ECTS2013 Oral Communications Treatment of osteoporosis (6 abstracts)
Testosterone replacement has a substantial benefit on bone mass, fracture incidence, libido, and sexual activities in male cardiac transplant patients: a 5-year randomized prospective controlled trial
Doris Wagner 1 , Guenther Prenner 1 , Harald Dobnig 2 , Hans Peter Dimai 2 , Thomas Pieber 2 , Stefan Pilz 2 , Andreas Tomaschitz 3 , Karin Amrein 2 & Astrid Fahrleitner-Pammer 2
1Division of Transplantation Surgery, Department of Surgery, Graz, Austria; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Graz, Austria; 3Division of Cardiology, Department of Internal Medicine, Graz, Austria.
Hypogonadism is common in cardiac transplant (CTX) patients and exerts negative effects on bone but also on libido and quality of life.
We investigated whether testosterone replacement therapy (TRT) has any positive effects on bone mass, fracture incidence, and quality of sex life when administered in addition to ibandronate (IBN) in hypogonadal CTX recipients. 52 male patients entered the study and received IBN (quarterly 2 μg i.v.). 60% of the patients were hypogonadal and were randomized to receive an additional testosterone therapy or IBN treatment only. At baseline, hypogonadal patients had considerably lower Z-score values at the femoral neck (−1.54 vs 0.15 S.D) and total hip (−1.34 vs 0.01 S.D; all P<0.0001) and more prevalent vertebral fractures (63 vs 14%, P<0.0003) when compared to patients with normal gonadal function. After 5 years of IBN, BMD (bone mineral density) had increased in all patients; however, hypogonadal patients with additional TRT showed a significantly higher increase (femoral neck from 12.4 to 16.4%, trochanteric region from 10.2 to 14.7%, total hip from 9.2% after 1 year to 12.4% after 5 years of therapy; all P<0.001) when compared to eugonadal patients and unreplaced hypogonadal patients. Fracture incidence was significantly lower in patients receiving TRT (P< 0.001) compared to only IBN treated patients..
At baseline, 77% of the hypogonadal patients indicated a loss of libido and an average of seven annual sexual activities (27% of eugonadal men, P<0.005 with 15 sexual activities P<0.005). Patients with TRT reported an increase in sexual activities after 1 year (29±8; P<0.0001) and 5 years (25±9; P<0.0005). No changes in sexual behavior were reported by the other groups.
Hypogonadism has a deleterious effect on bone health in transplant patients. IBN therapy increases BMD in CTX patients on immunosuppressive treatment independently of gonadal status. Hypogonadal patients benefit from additional TRT over 5 years with respect to bone mass, fracture rate as well as quality of life. This is the first study that showed IBN in combination with TRT as a safe and well tolerated treatment in CTX patients with osteoporosis.
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Bone Abstracts
ISSN 2052-1219 (online)
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