TOPLINE:

Long-term use of 5-alpha reductase inhibitors (5-ARIs), used off-label for androgenetic or frontal fibrosing alopecia (FFA) in women, was not associated with an increased risk for osteoporosis or osteopenia.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 1260 women aged 30-50 years (mean age, 39.1 years; 69% were White, 7.1% were Asian, and 5.1% were Black) with androgenetic alopecia or FFA from the TriNetX network, who initiated treatment with the 5-ARIs dutasteride or finasteride between January 2005 and October 2025.
• The analysis included a matched cohort of 1260 women with the same diagnoses who were not prescribed 5-ARIs.
• The primary outcome was new diagnoses of osteoporosis or osteopenia within 10 years.

TAKEAWAY:

• In the treated cohort, 1.98% of the patients were diagnosed with osteoporosis or osteopenia compared with 1.83% of those who did not receive 5-ARIs.
• No statistically significant increase in osteoporosis or osteopenia was observed with long-term 5-ARI exposure (risk ratio, 1.087; 95% CI, 0.62-1.905), compared with controls.

IN PRACTICE:

There has been “a significant knowledge gap” regarding the skeletal safety of 5-ARIs in women, the authors of the study wrote, noting that these agents reduce dihydrotestosterone, which may “indirectly disrupt estrogen pathways crucial for bone maintenance.” The results of the study, they concluded, “demonstrate that long-term use of dutasteride or finasteride does not increase osteoporosis or osteopenia risk in women with alopecia, supporting their continued use while informing safer prescribing practices.”

SOURCE:

The study was led by Daniela Mendez, MD, Department of Dermatology, Cleveland Clinic Foundation, Cleveland, and was published online on January 7 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The authors reported having no list of any study limitations.

DISCLOSURES:

No funding was received for the study. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.