Introduction Osteoporosis is a common, but often underdiagnosed, condition in elderly males, characterized by decreased bone mineral density (BMD), which leads to an increased risk of fractures. This study aims to assess the prevalence of osteoporosis and osteopenia in elderly men and investigate the association between osteoporosis, serum testosterone, and vitamin D levels. Methodology This cross-sectional study was carried out in a tertiary care centre during a period of two years (2019-2020). The study recruited 370 elderly male patients who were aged 60 years old or older. Patients had clinical examination with detailed medical history, physical examination, and laboratory investigations for measurement of serum total testosterone and vitamin D. Bone mineral density (BMD) was measured using DEXA scans, and subjects were classified according to their T-scores as having osteoporosis, osteopenia, and normal BMD. The relationship of T with VitD deficiency and osteoporosis was considered. Results The prevalence of osteoporosis, osteopenia, and normal BMD was 39.5%, 48.3%, and 12.2%, respectively. Low testosterone level was significantly associated with osteoporosis, and 47.5% of patients with low testosterone (<3 ng/ml) were osteoporotic (P = 0.001). Vitamin D deficiency was high and 50.6% of participants were having D level less than 20 ng/ml. Prevalence of osteoporosis was significantly higher in participants with vitamin D deficiency in comparison to those without (p-value = 0.03). The findings suggest that having the right amounts of testosterone and vitamin D are important for maximum bone health. Conclusion Osteoporosis and osteopenia are prevalent in a high proportion of elderly males, and deficiency in serum testosterone and vitamin D are significant risk factors. The early detection of those deficiencies and further management, replacement therapy of testosterone, and supplementation of vitamin D, could be used to prevent the oncoming of osteoporosis and related fractures. The results of this study underscore the importance of implementing standing programs and assessments designed to maintain bone health and thus also reduce the burden fracture-related osteoporosis has on elderly males by enhancing their quality of life.

This cross sectional study was carried out in a tertiary care hospital during two years, from 2019-2020. The purpose of this study was to investigate the prevalence of osteoporosis and the relationship between osteoporosis and serum testosterone (T) and vitamin D levels in elderly men from 60 years of age. A sample of 370 elderly male patients were included through convenience sampling from the injuries OPD of the hospital. Patients presenting to hospital for routine work-up or with symptoms not related to bone health were screened for eligibility. Inclusion criteria were for ambulant male patients 60 years of age or oldder independent in activities of daily life and who seemed to be in good general health. Exclusion criteria were rheumatological and previous vertebral and femoral fractures, chronic kidney and liver failure, thyroid diseases, alcohol consumption higher than 80 g/day, and long-term steroid therapy (longer than 3 months).

All the participants gave written consent for their participation in the study, which was approved by the hospital’s ethical review board. All participants were subjected to a thorough clinical interview, where medical history, lifestyle and diet history and those with reference diet in calcium and vitamin D were explored. In addition, weight, height and body mass index (BMI) of each individual were measured. Following blood specimens from each subject, the examination of biochemical results was biochemical including serum levels of vitamin D (25-hydroxyvitamin D), testosterone and other related variables like calcium and phosphate.

Dual-energy X-ray absorptiometry (DEXA) scans were performed to assess bone mineral density (BMD) at the lumbar spine and hip, with the results used to classify patients into three categories: osteoporosis (T-score ≤ -2.5), osteopenia (T-score between -1.1 and -2.4), and normal BMD (T-score > -1). The study also assessed the correlation between testosterone levels, vitamin D status, and BMD scores. Statistical analyses were performed using SPSS software to evaluate associations between osteoporosis and various demographic, clinical, and biochemical variables. Chi-square tests and correlation analyses were used to identify significant relationships. A p-value of less than 0.05 was considered statistically significant.

Table 1: Demographic Characteristics of the Study Population

The basic demographic data on the 370 elderly male patients employed in the study appear in Table 1. The subjects were middle-aged men with an average age and BMI of 68.33 ± 6.21 and 25.6 ± 3.9, respectively. Hypertension and diabetes were present in 48.6% and 43.2% of the study participants, respectively. Nearly one-third of the participants had a history of smoking (31.9%) and alcohol intake (21.3%). Only 4% from study sample were consuming 500mg or more of calcium daily, 50.6% were vitamin D deficient (<20ng/ml in sera). These data paint a comprehensive picture of health and risk in our population, allowing insight into important factors that may drive bone health in elderly men.

Table 2: Prevalence of Osteoporosis and Osteopenia in Elderly Males

Table 2 shows the prevalence of osteoporosis and osteopenia in the elderly male studied population. Among the 370 attendants, 161 (39.5%) were osteoporotic (T-score ≤ -2.5). Osteopenia, i.e., T-score value between −1.1 and −2.4, was detected in 197ee (48.3%), participants. Normal bone mineral density (12participants, 12.2%) of the cohort had a T-score ≥ -1. These data reflect the high prevalence of low bone mass in aging men, with a sizeable minority of the population having osteopenia and osteoporosis.

Figure 1 - Prevalence of Osteoporosis and Osteopenia in Elderly Males

Figure 1 visually represents the distribution of bone mineral density (BMD) categories in the study population. The figure highlights the high prevalence of osteoporosis and osteopenia among elderly males, with a significantly smaller portion exhibiting normal BMD.

Table 3: Serum Vitamin D and Testosterone Levels

Table 3 Serum vitamin D and testosterone levels in study population. With respect to 25(OH)D levels, 15.7% of participants had normal vitamin D status (>30 ng/ml), whereas 33.8% had insufficiency (20-29.9 ng/ml). 1 were considered vitamin D deficient, with less than 20 ng/ml in serum. Regarding the testosterone levels, 24.8% were low testosterone (5ng/ml). These results suggest relatively high incidence of vitamin D deficiency and low testosterone levels in old men, both of which have been reported as risk factors for osteoporosis.

Table 4: Association Between Osteoporosis and Serum Vitamin D

The relationship between osteoporosis and serum vitamin D levels in the study population (Table 4). In the vitamin D deficiency group (<20 ng/ml), 80 participants (51.6%) had osteoporosis and 107 participants (48.4%) did not. The relationship between vitamin D deficiency and osteoporosis was significant (p = 0.03). Among those with inadequate serum vitamin D levels (20-29.9ng/ml), 45 (32.6%) had osteoporosis and 93(67.4%) did not, with a p-value of 0.05; representing a marginal association. Among patients who had vitamin D levels beyond 30 ng/ml (compare Table 8), 36 (56.3%) had osteoporosis, whereas 28(43.7%) did not have osteoporosis, p = 0.02, which showed that there was a significant correlation between sufficient level of vitamin D and lower risk of osteoporosis.

Figure 2: Pie Chart: Serum Vitamin D and Testosterone Levels

The distribution of serum vitamin D and testosterone are presented in figure 2. The proportions of subjects who have sufficient, insufficient, and deficient vitamin D levels were visualized in the pie chart, leading one to understand the vitamin D status of elderly men easily. Similarly, the graph shows testosterone (T) levels with low and borderline values superimposed upon a normal range values boxes reflecting the hormonal status of the subjects. This visual representation supplements the information presented in Table 3, which helps us better understand the association between vitamin D and testosterone profiles with osteoporosis.

Table 5: Association Between Osteoporosis and Testosterone Levels

Table 5 shows the correlation between osteoporosis and the testosterone level of the study population. The results demonstrate the close association between osteoporosis and low testosterone levels. Within those participants with low testosterone levels (3-4ng/ml (borderline testosterone levels) in whom osteoporosis were found, were 60 (31.9%), whilst, those in whom osteoporosis were not found were 132 (68.1%), with p 5ng/ml of testosterone, pointing to a very strong association between being eugonadal and low risk of osteoporosis. The results of these studies indicate the important role of testosterone for bone health and low testosterone is a major risk factor for the development of osteoporosis in elderly males.

The box plot indicates that osteoporotic individuals mostly exhibit lower testosterone levels without such a wide variability; non-osteoporotic individuals show higher and variable testosterone levels. This graphic image serves to emphasize the notion that low testosterone leads to an increased likelihood of osteoporosis.

Figure 4 displays the correlation between testosterone levels and bone mineral density (BMD) T-scores. The scatter plot shows a negative correlation, indicating that individuals with higher testosterone levels tend to have better bone density (higher T-scores), while those with lower testosterone levels tend to have lower bone density. The regression line further emphasizes this relationship, supporting the findings that low testosterone is linked to osteoporosis.

The results of the present study indicate a high rate of osteoporosis and osteopenia in elderly male patients, with 39.5% having osteoporosis and a 48.3% osteopenia appearance. This highlights the necessity of targeting bone health in this elderly male population given that osteoporosis tends to be underdetected in this segment of patients. It has been reported that while men become prone to have osteoporosis as they grow old, osteoporosis is more commonly observed in postmenopausal women than is observed in men. In the current investigation, high osteoporosis rates are consistent with others, in which low BMD is a significant concern in older male populations at a great risk of fractures and subsequent disability [6].

Another important finding in the present study is the close correlation of low serum testosterone in osteoporosis. Testosterone, a hormone associated with important function in bone metabolism, was extremely low in the osteoporosis group. This finding supports previous studies that have demonstrated that low testosterone levels are a major risk factor for osteoporosis in elderly men. Testosterone therapy has been demonstrated to enhance BMD and to protect against the development of osteoporosis in hypogonadal men. The contribution of bone density is especially important for testosterone, as it aids in controlling osteoblastic activity and initiates bone formation, both of which are necessary for the retention of bone strength in aging men.[7-10]

Vitamin D insufficiency was also found to be a major factor contributing to osteoporosis in our study, as 50.6% had a serum 25(OH) D level less than 20 ng/ml. This is consistent with the extensive evidence suggesting an association between vitamin D deficiency and ill bone health, as well as higher fracture risk. Vitamin D is ential for calcium absorption, necessary for bone mineralisation. Vitamin D deficiency may interfere with calcium metabolism, which can result in decreased bone mineral density and bone weakening. Vitamin D deficiency is common in elderly, especially in low sunlight regions, as studies have demonstrated. Osteoporosis is completely incongruous in elderly subjects with values of vitamin D within normal limits as in this case, we found lower rates in subjects with severe vitamin D deficiency..Statistically the outcome are significant for vitamin D insufficiency. [11-14]

What is interesting is that when the extreme conditions for vitamin D are considered (insufficient and adequate levels), the linking of vitamin D levels to osteoporosis was less pronounced at these levels than at the less insufficeint and more sufficiency-insufficient levels. [15-16] This would imply that reaching adequate levels of vitamin D would be crucial for a healthy bone development. Numerous studies have shown low levels of vitamin D can lead to bone loss, osteoporosis, and fractures. But remember that vitamin D alone isn't necessarily sufficient for preventing osteoporosis in people with risk factors such as low testosterone levels, poor calcium intake and no physical activity.[17-20]

These observations have important clinical implications. Measurement of testosterone and vitamin D in elderly men, particularly among those with osteoporosis, is recommended. Prompt detection of testosterone deficiency and vitamin D deficiency enables the patients to receive treatment at the earliest point, such as the adiministration of hormone replacement therapy and vitamin D supplements, which is beneficial for enhancing the bone mineral density and preventing fracture. In addition, lifestyle modifications, such as encouraging physical activity and smoking cessation, need to be highlighted because it could also decrease the risk of developing osteoporosis in this group.

The present cross-sectional study is very informative regarding the high prevalence of osteoporosis and osteopenia in elderly males patients attending a tertiary care hospital; 39.5% of the studied patients were found to have osteoporosis and 48.3% had osteopenia. These results show that osteoporosis is also a major problem in older men, who are generally not included in clinical strategies for assessment of bone mass. The main findings of the study are the high correlation of low serum testosterone levels with the existence of osteoporosis. Osteoporosis was more frequently observed in those with serum testosterone levels <3 ng/ml (p = 0.001). Moreover, vitamin D insufficiency (<20 ng/ml) was noted in 50.6% of the individuals and was significantly associated with osteoporosis, thereby highlighting the importance of vitamin D in bone health.

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