Lack of biochemical hypogonadism in elderly Arab males with low bone mineral density disease

The aim of the study is to study the relationship between androgen levels and bone mineral density (BMD) in elderly Arab males. Forty-five elderly Arab males underwent Dual X-ray absorptiometry for measurement of BMD. The outcomes were defined as per WHO description. Assays for testosterone (T), gonadotropins (LH and FSH) and estradiol (E2), in the serum were carried out. The ratio of T/LH was used as a surrogate for the cFT assay. We excluded patients receiving hormonal ablation for prostatic neoplasm and patients with chronic liver or renal disease and patients receiving corticosteroids. Twelve were osteoporotic (26.5%); 22 osteopenic (49%); and 11(24.5%) had normal outcome. Osteoporotic patients were significantly older (78.17 ± 7.59 years) than the osteopenic (70.14 ± 5.92, P ≤ 0.01 and the normal subjects (71.20 ± 4.17, P ≤ 0.05). The means of total serum T, LH, FSH and E2 were all within the normal values and not significantly different between the three groups. Like wise were the means of the ratios of T/LH and E2/T too. A significant number of subjects in this cohort of elderly Arab males had reduced bone density that appears to be independent of androgen levels. Osteoporotics were significantly older than those with osteopenia or normal bone density. Aging seemed to have overridden the effect of normal sex hormones on bone density in these patients. Before considering these results as a possible exception to the widely established role of the hypoandrogenemia in male osteoporosis, other potential factors impacting on bone density need to be considered.