Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians

2017 ◽  
Vol 166 (11) ◽  
pp. 818 ◽  
Author(s):  
Amir Qaseem ◽  
Mary Ann Forciea ◽  
Robert M. McLean ◽  
Thomas D. Denberg ◽  
Keyword(s):  
Clinical Practice ◽  
Bone Density ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Men And Women ◽  
Low Bone Density

Management of testosterone therapy in adolescents and young men with hypogonadism: are we following adult clinical practice guidelines?

2015 ◽  
Vol 28 (5-6) ◽  
Author(s):  
Leena Nahata ◽  
Richard N. Yu ◽  
Shalender Bhasin ◽  
Laurie E. Cohen
Keyword(s):  
Clinical Practice ◽  
Bone Density ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Tertiary Care ◽  
Testosterone Replacement Therapy ◽  
Male Hypogonadism ◽  
Testosterone Therapy ◽  
Endocrine Society ◽  
Testosterone Levels

AbstractMale hypogonadism is a common disorder that is associated with low bone density, poor muscle mass, anemia, and sexual dysfunction. The Endocrine Society recently published a Clinical Practice Guideline for testosterone therapy in androgen-deficient men. Because treatment is frequently initiated in adolescence, the goal of this quality improvement initiative was to assess whether pediatric endocrinologists at a large tertiary care center follow these guidelines and to identify opportunities for improvement.We performed a retrospective chart review at Boston Children’s Hospital. Inclusion criteria were as follows: current age ≥16 years, diagnosis of hypogonadism, and testosterone replacement therapy. Data were collected about current age, age at treatment initiation, diagnoses, pre- and on-treatment testosterone levels, route of testosterone administration and dose, bone density, hematocrit levels, and adherence with therapy.Fifty-nine patients were included. Fourteen (24%) were prescribed lower testosterone doses than those recommended in the Clinical Practice Guideline. Seven (12%) had no pre-treatment testosterone levels, and 10 (17%) had no on-treatment levels. In 49 patients with on-treatment testosterone levels, 36 had at least one value that was lower than the adult reference range. Ten (28%) of the 36 men with low testosterone levels had no dose adjustments. Thirty-seven (63%) of the 59 patients had no dual-energy X-ray absorptiometry scans, and 18 (31%) did not have hematocrit levels.Pediatric endocrinologists in this review did not consistently follow the Clinical Practice Guideline for testosterone therapy in hypogonadal adult males. Strategies that improve adherence to guidelines could help maximize the benefits of therapy and minimize treatment-associated risks.

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