Low bone mass in hypogonadal males. Effect of testosterone substitution therapy, a densitometric study

Devogelaer, JP; Cooman, Serge de; Deuxchaisnes, C Nagant de

doi:10.1016/0378-5122(92)90057-b

Cited by 92 publications

(43 citation statements)

References 17 publications

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“…Bone mineral density has been shown to be significantly decreased in young adult males who experienced a delayed entry into puberty (constitutional delay of puberty) as compared with men who entered puberty normally (9). Similarly, bone density was increased in hypogonadal young men given testosterone substitution therapy (40). Since calcium is a major component of trabecular bone, our findings in the studies reported here strongly suggest that a pivotal role of both sex steroidal hormones and the tim- ing of exposure to these hormones in the adequate development of the density of the axial skeleton in man.…”

Section: Discussionsupporting

confidence: 70%

Calcium and protein kinetics in prepubertal boys. Positive effects of testosterone.

Mauras¹,

Haymond²,

Vieira³

et al. 1994

J. Clin. Invest.

101

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We investigated the effects of 4-6-wk administration of testosterone on calcium and protein metabolism in six healthy prepubertal short boys (mean age±SE = 12.9±0.6 yr). At baseline, subjects received a 4-h infusion of L-1l-'3Clleucine and L-12-'5Njglutamine, and were given 42Ca intravenously, and 'Ca PO. Testosterone enanthate ( -3 mg/ kg) was given I.M. 2 wk apart (two doses n = 5, three doses n = 1), and the study was repeated 4-5 d after the last injection.After testosterone therapy, there were significant increases in serum testosterone and mean peak and total growth hormone concentrations. Net calcium absorption (Va) and retention ( Vbal) also increased ( Va 13.3±2.3 vs 21.5±23; mg.kg-' * d-l, Vbal 8.0±2.1 vs 16.6±2.5, mg * kg-' -d-l, P < .05 both), as well as Ca's net forward flow into bone and total exchangeable pool (16 and 20%, respectively). The rate of appearance of leucine (an indicator of proteolysis) increased by 17.6±5.9%, P = 0.036. Leucine oxidation decreased by 48.6±8.0%, P = 0.004; thus, nonoxidative leucine disappearance, which estimates protein synthesis, increased significantly by 34.4±7.7%, P = 0.009. Glutamine's rate of appearance also increased (+32%), mostly through enhanced glutamine de novo synthesis (+42%).In conclusion, short term testosterone administration significantly increases calcium's retention and net forward flow into bone in prepubertal humans, as well as whole body estimates of protein and calcium anabolism. These effects may represent a pure androgen effect, an amplification of growth hormone's action or some combination of these factors. (J. Clin. Invest.

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Section: Discussionsupporting

confidence: 70%

Calcium and protein kinetics in prepubertal boys. Positive effects of testosterone.

Mauras¹,

Haymond²,

Vieira³

et al. 1994

J. Clin. Invest.

101

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“…Osteopenia has been reported in men with Klinefelter syndrome (26), men with idiopathic hypogonadotropic hypogonadism (27), hypogonadism associated with hyperprolactinaemia (28) and after orchidectomy (29). Previous reports have also shown beneficial effects of replacement therapy with testosterone, human choriogonadotrophin or GnRH on bone of men with different types of hypogonadism (3,4). The lower initial BMD and vertebral area found in men with IHH compared with other forms of hypogonadism indicate that the onset and duration of androgen deficiency may be crucial determinants of the extent of reduction in bone mass.…”

Section: Discussionmentioning

confidence: 94%

“…A correlation between serum testosterone levels and BMD has been reported by some investigators (26,31) but not by others (4,27). These discrepancies may be due to the fact that those studies that did not demonstrate a correlation included patients who had already been treated (4).…”

Section: Discussionmentioning

confidence: 94%

“…These discrepancies may be due to the fact that those studies that did not demonstrate a correlation included patients who had already been treated (4). Indeed, the serum testosterone levels, although indicative of the diagnosis, do not reflect duration and severity of the hypogonadism.…”

Section: Discussionmentioning

confidence: 98%

“…Physical fragility and bone fractures are the consequences (1,2). Beneficial effects of testosterone replacement therapy on bones and muscles in hypogonadal men have been reported (3)(4)(5)(6)(7)(8). Little is known, however, about whether the effects described for bone vary according to age and type of hypogonadism (9,10) or potential changes in muscle mass.…”

Section: Introductionmentioning

confidence: 99%

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Effects of testosterone replacement therapy on cortical and trabecular bone mineral density, vertebral body area and paraspinal muscle area in hypogonadal men

Leifke

Korner

Link

et al. 1998

European Journal of Endocrinology

133

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Loss of bone and muscle mass are major findings of male hypogonadism. In order to determine the long-term effect of testosterone replacement therapy on spinal bone and muscles, the trabecular and cortical bone mineral density, vertebral body area and paraspinal muscle area were assessed by quantitative computed tomography in 32 testosterone-substituted patients, aged 18-74 years, with idiopathic hypogonadotropic hypogonadism (n = 6), pituitary insufficiency (n = 5), Klinefelter syndrome (n = 12) or other forms of primary hypogonadism (n = 9). They were followed for a mean period of 3.2Ϯ1.7 years (meanϮS.D.), ranging from 1 to 7 years. A significant correlation between initial serum testosterone levels and bone mineral density was found in patients with congenital forms (r = 0.58; P<0.05) but not in those with acquired forms. A significant increase in trabecular and cortical bone mineral density (P<0.001) was documented in the course of replacement therapy in all patients regardless of the type of hypogonadism and age of patients. A slight but significant increase in paraspinal muscle area was observed if all patients were taken together (P<0.01). The area of paraspinal muscle correlated with body weight (r = 0.58; P<0.001) and moderately with trabecular bone mineral density (r = 0.4; P<0.01). Its increase did not correspond to the change observed for trabecular and cortical bone mineral density. Vertebral body area did not change over time. It correlated only with height and weight but not with bone mineral density. In conclusion, testosterone therapy of hypogonadal men improves both trabecular and cortical bone mineral density of the spine independently of age and type of hypogonadism while vertebral area remains unchanged. The effects seen on paraspinal muscles emphasize the clinical benefit of adequate replacement therapy for the physical fitness of hypogonadal men.

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Klinefelter Syndrome

Smyth¹,

Bremner²

1998

Arch Intern Med

245

171

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Klinefelter syndrome is the most common sex chromosome disorder. Affected males carry an additional X chromosome, which results in male hypogonadism, androgen deficiency, and impaired spermatogenesis. Some patients may exhibit all of the classic signs of this disorder, including gynecomastia, small testes, sparse body hair, tallness, and infertility, whereas others, because of the wide variability in clinical expression, lack many of these features. Treatment consists of testosterone replacement therapy to correct the androgen deficiency and to provide patients with appropriate virilization. This therapy also has positive effects on mood and self-esteem and has been shown to protect against osteoporosis, although it will not reverse infertility. Although the diagnosis of Klinefelter syndrome is now made definitively using chromosomal karyotyping, revealing in most instances a 47,XXY genotype, the diagnosis also can be made using a careful history and results of a physical examination, with the hallmark being small, firm testes. As it affects 1 in 500 male patients and presents with a variety of clinical features, primary care physicians should be familiar with this condition.

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Low bone mass in hypogonadal males. Effect of testosterone substitution therapy, a densitometric study

Cited by 92 publications

References 17 publications

Calcium and protein kinetics in prepubertal boys. Positive effects of testosterone.

Calcium and protein kinetics in prepubertal boys. Positive effects of testosterone.

Effects of testosterone replacement therapy on cortical and trabecular bone mineral density, vertebral body area and paraspinal muscle area in hypogonadal men

Klinefelter Syndrome

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