Effects Of Testosterone Replacement Therapy On Bone Mineral Density In Patients With LOH:A Meta-analysis

Objective:To evaluate the effects of testosterone replacement therapy on bone mineral density and risk of fracture in patients with late-onset hypogonadism.Methods:Randomized controlled trials about efficacy of testosterone replacement therapy on bone mineral density in patients with LOH from their establishment to Dec.2020 were searched in Pubmed,Embase,Cochrane library,Web of Science,CNKI,Wangfan data and VIP,and the relevant references were searched manually.The two independent evaluators strictly selected the trials according to the inclusion and exclusion criteria,and used the Cochrane bias risk assessment tool to evaluate the quality of the inclusion study,and then extracted the relevant data.Meta-analysis was performed with RevMan 5.3 and Stata 14.0 software.Results:10 studies involving,and 1230 patients were included.The results of meta-analysis showed that there were no significant differences in total BMD(WMD=-0.01,95%CI:-0.03～0.01,P=0.40),hip BMD(WMD=0.01,95%CI:-0.02～0.03,P=0.55),lumbar BMD(WMD=0.01,95%CI:-0.01～0.03,P=0.51),femoral neck BMD(WMD=0.00,95%CI:-0.01～0.02,P=0.66),trochanter BMD(WMD=0.02,95%CI:-0.01～0.04,P=0.29),grip strength(SMD=-0.03,95%CI:-0.24～0.17,P=0.70),bone turnover markers such as PINP(WMD=1.19,95%CI:-4.92～7.29,P=0.70),BASP(WMD=-0.02,95%CI:-1.60～1.55,P=0.76),OC(WMD=-0.36,95%CI:-2.03～1.31,P=0.67),NTX(WMD=0.22,95%CI:-8.80～9.24,P=0.96)between the two groups.However,there was a significant difference in the muscle strength of the lower extremity between the two groups(SMD=0.44,95%CI:0.15～0.72,P=0.003).Conclusion:1.Testosterone replacement therapy could not significantly improve the total bone mineral density,lumbar spine bone mineral density,hip bone mineral density,femoral neck bone mineral density and trochanter bone mineral density in patients with LOH.2.Testosterone replacement therapy has no significant effect on bone turnover markers and grip strength in patients with LOH.3.Testosterone replacement therapy increases lower extremity muscle strength in patients with LOH.4.The effect of testosterone replacement therapy on fracture risk in patients with LOH is not clear,and the above conclusions still need to be further verified by multicenter,large-sample,long-term randomized controlled trials.