Osteoporosis

Discussion in 'Men's Health Forum' started by Michael Scally MD, Apr 16, 2017.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Golds G, Houdek D, Arnason T. Male Hypogonadism and Osteoporosis: The Effects, Clinical Consequences, and Treatment of testosterone Deficiency in Bone Health. Int J Endocrinol. 2017:4602129. https://www.hindawi.com/journals/ije/2017/4602129/

    It is well recognized that bone loss accelerates in hypogonadal states, with female menopause being the classic example of sex hormones affecting the regulation of bone metabolism. Underrepresented is our knowledge of the clinical and metabolic consequences of overt male hypogonadism, as well as the more subtle age-related decline in testosterone on bone quality.

    While menopause and estrogen deficiency are well-known risk factors for osteoporosis in women, the effects of age-related testosterone decline in men on bone health are less well known. Much of our knowledge comes from observational studies and retrospective analysis on small groups of men with variable causes of primary or secondary hypogonadism and mild to overt testosterone deficiencies.

    This review aims to present the current knowledge of the consequences of adult male hypogonadism on bone metabolism. The direct and indirect effects of testosterone on bone cells will be explored as well as the important differences in male osteoporosis and assessment as compared to that in females.

    The clinical consequence of both primary and secondary hypogonadism, as well as testosterone decline in older males, on bone density and fracture risk in men will be summarized. Finally, the therapeutic options and their efficacy in male osteoporosis and hypogonadism will be discussed.
     
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Novel Anabolic Treatments for Osteoporosis

    Skeletal anabolic agents enhance bone formation, which is determined by the number and function of osteoblasts. Signals that influence the differentiation and function of cells of the osteoblast lineage play a role in the mechanism of action of anabolic agents in the skeleton.

    Wnts induce the differentiation of mesenchymal stem cells toward osteoblasts, and insulin-like growth factor I (IGF-I) enhances the function of mature osteoblasts. The activity of Wnt and IGF-I is controlled by proteins that bind to the growth factor or to its receptors. Sclerostin is a Wnt antagonist that binds to Wnt co-receptors and prevents Wnt signal activation.

    Teriparatide, a 1-34 amino terminal fragment of parathyroid hormone (PTH), and abaloparatide, a modified 1-34 amino terminal fragment of PTH-related peptide (PTHrp), induce IGF-I, increase bone mineral density (BMD), reduce the incidence of vertebral and non-vertebral fractures and are approved for the treatment of postmenopausal osteoporosis.

    Romosozumab, a humanized anti-sclerostin antibody, increases bone formation, decreases bone resorption, increases BMD and reduces the incidence of vertebral fractures. An increased incidence of cardiovascular events has been associated with romosozumab, which is yet to be approved for the treatment of osteoporosis.

    In conclusion, cell and molecular studies have formed the foundation for the development of new anabolic therapies for osteoporosis with proven efficacy on the incidence of new fractures.

    Canalis E. MANAGEMENT OF ENDOCRINE DISEASE: Novel Anabolic Treatments for Osteoporosis. European Journal of Endocrinology. MANAGEMENT OF ENDOCRINE DISEASE: Novel Anabolic Treatments for Osteoporosis
     
  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Body Composition and Circulating Estradiol Are the Main Bone Density Predictors

    PURPOSE: Current fracture risk assessment options in men call for improved evaluation strategies. Recent research directed towards non-classic bone mass determinants have often yielded scarce and conflicting results. We aimed at investigating the impact of novel potential bone mass regulators together with classic determinants of bone status in healthy young and middle-aged men.

    METHODS: Anthropometric measurements, all-site bone mineral density (BMD) and body composition parameters assessed by dual-energy X-ray absorptiometry and also serum concentrations of
    (1) the adipokines leptin and resistin,
    (2) vitamin D and parathormone (PTH),
    (3) sex hormone binding globulin (SHBG), total testosterone and estradiol (free testosterone was also calculated) and
    (4) C-terminal telopeptide of type I collagen (CTx)
    were obtained from 30 apparently healthy male volunteers aged 20-65 years enrolled in this cross-sectional study.

    RESULTS: Only lean mass (LM) and total estradiol independently predicted BMD in men in multiple regression analysis, together explaining 49% (p </= 0.001) of whole-body BMD variance. Hierarchical regression analysis with whole-body BMD as outcome variable demonstrated that the body mass index (BMI) beta coefficient became nonsignificant when LM was added to the model. Adipokines, fat parameters, testosterone (total and free), SHBG, PTH and vitamin D were not independently associated with BMD or CTx.

    CONCLUSIONS: The present study shows that LM and sex hormones-namely estradiol-are the main determinants of bone mass in young and middle-aged men. The effects of BMI upon BMD seem to be largely mediated by LM. Lifestyle interventions should focus on preserving LM in men for improved bone outcomes.

    Bilha SC, Branisteanu D, Buzduga C, et al. Body composition and circulating estradiol are the main bone density predictors in healthy young and middle-aged men. Journal of endocrinological investigation 2018. Body composition and circulating estradiol are the main bone density predictors in healthy young and middle-aged men
     
  4. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    testosterone and Male Osteoporosis

    Male osteoporosis is not a rare public health issue. The prevalence of hypogonadism increases with aging, and the gradual onset of moderate hypogonadism is the most common cause of male osteoporosis.

    Decreased testosterone levels with aging can directly or indirectly increase the risk of male osteoporosis and fractures. However, testosterone deficiency is not a universal feature of elderly men, and the association of testosterone with osteoporosis is not as strong as that of estrogen with osteoporosis in females; the effect of testosterone on male osteoporosis and treatment of osteoporosis is still controversial.

    Although many data and results have been released, the mechanism by which testosterone affects bone formation and resorption is not fully understood yet. Therefore, this review aims to present current knowledge about testosterone and male osteoporosis.

    Shin D-E, Ahn T-K, Kim J-W, Oh C-H, Choi S. Testosterone and Male Osteoporosis. Clinical Reviews in Bone and Mineral Metabolism 2018. https://doi.org/10.1007/s12018-018-9245-0
     

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