Testosterone Replacement Therapy Is Associated With Increased Incidence Rate of Vertebral Fractures: A Matched Retrospective Analysis
2025

Testosterone Therapy and Vertebral Fractures

Sample size: 77491 publication 10 minutes Evidence: high

Author Information

Author(s): Singh Manjot BS, Daher Mohammad BS, Diebo Bassel G. MD, Daniels Alan H. MD, Arcand Michel A. MD

Primary Institution: Warren Alpert Medical School, Brown University

Hypothesis

Does testosterone replacement therapy (TRT) increase the risk of vertebral fractures?

Conclusion

Testosterone replacement therapy is associated with a higher incidence of vertebral fractures over two years.

Supporting Evidence

  • Patients on TRT had a vertebral fracture rate of 0.31% compared to 0.04% in controls.
  • Men on TRT had a higher fracture rate of 0.36% versus 0.04% in controls.
  • Women on TRT had a fracture rate of 0.16% compared to 0.03% in controls.
  • The incidence of vertebral fractures increased with age among TRT patients.
  • Multivariate analysis showed TRT significantly increased fracture risk (OR = 7.7).

Takeaway

Taking testosterone can make you more likely to break your back, especially as you get older.

Methodology

Matched retrospective analysis using the PearlDiver database to compare vertebral fracture rates between patients on TRT and controls.

Potential Biases

Potential biases due to the retrospective nature and reliance on coding accuracy.

Limitations

The study is retrospective and cannot establish causation; it relies on accurate ICD coding and does not evaluate specific dosing or compliance.

Participant Demographics

Mean age 54.7 years, 74.3% male.

Statistical Information

P-Value

<0.001

Confidence Interval

95% CI = 5.1-11.7

Statistical Significance

p<0.001

Digital Object Identifier (DOI)

10.5435/JAAOSGlobal-D-24-00248

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