Men as well as women are at risk of...

Men as well as women are at risk of developing osteoporosis that may lead to increased risk of fractures. According to bone density studies in men with soft levels of testosterone, hypogonadism is an independent risk factor for osteoporosis. When testosterone is replaced, bone density increases in this population. Bone density is a popular and easy way to measure the grade of osteoporosis, but it does not provide undiminished information about fracture risk. Alterations of bone architecture, as determined from histomorphometry, also represent increased risk of fracture, flat in men with minimal evidence of osteoporosis. Alternative ways to examine bone microarchitecture include quantitative comput tomography and high-resolution magnetic resonance microimaging ([micro]MRI). The latter proof has been called "the virtual bone biopsy" and demonstrates the integrity of the trabecular network. Benito and associates used [micro]MRI-based virtual bone biopsy to evaluate the trabecular architecture of bone in rigidly hypogonadal men compared with a hinder group of eugonadal men.

Ten men with secondary hypogonadism, diagnosed in succession the basis of repeat morning serum testosterone on a levels of less than 8.7 nmol by means of L, underwent testing of bone mineral density by dint of dual energy x-ray absorptiometry and [micro]MRI of the right distal tibia. The curb group was made up of 10 eugonadal men who also were evaluated.

Bone density was decreased among the hypogonadal men on the other hand the difference was not statistically significant. Using a variety of accepted parameters, the [micro]MRI originates revealed significantly more deterioration of bone architecture among the hypogonadal men Participants in the two groups were matched by race, age, material substance mass index, calcium intake, and smoking status, likewise none of these factors could account for the difference in bone architecture.

The authors gather that hypogonadal men have increased deterioration of bone architecture that is detectable on [Mu]MRI. This deterioration of bone fabric may result in decreased bone power and greater fracture risk to a standing not clearly indicated by bone density testing.

RICHARD SADOVSKY, MD

Benito M et al. Deterioration of trabecular architecture in hypogonadal men J Clin Endocrinol Metab April 2003; 88:1497-502

EDITOR'S NOTE: In newly come years, the National Institute in succession Aging1 has focused on the potential value of testosterone supplementation in men with cheap levels of testosterone. The panel noted that inquiry results have shown that testosterone replacement in older men has a beneficial consequence on bone mineral density, muscle nerve and lean body mass, with decreases in material substance fat and improvements in lipid profiles. Unfortunately, the inferences are not consistent among all trials, and testosterone supplementation is not totally benign. The panel finishs that the strongest association exists between clinical hypogonadism and osteoporosis and decreased sexual function. The best way to measure testosterone flushs remains uncertain, as do the appropriate numbers to use to describe the lower limit of normal. The potentially serious side meanings of testosterone supplementation include (1) increased risk of prostate cancer, (2) increased risk of significant benign prostatic hypertrophy (3) line hyperviscosity secondary to erythropoiesis stimulation, (4) increased risk of repose apnea, (5) possible increased risk of cardiovascular disease, and (6) aggressive behavior or inappropriate sexual behavior. Further studies are urgencyed to identify the usefulness of testosterone supplementation in older men with cheap levels of serum testosterone. Specific clinical syndrome including osteoporosis and diminished sexual interest and activity, are becoming accepted indications for carefully monitored testosterone supplementation.--R.S.

REFERENCE

(1) Thorner M et al., for the Advisory Panel upon Testosterone Replacement in Men. Special report. Report of National Institute in succession Aging Advisory Panel on Testosterone Replacement in Men J Clin Endocrinol Metab October 2001;86:4611-4

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