在无低睾酮治疗指征的情况下启动睾酮治疗与肌腱撕裂风险增加相关。
Initiating Testosterone Therapy Without Indication for Treatment of Low Testosterone Is Associated With Higher Risk of Tendon Tear.
作者信息
Waters Timothy L, Winter Julianna E, Delvadia Bela P, May David S, O'Brien Michael J, Savoie Felix H, Sherman William F
机构信息
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
出版信息
Sports Health. 2025 Apr 28:19417381251334083. doi: 10.1177/19417381251334083.
BACKGROUND
Studies have demonstrated an increasing rate of testosterone supplementation in patients who do not meet criteria for testosterone deficiency, but the risks associated with testosterone supplementation are unclear.
HYPOTHESIS
Patients initiating testosterone therapy would be diagnosed with significantly more tendon tears and undergo significantly more tendon repairs than matched controls never on testosterone therapy.
STUDY DESIGN
Cohort study.
LEVEL OF EVIDENCE
Level 3.
METHODS
Male patients who initiated testosterone therapy within 30 days of a primary care visit and who did not meet criteria for treatment of low testosterone were identified (n = 112,242). Propensity score matching generated a control cohort (n = 448,968) with no history of testosterone therapy and based on several comorbidities at the time of said age-matched primary care visit. Rates of tendon tears and tendon repairs within 1 and 2 years after primary care visit were compared using multivariable logistic regression.
RESULTS
Within 1 and 2 years, compared with controls, the testosterone supplementation cohort demonstrated significantly higher rates of rotator cuff tear (odds ratio [OR], 1.35; OR, 1.31), patellar tendon tear (OR, 2.06; OR, 2.14), and any tendon tear (OR, 1.33; OR, 1.31). The testosterone supplementation cohort demonstrated significantly higher rates of quadriceps tendon tears within 1 year (OR, 1.59). Within 1 and 2 years, compared with controls, the testosterone supplementation cohort demonstrated significantly higher rates of rotator cuff repair (OR, 1.28; OR, 1.23), distal biceps tendon repair (OR, 1.65; OR, 1.54), patellar tendon repair (OR, 2.28; OR, 2.18), and any tendon repair (OR, 1.27; OR, 1.23).
CONCLUSION
Testosterone supplementation is associated with an increased risk of tendon tears and repairs for at least the first and second year after initiating therapy in patients with no documented laboratory testing. Patients considering testosterone therapy should be counseled on this increased risk of tendon injury.
背景
研究表明，在不符合睾酮缺乏标准的患者中，补充睾酮的比例呈上升趋势，但补充睾酮相关的风险尚不清楚。
假设
开始接受睾酮治疗的患者与从未接受过睾酮治疗的匹配对照组相比，被诊断出肌腱撕裂的情况显著更多，且接受肌腱修复的次数也显著更多。
研究设计
队列研究。
证据水平
3级。
方法
确定在初级保健就诊后30天内开始接受睾酮治疗且不符合低睾酮治疗标准的男性患者（n = 112,242）。倾向评分匹配产生了一个无睾酮治疗史的对照队列（n = 448,968），该队列基于上述年龄匹配的初级保健就诊时的几种合并症。使用多变量逻辑回归比较初级保健就诊后1年和2年内肌腱撕裂和肌腱修复的发生率。
结果
在1年和2年内，与对照组相比，补充睾酮队列的肩袖撕裂发生率显著更高（优势比[OR]，1.35；OR，1.31）、髌腱撕裂发生率显著更高（OR，2.06；OR，2.14）以及任何肌腱撕裂发生率显著更高（OR，1.33；OR，1.31）。补充睾酮队列在1年内股四头肌肌腱撕裂发生率显著更高（OR，1.59）。在1年和2年内，与对照组相比，补充睾酮队列的肩袖修复发生率显著更高（OR，1.28；OR，1.23）、肱二头肌远端肌腱修复发生率显著更高（OR，1.65；OR，1.54）、髌腱修复发生率显著更高（OR，2.28；OR，2.18）以及任何肌腱修复发生率显著更高（OR，1.27；OR，1.23）。
结论
对于没有实验室检测记录的患者，补充睾酮与开始治疗后的至少第一年和第二年肌腱撕裂和修复风险增加有关。应向考虑接受睾酮治疗的患者告知这种肌腱损伤风险增加的情况。
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