Golds Gary, Houdek Devon, Arnason Terra
Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8.
Division of Endocrinology and Metabolism, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8.
Int J Endocrinol. 2017;2017:4602129. doi: 10.1155/2017/4602129. Epub 2017 Mar 16.
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.
众所周知，性腺功能减退状态下骨量流失会加速，女性更年期就是性激素影响骨代谢调节的典型例子。我们对明显的男性性腺功能减退的临床和代谢后果以及睾酮水平随年龄更细微的下降对骨质的影响了解不足。虽然更年期和雌激素缺乏是女性骨质疏松的众所周知的危险因素，但男性睾酮水平随年龄下降对骨骼健康的影响却鲜为人知。我们的大部分知识来自对一小部分因原发性或继发性性腺功能减退以及轻度至明显睾酮缺乏而病因各异的男性进行的观察性研究和回顾性分析。本综述旨在介绍目前关于成年男性性腺功能减退对骨代谢影响的知识。将探讨睾酮对骨细胞的直接和间接影响，以及男性骨质疏松症与女性相比在评估方面的重要差异。将总结原发性和继发性性腺功能减退以及老年男性睾酮水平下降对男性骨密度和骨折风险的临床后果。最后，将讨论男性骨质疏松症和性腺功能减退的治疗选择及其疗效。
