Testosterone Replacement Therapy Is Associated With Increased Incidence Rate of Vertebral Fractures: A Matched Retrospective Analysis.

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.