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Testosterone replacement in congenital hypogonadotropic hypogonadism maintains bone density but has only limited osteoanabolic effects
Author(s) -
Antonio L.,
Caerels S.,
Jardi F.,
Delaunay E.,
Vanderschueren D.
Publication year - 2019
Publication title -
andrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.947
H-Index - 43
eISSN - 2047-2927
pISSN - 2047-2919
DOI - 10.1111/andr.12604
Subject(s) - medicine , osteopenia , osteoporosis , bone mineral , hypogonadotropic hypogonadism , bone density , lumbar , lumbar vertebrae , testosterone (patch) , surgery , urology , hormone
Background Congenital hypogonadotropic hypogonadism ( CHH ) is a rare condition characterized by complete sex steroid deficiency. Therefore, CHH is a unique human model to study the impact of long‐term testosterone replacement therapy ( TRT ) on bone. Objective In this single‐center retrospective observational study, we assessed the long‐term impact of TRT on femoral and lumbar bone mineral density ( BMD ) in adult CHH men. Methods A total of 25 patients with CHH were included. Femoral and lumbar BMD was assessed by dual‐energy X‐ray absorptiometry ( DEXA ) and reported as T‐scores. In six patients (treatment‐naive group), BMD was measured before start of TRT . The other 19 (pre‐treated group) had received TRT for a median duration of 7 years (range 1–41 years) before first BMD measurement. Results Age at which TRT was started ranged from 12 to 57 years old. Median time between first and last DEXA scan was 11 years (range 2–28). At the first DEXA scan, 83% and 61% of CHH patients had lumbar and femoral osteopenia/osteoporosis, respectively. In the treatment‐naive group, the increase in lumbar T‐score was 2.19 ± 0.13 (mean ± SEM , p < 0.01 between first and last DEXA scan) and 1.47 ± 0.29 at femoral level ( p < 0.001). For the pre‐treated group, the increase in lumbar and femoral T‐score was 0.77 ± 0.17 ( p < 0.001) and 0.19 ± 0.12 ( p = 0.13), respectively. However, lumbar and femoral osteopenia/osteoporosis persisted in 61% and 48% of CHH patients even after several years of continuous TRT . Additionally, BMD clearly decreased in patients who interrupted TRT . Conclusion Despite modest improvement after starting TRT , BMD remains in the osteopenic/osteoporotic range in most patients with CHH . However, prolonged TRT prevents further bone loss, both at lumbar and femoral level.