Osteoporosis and male age-related hypogonadism: role of sex steroids on bone (patho)physiology

Rochira, Vincenzo; Antonio, Balestrieri; Madeo, Bruno; Zirilli, Lucia; Granata, Antonio R. M.; Carani, Cesare

doi:10.1530/eje.1.02088

Cited by 89 publications

(126 citation statements)

References 102 publications

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“…In hypogonadal men testosterone replacement therapy increases BMD and should be considered as initial therapy, especially in younger men [71]. Testosterone replacement therapy doesn't increase BMD in eugonadal men, which is often a reason of confusion about the role of testosterone replacement therapy in men with low BMD.…”

Section: ) Laboratory Evaluationmentioning

confidence: 99%

Low Testosterone—An Important Predictor of Low Mineral Bone Density in Young Men—Our Own Experience and a Review of Literature

Funaro¹,

Bolyakov²,

Gimenez³

et al. 2013

ASM

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Urologists and reproductive endocrinologists have become the first contact physicians for young men of reproductive age and have the unique opportunity to positively affect men's health and quality of life. Growing evidence indicates that a significant proportion of men presenting with infertility or sexual dysfunction are hypogonadal. One hundred ninety nine men were enrolled in our center, and mean total testosterone was <300 ng/dl. Patients were divided into three groups based on their DEXA scan results; normal bone density (n = 122, 57%), osteopenia (n = 69, 39%) and osteoporosis (n = 8, 4%). There were no differences in the mean age (p < 0.64), height (p < 0.99) and weight (p < 0.06) among the three groups (ANOVA), but men with osteopenia had statistically significant lower weights (p < 0.02). Our results indicate that hypogonadism is one of the main risk factors for osteopenia and osteoporosis which can be found in 8% of hypogonadal men younger than 50 years of age. Testosterone replacement therapy may be indicated in most men with hypogonadism and low bone mineral density (BMD); however the benefits of testosterone treatment in eugonadal men are unproven. Selective estradiol and androgen receptor modulators expand our treatment modalities in men of reproductive age when suppression of gonadotropins may interfere with reproductive plans. Early detection of hypogonadism and osteoporosis may lower the risk of hip and vertebral fractures in some men. Further prospective RCTs are needed to prove cost-effectiveness of detection and the best treatment of osteoporosis in hypogonadal men of reproductive age. Urologists have the opportunity to be at the forefront of greater awareness of this clinical problem due to their frequent contact with this population of patients.

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Section: ) Laboratory Evaluationmentioning

confidence: 99%

Low Testosterone—An Important Predictor of Low Mineral Bone Density in Young Men—Our Own Experience and a Review of Literature

Funaro¹,

Bolyakov²,

Gimenez³

et al. 2013

ASM

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“…In part this relates to a greater cross-sectional bone area in males. The timing of gonadal steroid surges are critical for bone acquisition since there is a relatively short window of time in which bone formation is favored and matrix synthesis is markedly enhanced (Rochira et al 2006). In adulthood normal testosterone levels are required for the maintenance of BMD.…”

Section: Androgens and Bonementioning

confidence: 99%

“…In elderly men, estrogen seems to play a more dominant role than testosterone in regulating bone resorption. In elderly men, lower than normal levels of estrogen appeared to be associated with vertebral fractures (Rochira et al 2006). Age-related decreases of estradiol, especially levels below 40 pmol/l, may be the major cause of bone loss (Barrett-Connor et al 2000).…”

Section: Estrogens and Bonementioning

confidence: 99%

Osteoporosis in Men - A Crucial Role of Sex Hormones

Rabijewski¹,

Papierska²

2012

Sex Hormones

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“…A second major testosterone metabolite -dihydrotestosterone (DHT)-also plays a role in bone health. This role is not yet entirely clear, although preliminary studies suggest that it promotes periosteal apposition and modulates the activity of several bone growth factors, including insulin-like growth factor I (17). With the continued production of testosterone and aromatase being virtually ubiquitous, the average 50-year-old man can produce about twice as much estradiol as a menopausal woman of the same age.…”

Section: Introductionmentioning

confidence: 99%

Denosumab is really effective in the treatment of osteoporosis secondary to hypogonadism in prostate carcinoma patients? A prospective randomized multicenter international study

Doria

Leali

Solla

et al. 2016

ccmbm

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SummaryIntroduction. Osteoporosis is a complication of androgen deprivation therapy (ADT) in men with prostate carcinoma. The best defense against osteoporosis in prostate cancer is to identify patients with a high risk for fracture during the first clinical visit, select an effective anti-osteoporosis agent, and advise the patient to change his lifestyle and diet to prevent further bone loss. New agents include denosumab, a human monoclonal antibody that inhibits the RANK ligand (RANKL). RANKL promotes the formation, activity, and survival of osteoclasts and, thus, supports the breakdown of bone. Purpose. This is a multicenter, randomized, double-blind prospective study on use of denosumab versus alendronate in the therapy of secondary osteoporosis related to ADT in prostate cancer patients in three European countries (Italy, France, Switzerland). Patients and methods. In this 24-month observation study we enrolled 234 patients with diagnosis of osteoporosis underwent ADT for prostate cancer. All patients aged ≥55 years and had a dual-energy X-ray absorptiometry (DEXA) T-score <-1.0 (hip or spine, measured within last 2 years) and ≥ 1 fragility fracture. Patients were randomly assigned 1:1 to receive denosumab 60 mg subcutaneously every 6 months or alendronate (70 mg weekly) for 2 years. All patient received supplemental vitamin D (600 IU per day) and supplemental calcium to maintain a calcium intake of 1200 mg per day. Effectiveness of therapy in both groups (denosumab group and alendronate group) was assessed by changes in bone turnover markers (BTMs), Bone Mineral Density (BMD), fracture incidence, Visual Analogue Scale (VAS) score for back pain, and Short Form-8 (SF-8TM) health survey score for healthrelated quality of life (HRQoL). Percent changes from baseline in BTMs and BMD were assessed using the paired t test; a P-value 0.05). Mean changes in BMD at final follow-up differed significantly between two groups. BMD changes at the lumbar spine at 24 months were 5.6% with denosumab vs -1.1% with alendronate (P<0.001). New vertebral fractures developed in fewer patients in the denosumab group than in the alendronate group during the 24-month period, although this difference was not significant (P=0.10). Back pain significantly (P<0.001) improved from baseline at all time points during the study in both study groups. SF-8 health survey scores significantly improved following treatment with both drugs. Incidence of adverse drug reactions were similar in both groups. Conclusion. In our study denosumab and alendronate showed similar clinical efficacy in the therapy of ADT-related osteoporosis in men with prostate carcinoma; both drugs provided significant improvements in back pain and general health conditions. Denosumab showed significant increase of BTMs and BMD than alendronate with lower rate of new vertebral fractures.

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Osteoporosis and male age-related hypogonadism: role of sex steroids on bone (patho)physiology

Cited by 89 publications

References 102 publications

Low Testosterone—An Important Predictor of Low Mineral Bone Density in Young Men—Our Own Experience and a Review of Literature

Low Testosterone—An Important Predictor of Low Mineral Bone Density in Young Men—Our Own Experience and a Review of Literature

Osteoporosis in Men - A Crucial Role of Sex Hormones

Denosumab is really effective in the treatment of osteoporosis secondary to hypogonadism in prostate carcinoma patients? A prospective randomized multicenter international study

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