No Elevated Risk for Osteoporosis or Osteopenia Among Women With Androgenetic or Frontal Fibrosing Alopecia Treated With 5-Alpha Reductase Inhibitors: A Retrospective TriNetX Cohort Study

    January 2026 in “ Journal of the American Academy of Dermatology ”
    Daniela Mendez, Marc Hill, Melissa Piliang, Wilma Bergfeld
    TLDR 5-alpha reductase inhibitors do not increase osteoporosis risk in women with certain hair loss conditions.
    This retrospective cohort study using the TriNetX network investigated the potential risk of osteoporosis or osteopenia in women with androgenetic or frontal fibrosing alopecia treated with 5-alpha reductase inhibitors (5-ARIs), such as finasteride and dutasteride. Despite theoretical concerns that these treatments could negatively impact bone mineral density due to their mechanism of reducing dihydrotestosterone, the study found no elevated risk for osteoporosis or osteopenia among the women treated with 5-ARIs. This finding provides important evidence for the skeletal safety of long-term 5-ARI therapy in women, addressing a significant knowledge gap and supporting evidence-based prescribing practices.
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