(O-21) Bone health in aging men: It’s not just about testosterone

Abstract Objective Bone fractures due to reduced bone mineral density (BMD) in hypogonadal men significantly impact quality of life. Testosterone (TT) plays a key role in BMD maintenance, but its relationship with osteoporosis remains controversial. This study aimed to evaluate testosterone levels, BMD parameters (osteopenia and osteoporosis), and their correlation with body mass index (BMI), abdominal circumference (AC), serum TT, estradiol (E2), calcium (Ca), and the TT/E2 ratio in men over 60. Materials and Methods We reviewed records of men over 60 who underwent dual-energy X-ray absorptiometry (DEXA) at two urology centers. Data included BMI, AC, TT, E2, Ca, and TT/E2 ratio. None had ever used testosterone replacement therapy. These parameters were analyzed in relation to DEXA bone density outcomes. Results The study included 273 men (mean age: 69.0 ± 6.1 years; BMI: 27.3 ± 4.3 kg/m2; TT: 497 ± 226 ng/dL; E2: 27.5 ± 12.1 pg/mL; Ca: 9.41 ± 0.40 mg/dL; AC: 98.8 ± 11.4 cm). Higher AC (t = 3.17; p = 0.0018) and BMI (t = 3.21; p = 0.0016) were significantly associated with normal BMD. No significant associations were found between DEXA and TT (p = 0.1028), E2 (p = 0.8636), or TT/E2 ratio (p = 0.3601). BMI was inversely associated with the TT/E2 ratio (β = -0.5691; p = 0.0387). Conclusion Increased AC and BMI were significantly associated with preserved BMD in older men, suggesting their utility as clinical indicators of bone health. TT, E2, and TT/E2 ratio were not associated with BMD, highlighting the limited predictive value of isolated hormone levels. The inverse relationship between BMI and TT/E2 ratio reinforces the metabolic influence of adiposity. A multifactorial approach is essential for osteoporosis risk assessment in aging men. Financing No conflict.