Testosterone Therapy After Hip Fracture in Elderly Women

The purpose of this study is to determine the feasibility of testosterone replacement therapy in frail elderly female hip fracture patients who have testosterone deficiency, and to obtain preliminary information about the effects of testosterone therapy on muscle strength and size, bone density, mobility, daily functioning, and quality of life.

Study Overview

• Status: Completed
• Conditions: Muscle Weakness; Hip Fracture; Testosterone Deficiency
• Intervention / Treatment: Drug: Testosterone gel

Detailed Description

Hip fractures are common among elderly women and can have a devastating impact on their ability to remain independent. A significant functional decline following a hip fracture has been documented, and many patients have persistent strength and mobility deficits that impair their capacity for independent function. Such individuals are at high risk for continued supportive services, recurrent injury, and institutionalization. High-risk patients include those with deficits in skeletal muscle strength during the post-fracture period. Age-associated androgen deficiency contributes to deficits in muscle mass and strength that are common in this patient population. The role of testosterone therapy for improving deficits in muscle mass, strength, and functional capacity in the frail elderly is unclear, particularly for elderly women. There is insufficient information regarding tolerability of testosterone therapy, and the appropriate medication dosage and target serum testosterone levels necessary to induces changes in skeletal muscle mass and functional measures in elderly women with physical frailty due to muscle weakness.

The goals of this project are to conduct a randomized, double-blinded, placebo-controlled prospective study to determine the feasibility, tolerability, and safety of 6 months of testosterone therapy in community-dwelling, physically frail, elderly female hip fracture patients. Twenty-seven female hip fracture patients will be recruited, using objective criteria for testosterone deficiency and frailty. We plan to evaluate two dosages of testosterone, administered as a 0.5% topical gel: a physiologic replacement dosage, and a supraphysiologic dosage. We plan to carefully monitor testosterone levels, side effects, biochemical parameters, and factors related to compliance with therapy. We plan to obtain preliminary information regarding the changes in measurements of muscle strength, total score on an Objective Physical Performance Test, total lean body mass by dual energy x-ray absorptiometry (DEXA), thigh cross-sectional areas by magnetic resonance imaging (MRI), and self-reported performance of activities of daily living, and quality of life. These data will be used to develop a full-scale proposal to test the long-term hypothesis that testosterone therapy combined with exercise training can improve physical function after a hip fracture.

• Study Type: Interventional
• Enrollment (Actual): 15
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Washington University School of Medicine, Division of Geriatrics and Nutritional Science

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria: -female, hip fracture repair within previous 4 months

• age 65 years and older
• serum total testosterone level < 30 ng/dl
• modified Physical Performance Test Score between 13-28
• able to ambulate 50 ft

Exclusion Criteria: -permanent nursing home residence

• dementia severe enough to prohibit informed consent
• clinically significant visual or hearing impairments
• history of a hormone dependent neoplasia
• active or unstable cardiopulmonary disease
• history of sleep apnea
• elevated liver function tests
• hematocrit > 51%
• history of alcohol or substance abuse
• symptoms of depression severe enough to cause weight loss of >5% in previous 3 months or interfere with daily activities or medication compliance

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Double

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Serum testosterone levels, drug compliance, symptoms and side effects during the six months of treatment.	Six months

Secondary Outcome Measures

Outcome Measure	Time Frame
Modified Physical Performance Test Score at 6 months	Six months
1-RM muscle strength at 6 months	Six months
Thigh cross-sectional area by MRI at 6 months	Six months
Self-report of ADL function at 6 months	Six months
SF-36 score (quality of life) at 6 months	Six months
Total and regional bone density by DEXA at 6 months	Six months

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: National Institute on Aging (NIA)
• Investigators: Principal Investigator: Ellen F. Binder, MD, Washington University School of Medicine, Division of Geriatrics and Nutritional Science

Study record dates

Study Major Dates

• Study Start: August 1, 2004
• Primary Completion (Actual): December 1, 2006
• Study Completion (Actual): December 1, 2006

Study Registration Dates

• First Submitted: January 19, 2006
• First Submitted That Met QC Criteria: January 19, 2006
• First Posted (Estimate): January 20, 2006

Study Record Updates

• Last Update Posted (Estimate): February 4, 2009
• Last Update Submitted That Met QC Criteria: February 3, 2009
• Last Verified: February 1, 2009

More Information

Terms related to this study

• Keywords: muscle weakness; aging; frail elderly; testosterone; hip fracture
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Neurologic Manifestations; Wounds and Injuries; Leg Injuries; Musculoskeletal Diseases; Muscular Diseases; Neuromuscular Manifestations; Femoral Fractures; Hip Injuries; Muscle Weakness; Fractures, Bone; Hip Fractures; Paresis; Physiological Effects of Drugs; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Androgens; Testosterone
• Other Study ID Numbers: R21AG023716 (U.S. NIH Grant/Contract)