONS
This study highlights key links between hypogonadism, reduced bone density, and testosterone screening practices in men. Hypogonadism was more common in men with osteoporosis than with osteopenia, yet testosterone testing remains limited, with osteoporosis patients tested more frequently than those with osteopenia, suggesting a care gap. Of those tested, about half had low testosterone (<300 ng/mL) in both groups, and over 60% with hypogonadism received TRT. These findings underscore the need for routine testosterone screening in men with low bone density, especially in those with osteoporosis, to enhance hypogonadism diagnosis and management.
