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Skeletal effects of long-term estrogen and testosterone replacement treatment in a man with congenital aromatase deficiency: evidences of a priming effect of estrogen for sex steroids action on bone.
[aromatase deficiency]
The
relative
contribution
of
each
sex
steroid
(
i
.
e
.
estrogen
and
androgen
)
on
bone
in
men
and
the
relationships
among
sex
steroids
and
changes
in
BMD
and
bone
strength
are
still
unknown
.
A
defective
BMD
of
bone
tissue
is
constantly
present
in
men
with
aromatase
deficiency
.
This
study
evaluates
the
effects
of
different
regimens
of
treatment
with
sex
steroids
over
7
.
3
years
follow-up
on
BMD
in
an
adult
man
affected
by
aromatase
deficiency
and
by
a
concomitant
mild
hypogonadism
,
as
previously
described
.
The
aim
of
the
study
is
to
provide
additional
data
on
the
relative
roles
of
androgens
and
estrogens
in
male
bone
metabolism
.
The
effects
of
testosterone
(
T
)
treatment
alone
and
estrogen
(
tE
(
2
)
)
treatment
alone
as
well
as
the
effects
of
the
combined
treatment
with
testosterone
and
estradiol
(
T
plus
tE
(
2
)
)
on
areal
BMD
(
aBMD
)
at
dual-energy
X-
ray
absorptiometry
(
DXA
)
and
the
effects
of
T
plus
tE
(
2
)
on
volumetric
BMD
(
vBMD
)
,
particular
at
cortical
site
,
measured
by
peripheral
quantitative
computed
tomography
(
pQCT
)
,
are
investigated
.
Hormones
and
markers
of
bone
turnover
were
monitored
during
all
phases
of
the
study
.
Treatment
with
tE
(
2
)
normalized
serum
estradiol
,
but
only
the
combined
treatment
with
T
plus
tE
(
2
)
normalized
both
serum
estradiol
and
testosterone
.
Markers
of
bone
turnover
reached
a
pattern
close
to
normality
during
T
plus
tE
(
2
)
.
The
aBMD
was
little
modified
by
T
,
but
increased
more
during
tE
(
2
)
.
T
plus
tE
(
2
)
resulted
in
a
further
increase
in
both
aBMD
at
DXA
and
vBMD
at
pQCT
.
Cortical
thickness
increased
during
T
plus
tE
(
2
)
both
in
radius
and
tibia
.
Only
the
combined
treatment
led
to
optimal
parameters
of
aBMD
suggesting
that
testosterone
needs
estrogens
as
a
permissive
factor
for
a
direct
androgen
anabolic
action
on
bone
in
men
.
Diseases
Validation
Diseases presenting
"relative roles"
symptom
aromatase deficiency
heparin-induced thrombocytopenia
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