Additional modalities for therapy of androgenrelated bone loss

To date, testosterone substitution is the only form of therapy that has been systematically evaluated for the treatment of bone loss in male hypogonadism. However, some hypogonadal men may have contraindications to testosterone therapy, especially those with a prostate carcinoma. In addition, in some hypogonadal men, androgen therapy may not be fully sufficient to elevate bone mass into a safe range, which might be especially the case in persons receiving additional glucocorticoid therapy or being afflicted with chronic renal diseases. Thus, in addition to sex steroids, other hormones or substances valuable for maintenance of bone mass can be considered.

For example, the osteoclast-inhibitor alendronate exerts beneficial effects onbone tissue in men with osteoporosis (Orwoll etal. 2000). Also injections of a fragment of PTH, teriparatide (rhPTH1-34), has stimulatory effects on bone formation in men, resulting in significant increase of bone mass (Orwoll et al. 2003). Men suffering from growth hormone deficiency may profit from respective supplementation in regard to maintenance of bone tissue (Baum et al. 1996; Grinspoon et al. 1995; Monson 2003; Ahmad etal. 2003).

It has to be stressed that sufficient supplementation ofvitamin D and calcium to all these bone-protective agents has a measurable effect on their efficacy (Orwoll etal. 2000; 2003; Monson 2003).

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