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. 2025 Aug 18;17(8):e90445.
doi: 10.7759/cureus.90445. eCollection 2025 Aug.

Hip Fractures and Hypogonadism in Young Males: A Missed Opportunity for Secondary Prevention?

Chan Khin  1 , Olive Kyaw  1 , Shri Thangaraj  1 , Oriade Akinsolu  2 , Amr Elfiky  1 , Prashanth D'Sa  1 , Gareth Chan  3 , Benedict Rogers  1
Affiliations

Hip Fractures and Hypogonadism in Young Males: A Missed Opportunity for Secondary Prevention?

Chan Khin et al. Cureus. .

Abstract

Introduction: Low testosterone is a known risk factor for osteoporosis and fragility fractures in men. Unlike in women, osteoporosis in men often presents later in life. Fragility hip fractures in males under 60 years are uncommon and may represent an opportunity to diagnose and treat an underlying metabolic bone pathology. This study aims to evaluate whether low-energy hip fractures in young men are associated with low serum testosterone.

Materials and methods: We performed a retrospective review of a prospectively maintained database, identifying male patients aged <60 years who sustained hip fractures from low-energy trauma between January 2022 and December 2024. Fractures up to 5 cm distal to the lesser trochanter were included. Demographic, comorbidity, and laboratory data were collected; serum testosterone <198 pmol/L was defined as low.

Results: Sixty-one males (mean age 50.6 ± 7.2 years) sustained hip fractures in this study period; 23 (38%) had serum testosterone measured. Of those, 15 (65%) were found to have low testosterone; only one had a known endocrine disorder. Among the total cohort, 42 (69%) had multiple comorbidities, 24 (39%) were on polypharmacy (≥5 medications), 25 (41%) were current smokers, 17 (28%) reported excessive alcohol use, and 13 (21%) had a history of substance misuse.

Conclusions: A substantial proportion of young men with fragility hip fractures had unrecognized low testosterone levels. These findings indicate that hormonal abnormalities may be under-recognized in this population, and further studies are warranted to determine whether targeted hormonal screening could help reduce future fragility fracture risk.

Keywords: femoral neck fracture; fragility fracture; hip fracture; men; osteoporosis; testosterone.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Scatter plot showing total testosterone versus age
Figure 2
Figure 2. Grouped boxplot showing testosterone levels by substance abuse
Figure 3
Figure 3. Scatter plot showing SHBG versus total testosterone in relation to alcohol excess
SHBG: sex hormone binding globulin
See this image and copyright information in PMC

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