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Testosterone supplementation provides additional BMD gains in hypogonadal men following cardiac transplantation: Presented at ASBMR
By Patrice Olson
Special to DG News
SAN ANTONIO, TX -- September 23, 2002 -- Testosterone supplementation provides additional gains in bone mineral density (BMD) among hypogondal men already receiving intravenous (IV) ibandronate following cardiac transplantation, according to research presented at the 24th annual meeting of the American Society for Bone and Mineral Research.
Dr. Astrid Fahrleitner and colleagues from the Karl-Franzen University, Graz, Austria note that hypogonadism is a frequent complication of immunosuppression in these patients. They initially treated 41 patients, mean age 56 years, with intravenous ibandronate, 2 mg, every three months, along with 1200 mg of calcium and 800 IU vitamin D a day.
"We then evaluated the effects of testosterone supplementation in addition to intermittent intravenous bisphosphonates on bone metabolism," investigators observe. Ten men in the hypogondal group received additional testosterone replacement at a dose of 250 mg intramuscularly every four to six weeks.
DEXA measurements were done at baseline and one year after treatment had been initiated.
"Taken together as a group, we observed a significant increase in BMD of 6 percent of the femoral neck as well as the trochanteric region," investigators report. Looking at the subgroups of patients, they also observed that increases in BMD with ibandronate alone at 3 to 4 percent among hypogondal men was comparable to that observed in eugonadal men, they add.
However, hypogonadal men who received additional testosterone supplementation showed the largest increases in BMD ranging from 13 to 17 percent, which was significantly greater than for either hypogondal men who did not received additional testosterone and eugonadal men who received IV ibandronate alone.
"IV ibandronate by itself seems to enhance bone mass and normalize bone turnover markers even in patients requiring on-going triple immunosuppressive therapy," the group observe. "But testosterone replacement conferred additional benefits with respect to significant bone mass gains and further reduction in bone turnover."
In an interview with Doctors Guide, Dr. Fahrleitner noted that patients included in this study were about 14 months post-transplant, so that they were at a stage where it is generally believed they are not at risk for low BMD.
"But nearly all of the patients had elevated bone turnover, so I don't think it's enough to take care of patients during the first few months following transplantation because the longer they have to take immunosuppressive drugs, the higher the risk they will develop hypogonadism and this leads to further fracture risk," she said.
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