Bone fracture due to
osteoporosis is an important issue in decreasing the quality of life for elderly men in the current aging society. Thus,
osteoporosis and
bone fracture prevention is a clinical concern for many clinicians. Moreover,
testosterone has an important role in maintaining bone mineral density (BMD) among men. Some
testosterone molecular mechanisms on bone metabolism have been currently established by many experimental data. Concurrent with a decrease in
testosterone with age, various clinical symptoms and signs associated with
testosterone decline, including decreased BMD, are known to occur in elderly men. However, the relationship between
testosterone levels and
osteoporosis development has been conflicting in human epidemiological studies. Thus,
testosterone replacement
therapy (TRT) is a useful tool for managing clinical symptoms caused by
hypogonadism. Many recent studies support the benefit of TRT on BMD, especially in hypogonadal men with
osteopenia and
osteoporosis, although a few studies failed to demonstrate its effects. However, no evidence supporting the hypothesis that TRT can prevent the incidence of
bone fracture exists. Currently, TRT should be considered as one of the treatment options to improve hypogonadal symptoms and BMD simultaneously in symptomatic hypogonadal men with
osteopenia.