Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium.
Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
Rev Endocr Metab Disord. 2022 Dec;23(6):1173-1208. doi: 10.1007/s11154-022-09738-5. Epub 2022 Jul 16.
Osteoporosis does not only affect postmenopausal women, but also ageing men. The burden of disease is projected to increase with higher life expectancy both in females and males. Importantly, osteoporotic men remain more often undiagnosed and untreated compared to women. Sex steroid deficiency is associated with bone loss and increased fracture risk, and circulating sex steroid levels have been shown to be associated both with bone mineral density and fracture risk in elderly men. However, in contrast to postmenopausal osteoporosis, the contribution of relatively small decrease of circulating sex steroid concentrations in the ageing male to the development of osteoporosis and related fractures, is probably only minor. In this review we provide several clinical and preclinical arguments in favor of a 'bone threshold' for occurrence of hypogonadal osteoporosis, corresponding to a grade of sex steroid deficiency that in general will not occur in many elderly men. Testosterone replacement therapy has been shown to increase bone mineral density in men, however data in osteoporotic ageing males are scarce, and evidence on fracture risk reduction is lacking. We conclude that testosterone replacement therapy should not be used as a sole bone-specific treatment in osteoporotic elderly men.
骨质疏松症不仅影响绝经后妇女，也影响老年男性。预计女性和男性的预期寿命延长，疾病负担也将增加。重要的是，与女性相比，男性骨质疏松症的诊断和治疗率仍然较低。性激素缺乏与骨丢失和骨折风险增加有关，循环性激素水平与老年男性的骨密度和骨折风险均相关。然而，与绝经后骨质疏松症不同，循环性激素浓度相对较小的下降对男性骨质疏松症和相关骨折的发展的贡献可能较小。在这篇综述中，我们提供了一些临床和临床前的论据，支持发生性腺功能减退性骨质疏松症的“骨阈值”，这对应于一种通常不会在许多老年男性中发生的性激素缺乏程度。睾酮替代疗法已被证明可增加男性的骨密度，但在骨质疏松症老年男性中的数据有限，且缺乏关于骨折风险降低的证据。我们的结论是，睾酮替代疗法不应作为骨质疏松症老年男性的单一骨特异性治疗方法。
