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Testosterone Replacement Therapy Is Associated With Increased Incidence Rate of Vertebral Fractures: A Matched
Manjot Singh1, Mohammad Daher, Bassel G Diebo
1From the Warren Alpert Medical School, Brown University, Providence, RI (Singh and Daher), and the Department of Orthopedics, Brown University, Providence, RI (Dr. Diebo, Dr. Daniels, and Dr. Arcand).
Background:
Whether testosterone replacement therapy (TRT) can mitigate the risk of vertebral fractures has not been well-studied.
Methods:
PearlDiver was queried to identify patients with and without the history of TRT. Groups were matched 1:1 by demographic variables and 2-year vertebral fracture incidence rate was compared. Multivariate logistic regression was done to identify independent predictors of vertebral fractures.
Results:
Among 77,491 matched patients, mean age was 54.7 ± 10.4 years, 74.3% were males, and mean Charlson Comorbidity Index was 0.17 ± 0.54. Testosterone replacement therapy patients had higher rates of vertebral fractures (0.31% vs 0.04%, P < 0.001), and these rates were observed to increase with age. Both men alone (0.36% vs 0.04%, P < 0.001) and women alone (0.16% vs 0.03%, P < 0.001) on TRT had higher rates of vertebral fractures. Multivariate analysis revealed that TRT (OR = 7.7, 95%CI = 5.1-11.7, P < 0.001), as well as chronic kidney disease (OR = 1.4, 95%CI = 1.1-2.0, P = 0.026), alcohol abuse (OR = 2.5, 95%CI = 1.8-3.5, P < 0.001), and diphosphonate use (OR = 2.2, 95%CI = 1.4-3.5, P < 0.001), increased vertebral fracture rates.
Conclusions:
Exogenous testosterone use was associated with increased 2-year incidence of vertebral fractures. Although a causal relationship could not be established, our findings highlight the need to use screening measures, such as dual-energy X-ray absorptiometry (DEXA) scan, to identify patients at risk of vertebral fractures.
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