1
|
Loncar G, Cvetinovic N, Lainscak M, Isaković A, von Haehling S. Bone in heart failure. J Cachexia Sarcopenia Muscle 2020; 11:381-393. [PMID: 32087616 PMCID: PMC7113538 DOI: 10.1002/jcsm.12516] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
There is an increasing interest in osteoporosis and reduced bone mineral density affecting not only post-menopausal women but also men, particularly with coexisting chronic diseases. Bone status in patients with stable chronic heart failure (HF) has been rarely studied so far. HF and osteoporosis are highly prevalent aging-related syndromes that exact a huge impact on society. Both disorders are common causes of loss of function and independence, and of prolonged hospitalizations, presenting a heavy burden on the health care system. The most devastating complication of osteoporosis is hip fracture, which is associated with high mortality risk and among those who survive, leads to a loss of function and independence often necessitating admission to long-term care. Current HF guidelines do not suggest screening methods or patient education in terms of osteoporosis or osteoporotic fracture. This review may serve as a solid base to discuss the need for bone health evaluation in HF patients.
Collapse
Affiliation(s)
- Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany
| | - Natasa Cvetinovic
- Department of Cardiology, University Clinical Hospital Center 'Dr. Dragisa Misovic-Dedinje', Belgrade, Serbia
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| |
Collapse
|
2
|
Abstract
The use of exogenous testosterone to treat hypogonadism in the men with a history of prostate cancer (CaP) remains controversial due to fears of cancer recurrence or progression. Due to the detrimental impact of hypogonadism on patient quality of life, recent work has examined the safety of testosterone therapy (TTh) in men with a history of CaP. In this review, we evaluate the literature with regards to the safety of TTh in men with a history of CaP. TTh results in improvements in quality of life with little evidence of biochemical recurrence or progression in men with a history of CaP, or de novo cancer in unaffected men. An insufficient amount of evidence is currently available to truly demonstrate the safe use of TTh in men with low risk CaP. In men with high-risk cancer, more limited data suggest that TTh may be safe, but these findings remain inconclusive. Despite the historic avoidance of TTh in men with a history of CaP, the existing body of evidence largely supports the safe and effective use of testosterone in these men, although additional study is needed before unequivocal safety can be demonstrated.
Collapse
Affiliation(s)
- Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA;; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
3
|
Nguyen TM, Pastuszak AW. Testosterone Therapy Among Prostate Cancer Survivors. Sex Med Rev 2016; 4:376-88. [PMID: 27474995 PMCID: PMC5026903 DOI: 10.1016/j.sxmr.2016.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The use of testosterone in men with a history of prostate cancer remains controversial in light of established findings linking androgens to prostate cancer growth. However, hypogonadism significantly affects quality of life and has negative sequelae, and the risks and benefits of testosterone therapy might be worthwhile to consider in all men, even those with a history of high-risk prostate cancer. AIM To discuss the effects of testosterone on the prostate and the use of testosterone therapy in hypogonadal men with a history of prostate cancer. METHODS Review of the literature examining the effects of testosterone on the prostate and the efficacy and safety of exogenous testosterone in men with a history of prostate cancer. MAIN OUTCOME MEASURES Summary of effects of exogenous and endogenous testosterone on prostate tissue in vitro and in vivo, with a focus on effects in men with a history of prostate cancer. RESULTS Testosterone therapy ameliorates the symptoms of hypogonadism, decreases the risk for its negative sequelae, and can significantly improve quality of life. Recent studies do not support an increased risk for de novo prostate cancer, progression of the disease, or biochemical recurrence in hypogonadal men with a history of non-high-risk prostate cancer treated with testosterone therapy. Evidence supporting the use of testosterone in the setting of high-risk prostate cancer is less clear. CONCLUSION Despite the historical reluctance toward the use of testosterone therapy in men with a history of prostate cancer, modern evidence suggests that testosterone replacement is a safe and effective treatment option for hypogonadal men with non-high-risk prostate cancer. Additional work to definitively demonstrate the efficacy and safety of testosterone therapy in men with prostate cancer is needed, and persistent vigilance and surveillance of treated men remains necessary.
Collapse
Affiliation(s)
| | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
4
|
Buscarini M, Cardi A. RETRACTED ARTICLE: Importance of hypogonadism and testosterone replacement therapy in current urologic practice: a review. Int Urol Nephrol 2015. [DOI: 10.1007/s11255-010-9717-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
5
|
Leung KMYB, Alrabeeah K, Carrier S. Update on Testosterone Replacement Therapy in Hypogonadal Men. Curr Urol Rep 2015; 16:57. [DOI: 10.1007/s11934-015-0523-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
6
|
Aluoch AO, Jessee R, Habal H, Garcia-Rosell M, Shah R, Reed G, Carbone L. Heart failure as a risk factor for osteoporosis and fractures. Curr Osteoporos Rep 2012; 10:258-69. [PMID: 22915207 DOI: 10.1007/s11914-012-0115-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although heart failure (HF) and osteoporosis are common diseases, particularly in elderly populations, patients with HF have an increased risk for osteoporosis. The relationship of HF with osteoporosis is modified by gender and the severity of HF. In addition, shared risk factors, medication use, and common pathogenic mechanisms affect both HF and osteoporosis. Shared risk factors for these 2 conditions include advanced age, hypovitaminosis D, renal disease, and diabetes mellitus. Medications used to treat HF, including spironolactone, thiazide diuretics, nitric oxide donors, and aspirin, may protect against osteoporosis. In contrast, loop diuretics may make osteoporosis worse. HF and osteoporosis appear to share common pathogenic mechanisms, including activation of the renin-angiotensin-aldosterone system, increased parathyroid hormone levels, and/or oxidative/nitrosative stress. HF is a major risk factor for mortality following fractures. Thus, in HF patients, it is important to carefully assess osteoporosis and take measures to reduce the risk of osteoporotic fractures.
Collapse
Affiliation(s)
- Aloice O Aluoch
- Department of Medicine, University of TN Health Science Center, Memphis, 38163, USA
| | | | | | | | | | | | | |
Collapse
|
7
|
Hellstrom WJG, Paduch D, Donatucci CF. Importance of hypogonadism and testosterone replacement therapy in current urologic practice: a review. Int Urol Nephrol 2010; 44:61-70. [DOI: 10.1007/s11255-010-9879-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 11/10/2010] [Indexed: 11/29/2022]
|
8
|
Stanworth RD, Jones TH. Testosterone for the aging male; current evidence and recommended practice. Clin Interv Aging 2008; 3:25-44. [PMID: 18488876 PMCID: PMC2544367 DOI: 10.2147/cia.s190] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
An international consensus document was recently published and provides guidance on the diagnosis, treatment and monitoring of late-onset hypogonadism (LOH) in men. The diagnosis of LOH requires biochemical and clinical components. Controversy in defining the clinical syndrome continues due to the high prevalence of hypogonadal symptoms in the aging male population and the non-specific nature of these symptoms. Further controversy surrounds setting a lower limit of normal testosterone, the limitations of the commonly available total testosterone result in assessing some patients and the unavailability of reliable measures of bioavailable or free testosterone for general clinical use. As with any clinical intervention testosterone treatment should be judged on a balance of risk versus benefit. The traditional benefits of testosterone on sexual function, mood, strength and quality of life remain the primary goals of treatment but possible beneficial effects on other parameters such as bone density, obesity, insulin resistance and angina are emerging and will be reviewed. Potential concerns regarding the effects of testosterone on prostate disease, aggression and polycythaemia will also be addressed. The options available for treatment have increased in recent years with the availability of a number of testosterone preparations which can reliably produce physiological serum concentrations.
Collapse
Affiliation(s)
- Roger D Stanworth
- Centre of Diabetes and Endocrinology, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom
| | | |
Collapse
|
9
|
Becerra Fernández A, Enríquez Acosta L. Documento básico de consenso sobre el síndrome de hipogonadismo de inicio tardío. ACTA ACUST UNITED AC 2008; 55:5-28. [DOI: 10.1016/s1575-0922(08)70632-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 10/15/2007] [Indexed: 12/25/2022]
|
10
|
Higuchi RI, Thompson AW, Chen JH, Caferro TR, Cummings ML, Deckhut CP, Adams ME, Tegley CM, Edwards JP, López FJ, Kallel EA, Karanewsky DS, Schrader WT, Marschke KB, Zhi L. Potent, nonsteroidal selective androgen receptor modulators (SARMs) based on 8H-[1,4]oxazino[2,3-f]quinolin-8-ones. Bioorg Med Chem Lett 2007; 17:5442-6. [PMID: 17703938 PMCID: PMC2739385 DOI: 10.1016/j.bmcl.2007.07.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 07/09/2007] [Accepted: 07/10/2007] [Indexed: 10/23/2022]
Abstract
A series of androgen receptor modulators based on 8H-[1,4]oxazino[2,3-f]quinolin-8-ones was synthesized and evaluated in an androgen receptor transcriptional activation assay. The most potent analogues from the series exhibited single-digit nanomolar potency in vitro. Compound 18h demonstrated full efficacy in the maintenance of muscle weight, at 10 mg/kg, with reduced activity in prostate weight in an in vivo model of androgen action.
Collapse
Affiliation(s)
- Robert I Higuchi
- Discovery Research, Ligand Pharmaceuticals, 10275 Science Center Drive, San Diego, CA 92121, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Higuchi RI, Arienti KL, López FJ, Mani NS, Mais DE, Caferro TR, Long YO, Jones TK, Edwards JP, Zhi L, Schrader WT, Negro-Vilar A, Marschke KB. Novel series of potent, nonsteroidal, selective androgen receptor modulators based on 7H-[1,4]oxazino[3,2-g]quinolin-7-ones. J Med Chem 2007; 50:2486-96. [PMID: 17439112 DOI: 10.1021/jm061329j] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent interest in orally available androgens has fueled the search for new androgens for use in hormone replacement therapy and as anabolic agents. In pursuit of this, we have discovered a series of novel androgen receptor modulators derived from 7H-[1,4]oxazino[3,2-g]quinolin-7-ones. These compounds were synthesized and evaluated in competitive binding assays and an androgen receptor transcriptional activation assay. A number of compounds from the series demonstrated single-digit nanomolar agonist activity in vitro. In addition, lead compound (R)-16e was orally active in established rodent models that measure androgenic and anabolic properties of these agents. In this assay, (R)-16e demonstrated full efficacy in muscle and only partially stimulated the prostate at 100 mg/kg. These data suggest that these compounds may be utilized as selective androgen receptor modulators or SARMs. This series represents a novel class of compounds for use in androgen replacement therapy.
Collapse
Affiliation(s)
- Robert I Higuchi
- Discovery Research, Ligand Pharmaceuticals, Inc., 10275 Science Center Drive, San Diego, California 92121, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Aksglaede L, Andersson AM, Jørgensen N, Jensen TK, Carlsen E, McLachlan RI, Skakkebaek NE, Petersen JH, Juul A. Primary testicular failure in Klinefelter's syndrome: the use of bivariate luteinizing hormone-testosterone reference charts. Clin Endocrinol (Oxf) 2007; 66:276-81. [PMID: 17223999 DOI: 10.1111/j.1365-2265.2006.02722.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The diagnosis of androgen deficiency is based on clinical features and confirmatory low serum testosterone levels. In early primary testicular failure, a rise in serum LH levels suggests inadequate androgen action for the individual's physiological requirements despite a serum testosterone level within the normal range. The combined evaluation of serum LH and testosterone levels in the evaluation of testicular failure has not been widely advocated. PATIENTS Seven hundred and six healthy males and 39 patients with known primary hypogonadism due to Klinefelter's syndrome and SRY-positive 46,XX karyotypes were included in the study. DESIGN Testosterone, oestradiol and LH serum concentrations were measured in all individuals. Based on the 706 healthy males two-dimensional bivariate LH-testosterone reference charts were constructed. RESULTS Despite a median serum total and free testosterone and oestradiol levels being reduced (P < 0.001) and LH levels elevated (P < 0.001) in Klinefelter's syndrome and 46,XX-males, many subjects (69%) had total testosterone within the reference range. However, using the bivariate charts all subjects lay outside the 97.5 percentile. CONCLUSION Bivariate LH and testosterone charts are useful in the evaluation of men with known primary testicular failure due to sex chromosomal aneuploidy in whom evaluation based on testosterone measurement in isolation underestimates the prevalence of hypogonadism. It is, however, important to emphasize that isolated use of the bivariate evaluation should not form the basis for androgen substitution therapy. Further studies are needed in order to evaluate the use of bivariate LH and testosterone charts in the assessment of any younger man with possible primary testicular failure.
Collapse
Affiliation(s)
- Lise Aksglaede
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
van Oeveren A, Motamedi M, Mani NS, Marschke KB, López FJ, Schrader WT, Negro-Vilar A, Zhi L. Discovery of 6-N,N-Bis(2,2,2-trifluoroethyl)amino- 4-trifluoromethylquinolin-2(1H)-one as a Novel Selective Androgen Receptor Modulator. J Med Chem 2006; 49:6143-6. [PMID: 17034117 DOI: 10.1021/jm060792t] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The androgen receptor is a member of the extended family of nuclear receptors and is widely distributed throughout the body. Androgen therapy is used to compensate for low levels of the natural hormones testosterone (T) and dihydrotestosterone and consists of administration of T, prodrugs thereof, or synthetic androgens. However, currently available androgens have many drawbacks. We identified 6-dialkylamino-4-trifluoromethylquinolin-2(1H)-ones as orally available tissue-selective androgen receptor modulators.
Collapse
Affiliation(s)
- Arjan van Oeveren
- Discovery Research, Ligand Pharmaceuticals Inc., 10275 Science Center Drive, San Diego, California 92121, USA.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Fuente A, Reyes M, Alvarez YM, Ruiz JA, Vélez H, Viñas-Bravo O, Montiel-Smith S, Meza-Reyes S, Sandoval-Ramírez J. 1H and 13C NMR spectral assignment of androstane derivatives. MAGNETIC RESONANCE IN CHEMISTRY : MRC 2005; 43:676-8. [PMID: 15937975 DOI: 10.1002/mrc.1605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
(1)H and (13)C NMR spectroscopic data for 5alpha-androstanes and halo-5alpha-androstanes with different substituents at positions C-3, C-9, C-11 and C-17 were examined and assigned by a combination of 1D and 2D NMR experiments. The substituent effects on the (13)C chemical shifts were compared with those of epi-androsterone, used as a reference compound. The coupling constants (n)J((19)F,(13)C) were measured for compounds 6, 8, 11 and 14.
Collapse
Affiliation(s)
- Ariadna Fuente
- Centro de Química Farmacéutica, Apartado Postal 16042, Ciudad de La Habana, Cuba
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Aminorroaya A, Kelleher S, Conway AJ, Ly LP, Handelsman DJ. Adequacy of androgen replacement influences bone density response to testosterone in androgen-deficient men. Eur J Endocrinol 2005; 152:881-6. [PMID: 15941928 DOI: 10.1530/eje.1.01920] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Androgen deficiency (AD) leads to bone loss and contributes to osteoporotic fractures in men. Although low bone mineral density (BMD) in AD men is improved by testosterone replacement, the responses vary between individuals but the determinants of this variability are not well defined. DESIGN AND METHODS Retrospective review of dual energy X-ray absorptiometry (DEXA) of the lumbar spine and proximal femur in men with established AD requiring regular androgen replacement therapy (ART). After a DEXA scan all men were treated with testosterone implants (800 mg, approximately 6 month intervals). Patients were classified as having a congenital, childhood, or post-pubertal onset, as well as according to the adequacy of treatment prior to their first DEXA scan as untreated, partially treated or well treated. RESULTS Men with AD requiring regular ART (n = 169, aged 46.3+/-1.1 years, range 22-84 years) underwent a DEXA scan prior to being treated with testosterone implants (800 mg, approximately 6 month intervals). In cross-sectional analysis at the time of the first DEXA scan untreated men (n = 24) had significantly reduced age-adjusted BMD at all four sites (L1-L4, femoral neck, Ward's triangle and trochanter). Well-treated men (n = 77) had significantly better age-adjusted BMD at all four sites compared with those who were partially treated (n = 66) or untreated (n = 24) with their age-adjusted BMD being normalized. In a longitudinal assessment of men (n = 60) who had two or more serial DEXA scans, at the second DEXA scan after a median of 3 years, men who were previously partially treated (n = 19) or untreated (n = 11) had proportionately greater improvements in BMD, significantly for Ward's triangle (P = 0.025) and the trochanter (P = 0.044) compared with men (n = 30) previously well treated. CONCLUSIONS The present study demonstrates a positive relationship between adequacy of testosterone replacement and BMD in men with overt organic AD. Additionally, the BMD of well-treated AD men approximates that of age-matched non-AD controls. The greatest BMD gains are made by those who have been either untreated or partially treated, and optimal treatment over time (median 3 years) normalizes BMD to the level expected for healthy men of the same age.
Collapse
Affiliation(s)
- Ashraf Aminorroaya
- Department of Andrology, Concord Hospital and ANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, Australia
| | | | | | | | | |
Collapse
|
16
|
Lunenfeld B, Saad F, Hoesl CE. ISA, ISSAM and EAU recommendations for the investigation, treatment and monitoring of late-onset hypogonadism in males: scientific background and rationale. Aging Male 2005; 8:59-74. [PMID: 16096160 DOI: 10.1080/13685530500163416] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Prescription sales for testosterone products have substantially increased over the last several years reflecting the growing awareness of physicians for the potential benefits of testosterone replacement therapy in men with hypogonadism. Indiscriminate administration of testosterone poses a risk and has to be deprecated. Testosterone supplementation to treat late-onset hypogonadism (LOH), a term for androgen deficiency in elderly men, is still controversially discussed mainly due to a lack of large, controlled clinical trials on efficacy and safety. To provide guidance for physicians primarily dealing with aging men, ISSAM is periodically updating and publishing its recommendations as new data become available [Morales A, Lunenfeld B. International Society for the Study of the Aging Male. Investigation, treatment and monitoring of late-onset hypogonadism in males. Official recommendations of ISSAM. International Society for the Study of the Aging Male. Aging Male 2002;5:74-86 and Morales A, Lunenfeld B. Androgen replacement therapy in aging men with secondary hypogonadism. Draft recommendations for endorsement by ISSAM. Aging Male 2001;4:1]. Following a panel discussion at the 4th ISSAM Congress in Prague in February 2004, the International Society of Andrology (ISA), the International Society for the Study of the Aging Male (ISSAM) and the European Association of Urology (EAU) revised existing recommendations on the definition, diagnosis and management of LOH. The recommendations are based on the currently available scientific data on androgen supplementation therapy and should be regarded as provisional until larger-scale, long-term studies are available. While certainly not intending to be exhaustive, this review will highlight some relevant background information and provide the underlying scientific rationale for the ISA, ISSAM and EAU recommendations on LOH published in this issue.
Collapse
Affiliation(s)
- B Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | | | | |
Collapse
|
17
|
Abstract
The gradual reductions in bone mass and skeletal calcium density seen throughout adulthood occur in parallel with changes in the production of bioactive sex hormones in both men and women. The long-held belief that osteoporosis is dependent on androgens in men and estrogens in women has been challenged by recent reports of osteoporosis in young men with normal testosterone levels but extremely low estrogen levels. A review of the literature indicates that estrogens have a far greater influence on bone mass than do androgens. This may suggest new approaches to the treatment of male osteoporosis. Furthermore, osteoporosis induced by prostate cancer treatment should receive greater medical attention.
Collapse
Affiliation(s)
- Christian Alexandre
- Research Unit Inserm U366, Service de Rhumatologie, St-Etienne University, Hôpital Bellevue, CHU de St-Etienne, Boulevard Pasteur, 42055 St Etienne, France.
| |
Collapse
|
18
|
Cook CE, Kepler JA. 7α,11β-Dimethyl-19-nortestosterone: a potent and selective androgen response modulator with prostate-sparing properties. Bioorg Med Chem Lett 2005; 15:1213-6. [PMID: 15686944 DOI: 10.1016/j.bmcl.2004.11.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2004] [Revised: 11/23/2004] [Accepted: 11/30/2004] [Indexed: 10/26/2022]
Abstract
7alpha,11beta-Dimethyl-19-nortestosterone, made by 1,6-methyl addition to 17beta-acetoxy-11beta-methylestra-4,6-dien-3-one, was a highly potent and selective androgen response modulator, with enhanced androgen receptor binding, androgenic activity and anabolic:androgenic ratio over its two monomethyl homologs.
Collapse
Affiliation(s)
- C Edgar Cook
- Organic and Medicinal Chemistry, Science and Engineering Group, Research Triangle Institute, PO Box 12194, Research Triangle Park, NC 27709, USA.
| | | |
Collapse
|
19
|
Blain H. L'ostéoporose masculine: épidémiologie, physiopathologie, diagnostic, prévention et traitement. Rev Med Interne 2004; 25 Suppl 5:S552-9. [PMID: 15841947 DOI: 10.1016/s0248-8663(04)80054-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE This article reviews the most current information about epidemiology, risk factors, diagnosis, prevention and management of male osteoporosis. MAIN POINTS Although osteoporosis is often regarded as a disease of women, 30% of osteoporotic fractures occur in men. Risk factors for osteoporosis or fractures in men include previous fragility fractures, maternal history of fragility fracture, hypogonadism, low body mass index, smoking, high alcohol consumption, low calcium intake, corticoid therapy, physical inactivity, and the presence of conditions such as hyperthyroidism, hyperparathyroidism, hypercalciuria or chronic inflammatory diseases. Treatment of osteoporosis is recommended in men aged > 65 years with low bone mass (T-score < -2.5), in men aged 50 to 65 years with low bone mass and at least one risk factor for osteoporosis or fracture, in men aged < 50 years with Z-score < -2 with at least one risk factor for osteoporosis or fracture and in men with at least two fragility fractures. FUTURE ASPECTS Further studies are needed to better estimate the benefit of of bisphophonates in the prevention of glucocorticoid-induced osteoporosis and the prevention of androgen-deprivation therapy (treatment of prostate cancer) in men at high-risk for osteoporosis, of parathyroid hormone (1-34) in male primary osteoporosis, and of androgen therapy in men with symptoms (including low bone mineral density) and biological signs (with low blood free testosterone levels) of hypogonadism.
Collapse
Affiliation(s)
- H Blain
- Centre de prévention et de traitement des maladies du vieillissement Antonin-Balmès, CHU de Montpellier, 39, avenue Charles-Flahault, 34295 Montpellier 5, France.
| |
Collapse
|