Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men

Abstract

Purpose Hypogonadism and osteoporosis are frequently reported in HIV-infected men and, besides multifactorial pathogenesis, they might be directly linked because of testicular involvement in bone health. We evaluated the prevalence of osteoporosis and vertebral fractures (VFs) in HIV-infected men, and assessed their relationship with gonadal function. Methods We enrolled 168 HIV-infected men (median age 53). Osteoporosis and osteopenia were defined with T-score ≤ – 2.5SD and T-score between – 1 and – 2.5SD, respectively. VFs were assessed by quantitative morphometric analysis. Total testosterone (TT), calculated free testosterone (cFT), Sex Hormone Binding Globulin (SHBG), Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) were obtained; overt hypogonadism was defined on symptoms and low TT or cFT, and classified into primary and secondary according to gonadotropins; compensated hypogonadism was defined as normal TT and cFT with high LH levels. Results Overall, osteoporosis and osteopenia were found in 87.5% of patients, and VFs were detected in 25% of them; hypogonadism was identified in 26.2% of cases. Osteoporotic patients had higher SHBG vs those with normal bone mineral density (BMD). Fractured patients were more frequently hypogonadal and with higher SHBG. SHBG showed negative correlation with both spine and femoral BMD, and positive correlation with VFs. In multivariate models, FSH showed negative impact only on femoral BMD, whereas older age and higher SHBG predicted VFs. Conclusion We found a high burden of bone disease and hypogonadism in HIV-infected men, and we showed that the impact of gonadal function on bone health is more evident on VFs than on BMD.

Osteoporosis in men with hypogonadism because of ApoA‐I Leu75Pro amyloidosis under long‐term testosterone therapy

“…Interestingly, our study also confirms the correlation of lower BMD with higher levels of FSH and above all SHBG, which have been reported in other causes of hypogonadism, such as men with HIV 36 or Klinefelter syndrome 37 . Indeed, these parameters could be more sensitive markers than testosterone of male gonadal axis dysfunction, 36,38 and other studies 27,37 failed to find a close correlation between BMD and testosterone levels. The role of male gonadal function on bone health has also been related to estradiol, 27,39 but we did not confirm this hypothesis in hypogonadal patients with Apo A‐I Leu75Pro amyloidosis.…”

“…It is well known that aging and systemic comorbidities are risk factors for male osteoporosis, while a higher BMI has a protective effect. 27 Interestingly, our study also confirms the correlation of lower BMD with higher levels of FSH and above all SHBG, which have been reported in other causes of hypogonadism, such as men with HIV 36 or Klinefelter syndrome. 37 Indeed, these parameters could be more sensitive markers than testosterone of male gonadal axis dysfunction, 36,38 and other studies 27,37 failed to find a close correlation between BMD and testosterone levels.…”

Gender and sex considerations in HIV and bone health

“…Multivariate models suggested that the impact of gonadal function was greater on vertebral fractures than BMD, with older age and higher SHBG levels established as predictors for vertebral fractures. Importantly, oestradiol levels were not measured in this study [15 ▪ ]. In virologically suppressed men with HIV, testosterone use was associated with higher BMD T scores at the spine and hip [13].…”

Fisiologia Do Esporte: O Uso De Esteroides Anabolizantes

“…Inicialmente, os esteroides anabolizantes foram desenvolvidos com propósitos terapêuticos e, em algumas situações médicas específicas, são administrados para repor a deficiência de testosterona em pacientes que apresentam déficits hormonais devido a condições patológicas (DE OLIVEIRA FERREIRA et al, 2023) Além disso, em doses terapêuticas controladas, esses esteroides são utilizados no tratamento de diversas condições clínicas, como AIDS, hipogonadismo, puberdade anormal, certos tipos de câncer, desnutrição (para estimular o apetite), deficiências hormonais, osteoporose, alguns tipos de anemia, disfunção erétil, castração e baixa estatura devido à síndrome de Turner (WILLEMS et al, 2023;PEZZAIOLI et al, 2022;LIM et al, 2023;DE OLIVEIRA FERREIRA et al, 2023). Portanto, além do seu uso inadequado para ganho de massa muscular, os EAA desempenham um papel importante na terapia médica de várias condições clínicas, sob rigorosa supervisão profissional.…”