睾固酮值低的男性 通常骨密度也低


  【24drs.com】新研究认为,睾固酮值低的男性,骨质缺乏症的发生率较高,这些病患也有显著的骨质疏松风险;性腺功能减退的时间越久,风险越大。
  
  纽约Albany医学中心的Joseph Ellen医师表示,睾固酮低是男性骨质疏松确知的风险因素之一。
  
  Ellen医师在纽奥良的美国泌尿科协会(AUA)2015年会中表示,不过,令我们惊讶的是,在我们的诊所发现骨质缺乏和骨质疏松的发生率相当高,特别是这些男性的平均年龄只有约50岁。
  
  所有患者都有临床的与生化的性腺功能低下,定义是睾固酮值低于300 ng/dL,都使用相同机器进行双能量x光吸收仪(DEXA)骨骼扫描。
  
  骨质缺乏定义是股骨颈、全髋关节或全脊椎骨的骨质密度T值为-1.0至-2.5;骨质疏松定义是骨质密度T值小于等于-2.5。
  
  性腺功能低下的时间的定义是,从初次检验指出低睾固酮值的时间、到病患进行DEXA扫描的时间。
  
  研究对象的平均年龄为50.7岁。在该中心治疗的235例临床性腺功能减退患者中,56%有正常的骨密度值,39%为骨质缺乏、5%确实有骨质疏松。
  
  此外,性腺功能低下的时间越长,骨密度值异常的可能越高。
  
  Ellen医师表示,在我们的诊所,如果男性睾固酮值低于300 ng/dL,特别是它有低骨质密度的风险因素,如抽菸、长期使用类固醇、糖尿病时,我们认为,就值得进行骨骼扫描。
  
  Ellen医师表示,重点在于知道这名男性是否有骨质缺乏。特别是那些还算年轻的男性,因为它很可能就会恶化为骨质疏松症。
  
  但是,男性的骨质疏松没有被充分研究,没有良好的前瞻研究确认什么是最佳治疗。
  
  Ellen医师表示,我们试著增加睾固酮以提升骨骼健康,我们也使用了选择性雌激素受体调节剂(简称SERMS),因为它们也有帮助。此外,我们告诉男性要服用维他命D与钙,然后,我们通知他们的主要照护提供者,由他们判断是否适合为这些患者开立双磷酸盐。
  
  哈佛医学院Men's Health Boston的Abraham Morgentaler医师表示,缺乏睾固酮而引起症状令男性感到困扰,且与一般健康状况的担忧有关,这些都是与睾固酮相关的「诸多争论」。
  
  这篇新研究重申睾固酮对男性骨骼健康的重要性。
  
  研究中,睾固酮缺乏男性的骨质缺乏发生率高,与Morgentaler医师参与的另一篇研究结果一致,50岁以下男性中,性腺功能减退的男性有35%发生骨质缺乏,将近3%确实有骨质疏松( J Sex Med. 2014;11:1898-902)。
  
  Morgentaler医师报告指出,我们在Men's Health Boston的执业经验中,现在已对这些男性例行地进行DEXA影像检查,因为异常BMD的比率高,藉由睾固酮治疗,发现骨质密度有所改善。
  
  他表示,睾固酮缺乏变得这么政治化是个耻辱,这是真正会影响男性的真实情况。
  
  资料来源:http://www.24drs.com/
  
  Native link:Men With Low Testosterone Often Have Low Bone Density Too

Men With Low Testosterone Often Have Low Bone Density Too

By Pam Harrison
Medscape Medical News

There is a high incidence of osteopenia in men with low levels of testosterone, and these patients are at significant risk for osteoporosis, new research suggests. And the longer they are hypogonadal, the greater the risk.

"Low testosterone is one of the more established risk factors for osteoporosis in men," said Joseph Ellen, MD, from the Albany Medical Center in New York.

However, "we were surprised that we found such a high incidence of osteopenia and osteoporosis in our clinic, especially because the average age of the men was only about 50 years," Dr Ellen said at the American Urological Association (AUA) 2015 Annual Meeting in New Orleans.

All patients had clinical and biochemical hypogonadism, defined as a testosterone level lower than 300 ng/dL, and all underwent dual-energy x-ray absorptiometry (DEXA) bone scans on the same machine.

Osteopenia was defined as a femoral neck, total hip, or total spine bone mineral density T-score of -1.0 to -2.5; osteoporosis was defined as a bone mineral density T-score of -2.5 or less.

The duration of hypogonadism was defined as the time from the first laboratory test indicating low testosterone to the time the patient underwent the DEXA scan.

Mean age in the cohort was 50.7 years.

Of 235 consecutive patients with clinical hypogonadism treated at the center, 56% had normal bone mineral density levels, 39% were osteopenic, and 5% had frank osteoporosis.

Furthermore, the longer the duration of hypogonadism, the greater the likelihood of normal bone mineral density levels.

"In our clinic, if a man has a testosterone of below 300 ng/dL, especially if he has risk factors for low BMD — including smoking, long-term steroid use, and diabetes — we think it's worthwhile to get a bone scan," said Dr Ellen.

Osteopenia Risk

"It's important to know if a man is osteopenic or not," Dr Ellen told Medscape Medical News. This is particularly true for younger men with years of life ahead of them, "because it's quite possible they will deteriorate into osteoporosis."

"But osteoporosis in men has not been well studied," he added. "There is no good prospective study to determine what the best treatment is."

"We try to get testosterone up to increase bone health, and we also use selective estrogen receptor modifiers, or SERMS, because they help too," said Dr Ellen. In addition, "we tell men to take vitamin D and calcium, then we notify their primary care providers and leave it up to them to start bisphosphonates if they feel it's appropriate."

This new study reaffirms the importance of testosterone for bone health in men Dr Abraham Morgentaler

The fact that testosterone deficiency causes symptoms that are troubling to men and is associated with significant general health concerns has been lost amid all the "recent senseless noise" regarding testosterone, said Abraham Morgentaler, MD, from Harvard Medical School and Men's Health Boston.

"This new study reaffirms the importance of testosterone for bone health in men," he told Medscape Medical News.

The high rates of osteopenia in men with testosterone deficiency seen in this study are consistent with rates in men younger than 50 years seen in a study Dr Morgentaler was involved in, in which 35% of hypogonadal men had osteopenia, and nearly 3% had frank osteoporosis ( J Sex Med. 2014;11:1898-902).

"In our practice at Men's Health Boston, we now routinely obtain DEXA imaging in these men because of the high rate of abnormal BMD, and we regularly see improvements in bone density with testosterone therapy," Dr Morgentaler reported.

"It is a shame that testosterone deficiency has become so politicized. This is a real condition affecting real men," he said.

Dr Ellen and Dr Morgentaler have disclosed no relevant financial relationships.

American Urological Association (AUA) 2015 Annual Meeting. Abstract PD37-09. Presented May 18, 2015.

    
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