Testosterone deficiency in aging males: a dual threat to vascular and bone health through coronary artery calcification and osteoporosis - a narrative review

Testosterone deficiency, a common condition in aging males, has been increasingly associated with two significant age-related conditions: coronary artery calcification (CAC) and osteoporosis. This comprehensive review examines the current evidence regarding the complex relationship between testosterone levels and these conditions in elderly male patients. We synthesize findings from recent studies exploring the pathophysiological mechanisms, clinical correlations, and potential therapeutic implications of testosterone status in cardiovascular and bone health. Evidence suggests that low testosterone levels are associated with increased coronary calcification burden, more advanced atherosclerotic plaques, and greater risk of osteoporotic fractures. The biological mechanisms connecting testosterone deficiency to these conditions include impaired lipid metabolism, chronic inflammation, endothelial dysfunction, disrupted bone remodeling processes, and altered calcium homeostasis. While observational studies consistently demonstrate associations between hypogonadism and worse cardiovascular and bone outcomes, results from interventional trials on testosterone replacement therapy (TRT) remain mixed, with some studies showing potential benefits for bone health but uncertain effects on cardiovascular risk. This review highlights the need for further research to establish causality, elucidate underlying mechanisms, and develop targeted therapeutic strategies for elderly men with testosterone deficiency affecting cardiovascular and skeletal systems.