Effect of Testosterone Pellet Therapy on Bone Mineral Density in Postmenopausal Women

Purpose/Aims

Estrogen therapies have been proven efficacious for the improvement of BMD and fracture risk reduction. Estradiol(E2) and testosterone(T) therapy using pellets have been shown to improve BMD. Current trends in hormone pellet therapy include T with minimal or no E2. Lower doses of E2 minimize the occurrence of adverse effects such as vaginal bleeding, fibroid enlargement, bloating, and breast tenderness. Studies have reported improved climacteric symptoms and sexual health with the use of T pellets though the effects on BMD remain less clear with current treatment trends. This study addresses the effect on BMD of T with little or no E2.

Rationale/Background

The risk of osteoporosis is well-established in postmenopausal women, as is the role of hormone therapy to decrease the risks of vertebral and non-vertebral fractures. The use of hormone therapy is controversial due to the misrepresentation of results from the Women's Health Initiative (WHI) Study in 2002. Accordingly, the incidence of hip fractures has continued to rise. The mechanisms by which estrogen and testosterone affect bone homeostasis are synergistic and multifactorial. The conversion of T to E2 via aromatase occurs in the ovaries, gonads, and end-organ sites, including bone. T and E2 are equally important for men and women. Testosterone is critical for the physical and mental health of women and plays an important role in wellness, bone density, strength, energy, sleep, sexual function, urinary continence, and quality of life.

Methods

BMD was measured in 35 postmenopausal women aged 53-84 years, receiving low-dose E2/T pellet therapy. Pellets were administered every 3 to 5 months. Replacement of T alone or with 10 mg or less of E2 was considered minimal or no E, while T in combination with greater than 10 mg was considered low E2. BMD at hip and spine was measured at baseline or within three months of initiating pellet therapy and repeated every 12 ± 5 months. All patients received counseling regarding exercise, vitamin D and calcium.

Results

All patients in this study had improved BMD or cessation of bone loss. The average BMD improvement was 1.6% at the hip and 6.2% at the spine. Patients who received low-dose E2 had greater improvement of BMD at the spine than those who received minimal or no E2, 6.8% vs. 5.4%. The change at the hip was more closely correlated 1.6% vs. 1.7% respectively.

Implications

Osteoporosis remains a significant health risk in women and hormones have been poorly addressed since the publication of the WHI trial. In this study, testosterone pellet therapy alone or in combination with low-dose E2 pellet therapy improved spine and hip BMD. Little or no E2 exposure minimizes vaginal bleeding, breast tenderness, and bloating while having no apparent adverse effects on bone. Testosterone additionally provides significant improvement in climacteric symptoms and sexual health in postmenopausal women making it a multifaceted treatment option.