{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T13:06:30Z","timestamp":1779023190244,"version":"3.51.4"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Sidney Kimmel Center for Prostate and Urologic Cancers and the National Institutes of Health"},{"name":"National Cancer Institute to Memorial Sloan Kettering Cancer Center"},{"name":"Cancer Center Support Grant","award":["P30 CA008748"],"award-info":[{"award-number":["P30 CA008748"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low testosterone (T) is associated with several sequelae, including a high prevalence of bone density loss (BDL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We aimed to identify predictors of BDL in men with low T.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The sample included (1) men \u226550\u00a0years old, (2) with low total T levels (&amp;lt;300\u00a0ng\/dL using LCMS on 2 early morning blood draws), (3) who had dual-energy X-ray absorptiometry (DEXA) within 6\u00a0months of T measurement. Men with prior T therapy were excluded. On DEXA, osteopenia was defined as a T score between \u22121.0 and \u22122.5, and osteoporosis as a T score below \u22122.5. Additionally, demographics and comorbidity data were collected. We report BDL rates and identify predictors of any BDL using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Bone density loss, which was defined as the presence of osteopenia or osteoporosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine hundred ninety-seven men were analyzed, with a median age of 64 (IQR 59, 70) years. Median total T was 202 (IQR: 107, 256) ng\/dL, median free T 5.8 (IQR: 4.3, 7.5) ng\/dL. 24% had a total T\u2009\u2264\u2009100\u00a0ng\/dL. Thirty-three percent had \u22653 comorbidities. Seventy-four percent of our cohort had an oncological history; most of them had a history of prostate cancer. Bone density loss was present in 36% of the patients (89% osteopenia, 11% osteoporosis). On multivariable analysis, significant predictors of BDL were lower total T levels (OR\u2009=\u20091.09), older age (OR\u2009=\u20091.59), and the presence of \u22653 comorbidities (OR\u2009=\u20091.60).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>It is critical to be aware of the significant prevalence of BDL in men with low T. Early identification may enable targeted counseling, the initiation of preventive or therapeutic strategies to improve bone density outcomes, and the reduction of the risk of fractures and other serious skeletal complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths &amp; Limitations<\/jats:title>\n                    <jats:p>Limitations related to retrospective design, including selection bias and unmeasured confounding factors. Another limitation is that most cases had an oncological history. However, several strengths include the use of a large, systematically audited database; T labs were assessed using gold-standard methodology; and bone mineral density was assessed using a standardized scanning protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In our cohort of older men, most with oncological history and low T, around one-third had BDL, and around 10% of those with BDL had osteoporosis. Lower T levels, older age, and a greater number of comorbidities were significant predictors of BDL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdag149","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:08:14Z","timestamp":1777637294000},"source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and predictors of bone density loss in men with low testosterone"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8912-7037","authenticated-orcid":false,"given":"Jose M","family":"Flores","sequence":"first","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , New York, NY 10065, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Liso","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center , New York, NY 10065, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5455-3047","authenticated-orcid":false,"given":"John P","family":"Mulhall","sequence":"additional","affiliation":[{"name":"Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center , New York, NY 10065, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,5,17]]},"reference":[{"key":"2026051708102677600_ref1","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1016\/j.juro.2018.03.115","article-title":"Evaluation and management of testosterone deficiency: AUA guideline","volume":"200","author":"Mulhall","year":"2018","journal-title":"J Urol"},{"key":"2026051708102677600_ref2","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1016\/j.jsxm.2022.03.619","article-title":"The pre-testosterone therapy checklist","volume":"19","author":"Flores","year":"2022","journal-title":"J Sex Med"},{"key":"2026051708102677600_ref3","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1016\/j.acuro.2023.09.005","article-title":"M.: clinical evaluation and treatment in men with low testosterone levels and prostate cancer","volume":"48","author":"Ljubetic","year":"2024","journal-title":"Actas Urol Esp (Engl Ed)"},{"key":"2026051708102677600_ref4","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1056\/NEJMoa2215025","article-title":"Cardiovascular safety of testosterone-replacement therapy","volume":"389","author":"Lincoff","year":"2023","journal-title":"N Engl J Med"},{"key":"2026051708102677600_ref5","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.ahj.2021.11.016","article-title":"Effects of long-term testosterone treatment on cardiovascular outcomes in men with hypogonadism: rationale and design of the TRAVERSE study","volume":"245","author":"Bhasin","year":"2022","journal-title":"Am Heart J"},{"key":"2026051708102677600_ref6","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1210\/jcem.87.2.8201","article-title":"Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study","volume":"87","author":"Feldman","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"2026051708102677600_ref7","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.urology.2013.03.049","article-title":"Use of testosterone replacement therapy in the United States and its effect on subsequent prostate cancer outcomes","volume":"82","author":"Kaplan","year":"2013","journal-title":"Urology"},{"key":"2026051708102677600_ref8","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1038\/sj.ijir.3901397","article-title":"Male hypogonadism. 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