TESTOSTERONE THERAPY AFTER HIP FRACTURE IN ELDERLY WOMEN

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 髋部骨折在老年女性中很常见，可能会对她们保持独立的能力产生毁灭性的影响。髋部骨折后出现明显的功能衰退，许多患者有持续性的力量和活动能力缺陷，损害了他们的独立功能能力。这些人接受持续的支持性服务、反复受伤和住院的风险很高。高危患者包括那些在骨折后阶段骨骼肌力量不足的患者。与年龄相关的雄激素缺乏导致肌肉质量和强度的缺陷，这在该患者群体中很常见。睾酮疗法对改善虚弱老年人肌肉质量、力量和功能能力缺陷的作用尚不清楚，特别是对老年妇女。对于因肌肉无力而导致身体虚弱的老年妇女，缺乏关于睾酮治疗耐受性的信息，以及诱导骨骼肌质量和功能措施改变所需的适当药物剂量和目标血清睾酮水平。 该项目的目标是进行一项随机、双盲、安慰剂对照的前瞻性研究，以确定在社区居住、身体虚弱的老年女性髋部骨折患者中进行6个月睾酮治疗的可行性、耐受性和安全性。27名女性髋部骨折患者将被招募，使用睾丸激素抵抗和虚弱的客观标准。我们计划评估两种剂量的睾酮，作为0.5%的局部凝胶使用：生理替代剂量和生理超生理剂量。我们计划仔细监测睾酮水平、副作用、生化参数以及与治疗依从性相关的因素。我们计划获得有关以下方面的初步信息：肌肉力量测量的变化、客观体能测试的总分、双能X射线吸收法(DEXA)的总瘦体重、磁共振成像(MRI)的大腿横截面积以及自我报告的日常生活活动表现和生活质量。这些数据将被用来制定一项全面的建议，以检验长期假设，即睾酮治疗结合运动训练可以改善髋部骨折后的身体功能。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hip fractures are common among elderly women and can have a devastating impact on their ability to remain independent. A significant funtional 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 strenth that are common in this patient population. The role of testosterone therapy for improving deficits in muscle mass, strenght and fucntional capacity in the frail elderly is unclear particularly for elderly women. There is insufficient information regrdaing tolerability of testosterone therapy, and the appropriate medication dosage and target serum testosterone levels necessary to induce 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-blind, 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 defiency 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 preiminary 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 funciton after a hip fracture.