Low serum testosterone levels independently associated with fall risk in elderly men

Prolonged hypogonadism may result in erectile dysfunction, decreased libido, anemia, sarcopenia, memory loss, bone mineral loss, and the metabolic syndrome.

While a low serum testosterone level is well-known for its association with osteoporosis, the impact of hypogonadism on overall physical functioning and fall risk has not been prospectively evaluated.

In the October 23 issue of the Archives of Internal Medicine, Orwoll and colleagues from the Osteoporotic Fractures in Men Study Group report on a longitudinal, observational study designed to evaluate the relationship between serum testosterone and the development of age-related disorders, including the risk of falling.

A total of 2586 men ages 65 to 99 were randomly selected from a cohort of 5995 volunteers. Serum testosterone and estradiol levels were measured at baseline and compared to the incidence of falls, which were ascertained every 4 months for 4 years.

Fifty six percent of men reported at least one fall over the follow-up period. The risk of a fall was 40% higher in men in the lowest testosterone quartile when compared to those in the highest testosterone quartile. Interestingly, the association between low serum testosterone and falling was highest among the youngest men (relative risk 1.8, 95% CI 1.2 to 2.7) and was not statistically significant in those men over 80 years of age. This association persisted despite adjusting for overall physical performance.

This important study suggests that in a cohort of men older than 65 years, a low serum testosterone was associated with an increased risk of falling which was independent of the patient's overall physical performance. While testosterone replacement in this age group should be used cautiously due to their higher prostate cancer risk, these data certainly should heighten our awareness that androgen deprivation is not innocuous and may be associated with significant risks beyond bone mineral loss.

Eric Orwoll, MD; Lori C. Lambert, MS; Lynn M. Marshall, ScD; Janet Blank, MS; Elizabeth Barrett-Connor, MD; Jane Cauley, MD; Kris Ensrud, MD; Steven R. Cummings, MD; for the Osteoporotic Fractures in Men Study Group

Arch Intern Med. 2006;166:2124-2131.

By Ricardo Sanchez-Ortiz