Tryniszewski Wieslaw, Kamiński Grzegorz, Maziarz Zbigniew, Nowak Michal, Gadzicki Mariusz, Radek Maciej
Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, 113 Zeromskiego Street, 90-549 Lodz, Poland.
Nucl Med Rev Cent East Eur. 2018;21(1):14-19. doi: 10.5603/NMR.a2018.0002. Epub 2018 Jan 10.
Testosterone deficiency in men is characterized by typical symptoms of hypogonadism and negative influence on the preservation of bone mass. In this study, we analysed the relationship between testosterone concentration and bone metabolism. Moreover, we assessed the impact of one-year compensation of testosterone deficiency in elderly men on bone metabolism and bone mineral density. Radioisotopic methods of bone metabolism assessment provide new research opportunities.
Men with total testosterone concentration (TT) ≤ 3 ng/ml were included into this study. Patients with disorders or injuries of bone system, elevated prostate-specific antigen (PSA), enlarged prostate, disorders of thyroid and liver, diabetes mellitus or a history of chemotherapy as well as those treated for a long time with antibiotics were excluded from this study. The results of 50 men aged 57.52 ± 6.71 years obtained before the treatment (I test) and after one year of oral testosterone supplementation (test II) were analysed in this study. The following examinations and analyses were performed: interview and physical examination, orthopaedic, neurological and urological consultations, blood biochemistry, determination of hormones levels, assessment of Testosterone Deficiency Syndrome (TDS), densitometric and radioisotope assessment of bone metabolism. Moreover, radioisotopic index of bone metabolism was calculated. Testosterone therapy with oral preparation Undestor Testo Caps (Organon) containing 40 mg of testosterone lasted for 12 months. Statistical analysis was performed using Statistica 12 and Excel 2010 programs. Correlations between results before and after treatment were analysed.
After 12 months of treatment, testosterone concentration increased by mean 78% and the level of luteinizing hormone (LH) decreased by 62%. TDS index increased from 0.53 ± 0.21 (in test I) to 1.91 ± 0.60 (in test II). After the therapy this index was significantly higher in all men (p < 0.0001). Moreover, BMD was also improved following therapy, however, the difference between test I and II was statistically insignificant. The greatest change was found in case of IBM (Index of Bone Metabolism). We observed a positive correlation between IBM and BMD before treatment (r = 0.7991), however, its strength decreased after one-year therapy (r = 0.6757).
In our opinion, IBM is more sensitive than other methods of the assessment of changes occurring in bone system under the influence of testosterone therapy. The observed changes in IBM were proportional to changes in testosterone concentration. Testosterone level, TDS and radioisotopic assessment of bone metabolism may be used as prognostic and therapeutic factors of osteoporosis and bone fractures in elderly men.
男性睾酮缺乏的特征是性腺功能减退的典型症状以及对骨量维持的负面影响。在本研究中，我们分析了睾酮浓度与骨代谢之间的关系。此外，我们评估了老年男性睾酮缺乏一年的补充对骨代谢和骨密度的影响。骨代谢评估的放射性同位素方法提供了新的研究机会。
本研究纳入总睾酮浓度（TT）≤3 ng/ml的男性。排除有骨骼系统疾病或损伤、前列腺特异性抗原（PSA）升高、前列腺肿大、甲状腺和肝脏疾病、糖尿病或化疗史以及长期使用抗生素治疗的患者。分析了50名年龄在57.52±6.71岁的男性在治疗前（测试I）和口服睾酮补充一年后（测试II）的结果。进行了以下检查和分析：访谈和体格检查、骨科、神经科和泌尿科会诊、血液生化检查、激素水平测定、睾酮缺乏综合征（TDS）评估、骨代谢的密度测定和放射性同位素评估。此外，还计算了骨代谢的放射性同位素指数。使用含40 mg睾酮的口服制剂Undestor Testo Caps（欧加农）进行睾酮治疗持续12个月。使用Statistica 12和Excel 2010程序进行统计分析。分析治疗前后结果之间的相关性。
治疗12个月后，睾酮浓度平均增加78%，促黄体生成素（LH）水平下降62%。TDS指数从0.53±0.21（测试I）增加到1.91±0.60（测试II）。治疗后，该指数在所有男性中均显著升高（p<0.0001）。此外，治疗后骨密度也有所改善，然而，测试I和测试II之间的差异无统计学意义。在骨代谢指数（IBM）方面发现了最大的变化。我们观察到治疗前IBM与骨密度之间呈正相关（r=0.7991），然而，一年治疗后其强度降低（r=0.6757）。
我们认为，IBM比其他评估睾酮治疗影响下骨骼系统发生变化的方法更敏感。观察到的IBM变化与睾酮浓度变化成比例。睾酮水平、TDS和骨代谢的放射性同位素评估可作为老年男性骨质疏松和骨折的预后和治疗因素。
