Testosterone Therapy After Hip Fracture in Elderly Women

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Testosterone Therapy After Hip Fracture in Elderly Women

Conditions
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Hip Fracture, Testosterone Deficiency, Muscle Weakness

Intervention / Treatment
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* Drug: Testosterone gel


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Testosterone gel|nan|

What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

| Outcome Measure | Measure Description | 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hip fracture, testosterone, muscle weakness, frail elderly, aging