睾酮治疗对体质性青春期延迟男孩骨密度降低的短期影响。

Short-term effect of testosterone treatment on reduced bone density in boys with constitutional delay of puberty.

作者信息

Bertelloni S, Baroncelli G I, Battini R, Perri G, Saggese G

机构信息

Department of Pediatrics, University of Pisa, Italy.

出版信息

J Bone Miner Res. 1995 Oct;10(10):1488-95. doi: 10.1002/jbmr.5650101009.

DOI:10.1002/jbmr.5650101009

PMID:8686504

Abstract

We studied bone mineral content (BMC), bone mineral density (BMD), cortical thickness/total width (CT/TW) ratio and cortical area/total area (CA/TA) ratio in boys with constitutional delay of puberty and the effect of short-term testosterone treatment on bone mass. Seventeen boys (age 13.1-15.8 years) who met the family history and the clinical criteria of constitutional delay of puberty were selected and enrolled in the study. All subjects were eating a diet assuring an adequate intake of calories and calcium. A subset of 8 boys (group A) was treated with testosterone depot (100 mg/month x 6 months) while 9 boys (group B) were not. At inclusion, BMC and BMD were reduced in the patients according to their chronological age (BMC -4.04 +/- 1.34 standard deviation scores [SDS]; BMD -2.95 +/- 0.56 SDS), statural age (BMC -1.75 +/- 0.79 SDS; BMD -1.69 +/- 0.78 SDS), and bone age (BMC -1.80 +/- 0.65 SDS; BMD -1.86 +/- 0.68 SDS). No significant differences between the groups were found (group A: BMC 0.480 +/- 0.57 g/cm, BMD 0.488 +/- 0.037 g/cm2, CT/TW ratio 0.43 +/- 0.4, CA/TA ratio 0.68 +/- 0.04; group B: BMC 0.476 +/- 0.060, p = NS vs. group A; BMD 0.491 +/- 0.036 g/cm2, p = NS vs. group A). At 12 months of follow-up, BMC, BMD, CT/TW ratio, and CA/TA ratio significantly increased in group A (BMC 0.70 +/- 0.13 g/cm, delta +41.1 +/- 28.8%, p < 0.003 vs. 0 month; BMD 0.617 +/- 0.082 g/cm2, delta +26.2 +/- 13.6%, p < 0.005 vs. 0 month; CT/TW ratio 0.52 +/- 0.05, delta +20.59 +/- 10.65%, p < 0.001 vs. 0 month; CA/TA ratio 0.77 +/- 0.05 vs. 0 month; CT/TW ratio 13.60 +/- 6.65%, p < 0.004 vs 0 month), but not in group B (BMC: 0.48 +/- 0.05 g/cm; delta +5.1 7.8%, p = NS vs. 00 month; BMD: 0.492 +/- 0.037 g/cm2; delta +0.54 +/- 8.7%, p = NS vs. 0 month; CT/TW ratio 0.44 +/- 0.04, delta +4.04 +/- 6.75%, p = NS vs. 0 month; CA/TA ratio 0.68 +/- 0.05, delta +2.39 +/- 5.90%, p = NS vs. 0 month). We conclude that boys with constitutional delay of puberty have reduced BMC and BMD. The delay in statural and bone ages did not totally account for the decreased bone mass. Testosterone treatment for 6 months significantly increased BMC, BMD, CT/TW ratio, and CA/TA ratio in these patients, but definitive conclusions on the efficacy of the treatment in improving adult bone mass can be drawn only when our patients reach early childhood.

摘要

我们研究了青春期体质性发育延迟男孩的骨矿物质含量（BMC）、骨矿物质密度（BMD）、皮质厚度/总宽度（CT/TW）比值和皮质面积/总面积（CA/TA）比值，以及短期睾酮治疗对骨量的影响。选取了17名符合青春期体质性发育延迟家族史和临床标准的男孩（年龄13.1 - 15.8岁）纳入本研究。所有受试者的饮食确保了热量和钙的充足摄入。8名男孩组成的A组接受长效睾酮治疗（100mg/月×6个月），而9名男孩组成的B组未接受治疗。入组时，根据实际年龄，患者的BMC和BMD降低（BMC -4.04±1.34标准差评分[SDS]；BMD -2.95±0.56 SDS），根据身高年龄也是如此（BMC -1.75±0.79 SDS；BMD -1.69±0.78 SDS），根据骨龄同样降低（BMC -1.80±0.65 SDS；BMD -1.86±0.68 SDS）。两组之间未发现显著差异（A组：BMC 0.480±0.57g/cm，BMD 0.488±0.037g/cm²，CT/TW比值0.43±0.4，CA/TA比值0.68±0.04；B组：BMC 0.476±0.060，与A组相比p =无显著性差异；BMD 0.491±0.036g/cm²，与A组相比p =无显著性差异）。随访12个月时，A组的BMC、BMD、CT/TW比值和CA/TA比值显著增加（BMC 0.70±0.13g/cm，增量+41.1±28.8%，与0个月相比p < 0.003；BMD 0.617±0.082g/cm²，增量+26.2±13.6%，与0个月相比p < 0.005；CT/TW比值0.52±0.05，增量+20.59±10.65%，与0个月相比p < 0.001；CA/TA比值0.77±0.05与0个月相比；CT/TW比值13.60±6.65%，与0个月相比p < 0.004），但B组未增加（BMC：0.48±0.05g/cm；增量+5.1±7.8%，与0个月相比p =无显著性差异；BMD：0.492±0.037g/cm²；增量+0.54±8.7%，与0个月相比p =无显著性差异；CT/TW比值0.44±0.04，增量+4.04±6.75%，与0个月相比p =无显著性差异；CA/TA比值0.68±0.05，增量+2.39±5.90%，与0个月相比p =无显著性差异）。我们得出结论，青春期体质性发育延迟的男孩BMC和BMD降低。身高和骨龄的延迟并不能完全解释骨量的减少。对这些患者进行6个月的睾酮治疗显著增加了BMC、BMD、CT/TW比值和CA/TA比值，但只有当我们的患者进入成年期时，才能得出关于该治疗改善成年骨量疗效的确切结论。