Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy.
Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy.
Endocrine. 2018 Aug;61(2):327-335. doi: 10.1007/s12020-018-1604-6. Epub 2018 Apr 25.
To assess different aspects of bone damage in untreated adult patients with Klinefelter Syndrome (KS) before and during testosterone replacement therapy (TRT).
Fifteen untreated hypogonadal men with KS and 26 control subjects (C) matched for age and BMI were recruited. Sex hormone levels were measured in all subjects. Lumbar spine (LS) and femoral (neck: FN and total hip: TH) bone mineral density (BMD), trabecular bone score (TBS), hip structure analysis (HSA) and fat measures (percentage of fat mass, android/gynoid ratio and visceral adipose tissue) were evaluated by DEXA. In KS patients, blood analysis and DEXA measurements were assessed at baseline and repeated yearly for three years during TRT.
Fat measures were significantly higher in KS than C (p < 0.01). In contrast, mean LS, FN and TH BMD were significantly reduced in KS compared to C (p < 0.01), while there was no difference in TBS. HSA revealed a significantly lower cortical thickness and significantly higher buckling ratio in KS compared to C at all femoral sites (p < 0.01). In KS patients, TRT significantly increased BMD at LS only, but did not improve TBS and HSA parameters. Fat measures were inversely associated with TBS values, and TRT did not influence this relationship.
In untreated hypogonadal men with KS, lumbar and femoral BMD was reduced, and femoral bone quality was impaired. Adiposity seemed to have a detrimental effect on lumbar bone microarchitecture, as indirectly evaluated by TBS. However, TRT failed to remedy these negative effects on bone.
评估未经治疗的克氏综合征（KS）成年男性患者在接受睾丸激素替代治疗（TRT）前后不同方面的骨损伤。
招募了 15 名未经治疗的性腺功能减退的 KS 男性患者和 26 名年龄和 BMI 匹配的对照受试者（C）。所有受试者均测量了性激素水平。通过 DEXA 评估腰椎（LS）和股骨（颈：FN 和总髋：TH）骨密度（BMD）、小梁骨评分（TBS）、髋关节结构分析（HSA）和脂肪测量（脂肪量百分比、安卓/女性比例和内脏脂肪组织）。在 KS 患者中，在基线时进行血液分析和 DEXA 测量，并在 TRT 期间每年重复测量三年。
KS 组的脂肪测量值明显高于 C 组（p<0.01）。相比之下，KS 组的 LS、FN 和 TH BMD 明显低于 C 组（p<0.01），而 TBS 没有差异。HSA 显示 KS 组在所有股骨部位的皮质厚度明显较低，而屈曲比明显较高（p<0.01）。在 KS 患者中，TRT 仅显著增加 LS 的 BMD，但不能改善 TBS 和 HSA 参数。脂肪测量值与 TBS 值呈负相关，TRT 并未影响这种关系。
在未经治疗的性腺功能减退的 KS 男性中，腰椎和股骨 BMD 降低，股骨骨质量受损。肥胖似乎对腰椎骨微结构有不利影响，这可通过 TBS 间接评估。然而，TRT 未能纠正这些对骨骼的负面影响。
