Hip Fractures and Hypogonadism in Young Males: A Missed Opportunity for Secondary Prevention?

Low testosterone is a known risk factor for osteoporosis and fragility fractures in men. Unlike in women, osteoporosis in men often presents later in life. Fragility hip fractures in males under 60 years are uncommon and may represent an opportunity to diagnose and treat an underlying metabolic bone pathology. This study aims to evaluate whether low-energy hip fractures in young men are associated with low serum testosterone.

We performed a retrospective review of a prospectively maintained database, identifying male patients aged <60 years who sustained hip fractures from low-energy trauma between January 2022 and December 2024. Fractures up to 5 cm distal to the lesser trochanter were included. Demographic, comorbidity, and laboratory data were collected; serum testosterone <198 pmol/L was defined as low.

Sixty-one males (mean age 50.6 ± 7.2 years) sustained hip fractures in this study period; 23 (38%) had serum testosterone measured. Of those, 15 (65%) were found to have low testosterone; only one had a known endocrine disorder. Among the total cohort, 42 (69%) had multiple comorbidities, 24 (39%) were on polypharmacy (≥5 medications), 25 (41%) were current smokers, 17 (28%) reported excessive alcohol use, and 13 (21%) had a history of substance misuse.

A substantial proportion of young men with fragility hip fractures had unrecognized low testosterone levels. These findings indicate that hormonal abnormalities may be under-recognized in this population, and further studies are warranted to determine whether targeted hormonal screening could help reduce future fragility fracture risk.