睾固酮值低的男性 通常骨密度也低


  【24drs.com】新研究認為,睾固酮值低的男性,骨質缺乏症的發生率較高,這些病患也有顯著的骨質疏鬆風險;性腺功能減退的時間越久,風險越大。
  
  紐約Albany醫學中心的Joseph Ellen醫師表示,睪固酮低是男性骨質疏鬆確知的風險因素之一。
  
  Ellen醫師在紐奧良的美國泌尿科協會(AUA)2015年會中表示,不過,令我們驚訝的是,在我們的診所發現骨質缺乏和骨質疏鬆的發生率相當高,特別是這些男性的平均年齡只有約50歲。
  
  所有患者都有臨床的與生化的性腺功能低下,定義是睪固酮值低於300 ng/dL,都使用相同機器進行雙能量x光吸收儀(DEXA)骨骼掃描。
  
  骨質缺乏定義是股骨頸、全髖關節或全脊椎骨的骨質密度T值為-1.0至-2.5;骨質疏鬆定義是骨質密度T值小於等於-2.5。
  
  性腺功能低下的時間的定義是,從初次檢驗指出低睪固酮值的時間、到病患進行DEXA掃描的時間。
  
  研究對象的平均年齡為50.7歲。在該中心治療的235例臨床性腺功能減退患者中,56%有正常的骨密度值,39%為骨質缺乏、5%確實有骨質疏鬆。
  
  此外,性腺功能低下的時間越長,骨密度值異常的可能越高。
  
  Ellen醫師表示,在我們的診所,如果男性睪固酮值低於300 ng/dL,特別是它有低骨質密度的風險因素,如抽菸、長期使用類固醇、糖尿病時,我們認為,就值得進行骨骼掃描。
  
  Ellen醫師表示,重點在於知道這名男性是否有骨質缺乏。特別是那些還算年輕的男性,因為它很可能就會惡化為骨質疏鬆症。
  
  但是,男性的骨質疏鬆沒有被充分研究,沒有良好的前瞻研究確認什麼是最佳治療。
  
  Ellen醫師表示,我們試著增加睪固酮以提升骨骼健康,我們也使用了選擇性雌激素受體調節劑(簡稱SERMS),因為它們也有幫助。此外,我們告訴男性要服用維他命D與鈣,然後,我們通知他們的主要照護提供者,由他們判斷是否適合為這些患者開立雙磷酸鹽。
  
  哈佛醫學院Men's Health Boston的Abraham Morgentaler醫師表示,缺乏睪固酮而引起症狀令男性感到困擾,且與一般健康狀況的擔憂有關,這些都是與睪固酮相關的「諸多爭論」。
  
  這篇新研究重申睾固酮對男性骨骼健康的重要性。
  
  研究中,睪固酮缺乏男性的骨質缺乏發生率高,與Morgentaler醫師參與的另一篇研究結果一致,50歲以下男性中,性腺功能減退的男性有35%發生骨質缺乏,將近3%確實有骨質疏鬆( J Sex Med. 2014;11:1898-902)。
  
  Morgentaler醫師報告指出,我們在Men's Health Boston的執業經驗中,現在已對這些男性例行地進行DEXA影像檢查,因為異常BMD的比率高,藉由睪固酮治療,發現骨質密度有所改善。
  
  他表示,睪固酮缺乏變得這麼政治化是個恥辱,這是真正會影響男性的真實情況。
  
  資料來源: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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