Therapeutic role of androgens in the treatment of osteoporosis in men

There has been much recent interest in the relationship between androgens a nd bone mineralization in men. Increases in serum androgens during puberty allow for skeletal maturation and the attainment of peak bone mass, and the persistence of normal testosterone secretion during adulthood is important for the maintenance of bone density. Testosterone deficiency is associated with heightened bone turnover and is a major risk factor for osteoporosis in men. The administration of testosterone to androgen-deficient men leads to an increase in bone mass, particularly in the trabecular bone compartmen t, and a reduction in levels of surrogate markers of bone turnover, suggest ing that androgens have a dampening effect on bone remodelling. In addition , the administration of androgens to eugonadal men with idiopathic osteopor osis, with resulting supraphysiological testosterone concentrations, may le ad to increases in bone mineral density. The risk of osteopenia due to andr ogen deficiency and the benefits of testosterone substitution therapy or su praphysiological administration on bone will be reviewed.