A simultaneous deficiency of testosterone and vitamin D was found to significantly increase the risk of reduced hip bone density.
A research team led by Bae Woong-jin, a professor of urology at Seoul St. Mary’s Hospital, and Lee Dong-seop, a professor of urology at St. Vincent’s Hospital, announced Sept. 4 that low testosterone and vitamin D deficiency are independent risk factors for reduced hip bone density.
Osteoporosis is a condition in which bones become weaker as their quantity and quality decline, making them more susceptible to fractures even from minor impacts. Hip and spinal fractures in particular can lead to prolonged hospitalization, disability and an increased risk of death, making osteoporosis a major health threat among older adults.
Although osteoporosis is primarily known as a disease affecting postmenopausal women, men also face an increased risk as bone density declines with aging and falling testosterone levels.
In fact, about 50% of men age 60 and older have osteopenia, a rate similar to that among women. However, only about 7% of men with testosterone deficiency are known to undergo bone density testing.
The research team analyzed 557 men age 60 and older who underwent health screenings at Seoul St. Mary’s Hospital and St. Vincent’s Hospital from January 2020 through December 2024. Bone density was measured using dual-energy X-ray absorptiometry (DXA), while blood testosterone and vitamin D levels were analyzed in detail.
The analysis found that factors affecting bone density differed by body region. Lumbar spine bone density was affected by body mass index (BMI) and testosterone, while hip bone density was affected by age, BMI, testosterone and vitamin D.
In particular, men with testosterone deficiency, defined as levels below 3.5 ng/mL, had about 1.9 times the risk of reduced hip bone density compared with those in the normal group, while those with vitamin D deficiency, defined as levels below 30 ng/mL, had about 1.6 times the risk. A vitamin D level of at least 30 ng/mL is generally considered the recommended threshold for maintaining bone health.
The researchers said they found that the two factors not only acted independently but also interacted with each other. Among men with low testosterone, changes in hip bone density according to vitamin D levels were more pronounced.
The findings suggest that when vitamin D deficiency occurs in a state of low testosterone, calcium absorption may become less efficient and bone loss may accelerate, according to the research team.
The researchers focused in particular on the hip. Bone loss associated with aging is more concentrated in the hip than in the spine, and a femoral fracture can lead to prolonged bed rest and various complications. Men are also known to have higher mortality rates and greater economic burdens than women following osteoporotic fractures.
Bae said, “For middle-aged and older men, it is important to proactively manage bone health by checking testosterone and vitamin D levels together. Rather than taking symptoms of male menopause, such as fatigue, reduced muscle strength and declining sexual function, lightly, I recommend regularly undergoing hormone and bone density tests through a urology specialist.”
Lee said, “Because hip fractures can pose a significant threat to the health and quality of life of older patients, they should not simply be dismissed as a normal part of aging and require a multifaceted approach.”
