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Bones and Crohn's: estradiol deficiency in men with Crohn's disease is not associated with reduced bone mineral density.
BMC Gastroenterol 2008; 8:48BG

Abstract

BACKGROUND

Reduced bone mineral density (BMD) and osteoporosis are frequent in Crohn's disease (CD), but the underlying mechanisms are still not fully understood. Deficiency of sex steroids, especially estradiol (E2), is an established risk factor in postmenopausal osteoporosis.

AIM

To assess if hormonal deficiencies in male CD patients are frequent we investigated both, sex steroids, bone density and bone metabolism markers.

METHODS

111 male CD patients underwent osteodensitometry (DXA) of the spine (L1-L4). Disease related data were recorded. Disease activity was estimated using Crohn's disease activity index (CDAI). Testosterone (T), dihydrotestosterone (DHT), estradiol (E2), sex hormone binding globulin (SHBG), Osteocalcin and carboxyterminal cross-linked telopeptids (ICTP) were measured in 111 patients and 99 age-matched controls.

RESULTS

Patients had lower T, E2 and SHBG serum levels (p < 0.001) compared to age-matched controls. E2 deficiency was seen in 30 (27.0%) and T deficiency in 3 (2.7%) patients but only in 5 (5.1%) and 1 (1%) controls. Patients with E2 deficiency had significantly decreased T and DHT serum levels. Use of corticosteroids for 3 of 12 months was associated with lower E2 levels (p < 0.05). Patients with life-time steroids >10 g had lower BMD. 32 (28.8%) patients showed osteoporosis, 55 (49.5%) osteopenia and 24 (21.6%) had normal BMD. Patients with normal or decreased BMD showed no significant difference in their hormonal status. No correlation between markers of bone turnover and sex steroids could be found. ICTP was increased in CD patients (p < 0.001), and patients with osteoporosis had higher ICTP levels than those with normal BMD.

CONCLUSION

We found an altered hormonal status--i.e. E2 and, to a lesser extent T deficiency--in male CD patients but failed to show an association to bone density or markers of bone turnover. The role of E2 in the negative skeletal balance in males with CD, analogous to E2 deficiency in postmenopausal females, deserves further attention.

Authors+Show Affiliations

University of Ulm, Department of Internal Medicine I, Robert Koch Str, 8, 89081 Ulm, Germany. jochen.klaus@uniklinik-ulm.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18947388

Citation

Klaus, J, et al. "Bones and Crohn's: Estradiol Deficiency in Men With Crohn's Disease Is Not Associated With Reduced Bone Mineral Density." BMC Gastroenterology, vol. 8, 2008, p. 48.
Klaus J, Reinshagen M, Adler G, et al. Bones and Crohn's: estradiol deficiency in men with Crohn's disease is not associated with reduced bone mineral density. BMC Gastroenterol. 2008;8:48.
Klaus, J., Reinshagen, M., Adler, G., Boehm, B., & von Tirpitz, C. (2008). Bones and Crohn's: estradiol deficiency in men with Crohn's disease is not associated with reduced bone mineral density. BMC Gastroenterology, 8, p. 48. doi:10.1186/1471-230X-8-48.
Klaus J, et al. Bones and Crohn's: Estradiol Deficiency in Men With Crohn's Disease Is Not Associated With Reduced Bone Mineral Density. BMC Gastroenterol. 2008 Oct 23;8:48. PubMed PMID: 18947388.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bones and Crohn's: estradiol deficiency in men with Crohn's disease is not associated with reduced bone mineral density. AU - Klaus,J, AU - Reinshagen,M, AU - Adler,G, AU - Boehm,Bo, AU - von Tirpitz,C, Y1 - 2008/10/23/ PY - 2008/05/30/received PY - 2008/10/23/accepted PY - 2008/10/25/pubmed PY - 2008/12/17/medline PY - 2008/10/25/entrez SP - 48 EP - 48 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 8 N2 - BACKGROUND: Reduced bone mineral density (BMD) and osteoporosis are frequent in Crohn's disease (CD), but the underlying mechanisms are still not fully understood. Deficiency of sex steroids, especially estradiol (E2), is an established risk factor in postmenopausal osteoporosis. AIM: To assess if hormonal deficiencies in male CD patients are frequent we investigated both, sex steroids, bone density and bone metabolism markers. METHODS: 111 male CD patients underwent osteodensitometry (DXA) of the spine (L1-L4). Disease related data were recorded. Disease activity was estimated using Crohn's disease activity index (CDAI). Testosterone (T), dihydrotestosterone (DHT), estradiol (E2), sex hormone binding globulin (SHBG), Osteocalcin and carboxyterminal cross-linked telopeptids (ICTP) were measured in 111 patients and 99 age-matched controls. RESULTS: Patients had lower T, E2 and SHBG serum levels (p < 0.001) compared to age-matched controls. E2 deficiency was seen in 30 (27.0%) and T deficiency in 3 (2.7%) patients but only in 5 (5.1%) and 1 (1%) controls. Patients with E2 deficiency had significantly decreased T and DHT serum levels. Use of corticosteroids for 3 of 12 months was associated with lower E2 levels (p < 0.05). Patients with life-time steroids >10 g had lower BMD. 32 (28.8%) patients showed osteoporosis, 55 (49.5%) osteopenia and 24 (21.6%) had normal BMD. Patients with normal or decreased BMD showed no significant difference in their hormonal status. No correlation between markers of bone turnover and sex steroids could be found. ICTP was increased in CD patients (p < 0.001), and patients with osteoporosis had higher ICTP levels than those with normal BMD. CONCLUSION: We found an altered hormonal status--i.e. E2 and, to a lesser extent T deficiency--in male CD patients but failed to show an association to bone density or markers of bone turnover. The role of E2 in the negative skeletal balance in males with CD, analogous to E2 deficiency in postmenopausal females, deserves further attention. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/18947388/Bones_and_Crohn's:_estradiol_deficiency_in_men_with_Crohn's_disease_is_not_associated_with_reduced_bone_mineral_density_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-8-48 DB - PRIME DP - Unbound Medicine ER -