Pathogenetically Complicated Case of Osteoporosis in a Young Man
Authors:
I. Žofková
Authors‘ workplace:
Endokrinologický ústav, Praha
Published in:
Čas. Lék. čes. 2008; 147: 574-578
Category:
Case Report
Overview
Osteoporosis, is a serious disease both in women and men, with a high risk of fractures. However, its pathogenesis differs markedly, with the secondary form being more common in men. The aim of this case study is to demonstrate the complex pathogenesis of a severe osteoporosis in a 23-year-old heavy smoker with histiocytosis X, diabetes insipidus (DI), subclinical hypogonadism and low serum levels of IGF-I. Later, after normalization of sex hormones and IGF-I levels, vasopressin substitution, cessation of smoking and after long-term antiresorption therapy, adequate increase in bone density at the hip was documented, but insufficient and very slow increase at the lumbar spine was observed. Severe osteoporosis at the spine is most probably the consequence of the interaction of smoking with multiple hormone insufficiency during development of peak bone mass. The effect of additional, unidentified factor(s) (gene or hormone) is also likely. On the other hand, a direct causal association between histiocytosis X and osteoporosis was not confirmed histomorphometrically in this patient.
Key words:
osteoporosis in men, histiocytosis X, free testosterone, IGF-I, diabetes insipidus, smoking.
Sources
1. Madeo, B., Zirilli, L., Caffagni, G. et al.: The osteoporotic male: overlooked and undermanaged? Clin. Interv. Aging, 2007, 2, s. 305–312.
2. Žofková, I.: Kvantitativní a kvalitativní parametry mužského skeletu ve vztahu k hormonální homeostáze. Osteologický bulletin, 2008, 13, s. 4–7.
3. Rucker, D., Ezzat, S., Diamandi, A. et al.: IGF-I and testosterone levels as predictors of bone mineral density in healthy, community-dwelling men. Clin. Endocrinol. (Oxf), 2004, 60, s. 491–499.
4. Marek J., Hána, V., Kršek, M.: Hypothalamické hypofunkční syndromy. In: Klener, P. et al.: Vnitřní lékařství, Praha, Galén, 2006, s. 903–904.
5. Ghirardello, S., Malattia, C, Scagnelli, P. et al.: Current perspective on the pathogenesis of central diabetes insipidus. J. Pediatr. Endocrinol. Metab., 2005, 18, s. 631–645.
6. Mikami-Terao, Y., Akiyama, M., Yanagisawa, T. et al.: Lymphocytic hypophysitis with central diabetes insipidus and subsequent hypopituitarism masking a suprasellar germinoma in a 13-year-old girl. Childs Nerv. Syst., 2006, 22, s. 1338–1343.
7. Hashimoto, K., Araba, K., Tamura, K. et al.: A case of lymphocytic infundibuloneurohypophysitis associated with systemic lupus erythematosus. Endocr. J., 2002, 49, s. 605–610.
8. Maghnie, M., Ghirardello, S., De Bellis, A. et al.: Idiopathic central diabetes insipidus in children and young adults is commonly associated with vasopressin-cell antibodies and markers of autoimmunity. Clin. Endocrinol. (Oxf), 2007, 65, s. 470–478.
9. Rush, W. L., Andriko, J. A., Galateau-Salle, F. et al.: Pulmonary patology of Erdheim-Chester disease. Mod. Pathol., 2000, 13, s. 747–754.
10. Shamburek, R. D., Brewer, H. B., Jr., Gochuico, B. R.: Erdheim-Chester disease: a rare multisystem histiocytic disorder associated with interstitial lung disease. Am. J. Med. Sci., 2001, 321, s. 66–75.
11. Maghnie, M., Cosi, G., Genovese, E. et al.: Central diabetes insipidus in children and young adults. N. Engl. J. Med., 2000, 343, s. 998–1007.
12. Stull, M.A., Kransdorf, M.J., Devaney, K.O.: Langershans cell histiocytosis of bone. Radiographics, 1992, 12, s. 801–823.
13. Per, H., Koc, K. R., Gümüs, H. et al.: Cervical eosinophilic granuloma and torticollis: a case report and review of the literature. J. Emerg. Med., 2008 (preprint).
14. Rosso, D. A., Ripoli, M. F., Roy, A. et al.: Serum levels of interleukin-1 agonist and tumor necrosis factor-alpha are elevated in children with Langerhans cell histiocytosis. J. Pediatr. Hematol. Oncol., 2003, 25, s. 480–483.
15. Meier, C., Nguyen, T. V., Handelsman, D. J. et al.: Endogenous sex hormones and incident fracture risk in older men: the Dubo Osteoporosis Epidemiology Study. Arch. Intern. Med., 2008, 168, s. 47–54.
16. Lorentzon, M., Swanson, C., Anderson, N. et al.: Free testosterone is a positive, whereas free estradiol is a negative, predictor of cortical bone size in young Swedish men: the GOOD study. J. Miner. Res., 2005, 20, s. 1334–1341.
17. Kuchuk, N. O., van Schoor N. M., Pluijm, S. M. et al.: The association of sex hormone levels with quantitative ultrasound, bone mineral density, bone turnover and osteoporotic fractures in older men and women. Clin. Endocrinol. (Oxf), 2007, 67, s. 295–303.
18. Lormeau, C., Soudan, B., d’Herbomez, M. et al.: Sex hormone-binding globulin, estradiol, and bone turnover markers in male osteoporosis. Bone, 2004, 34, s. 933–939.
19. Araujo, A. B., Travison, T. G., Leder, B. Z. et al.: Correlations between serum testosterone, estradiol, and sex hormone-binding globulin and bone mineral density in a diverse sample of men. J. Clin. Endocrinol. Metab., 2008, 93, s. 2135–2141.
20. Patel, M. B. R., Arden, N. K., Masterson, L. M. et al.: Investigating the role of the growth hormone-insulin-like growth factor (GH-IGF) axis as a determinant of male bone mineral density (BMD). Bone, 2005, 37, s. 833–841.
21. Elabd, S. K., Sabry, X., Hassan, W. B. et al.: Possible neuroendocrine role for oxytocin in bone remodeling. Endocr. Regul., 2007, 41, s. 131–141.
22. Bakhireva, L. N., Barrett-Connor, E., Kritz-Silverstein, D. et al.: Modifiable predictors of bone loss in older men: s prospective study. Am. J. Prev. Med., 2004, 26, s. 436–442.
23. Sharma, S., Fraser, M., Lovell, F, et al.: Characteristics of males over 50 years who present with a fracture: epidemiology and underlying risk factors. J. Bone Joint Surg. Br., 2008, 90, s. 72–77.
24. Kirbas, G., Abaky, A., Topcu, F. et al.: Obstructive slep apnoea, cigarette smoking and serum testosterone levels in a male sleep clinic cohort. J. Int. Med. Res., 2007, 35, s. 38–45.
25. Lorentzon, M., Mellström, D., Haug, E. et al.: Smoking is associated with lower bone mineral density and reduced cortical thickness in young men. J. Clin. Endocrinol. Metab., 2007, 92, s. 497–503.
26. Jorde, R., Saleh, F., Figenschau, Y. et al.: Serum parathyroid hormone (PTH) levels in smokers and non-smokers. The fifth Tromse study. Eur. J. Endocrinol., 2005, 152, s. 39–45.
27. Ruohola, J. P. Laaksi, I., Ylikomi, T. et al.: Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men. J. Bone Miner. Res., 2006, 21, s. 1483–1488.
28. Sneve, M., Emaus, N., Joakimsen R. M. et al.: The association between serum parathyroid hormone and bone mineral density, and the impact of smoking: the Tromso Study. Eur. J. Endocrinol., 2008, 158, s. 401–409.
29. Jorgensen, N. R., Schwarz, P.: Osteoporosis in chronic obstructive pulmonary disease patients. Curr. Opin. Pulm. Med., 2008, 14, s. 122–127.
30. Lorentzon, M, Landin, K, Mellström, D. et al.: Leptin is a negative independent predictor of areal BMD and cortical bone size in young adult Swedish men. J. Bone Miner. Res., 2006, 21, s. 1871–1878.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistArticle was published in
Journal of Czech Physicians
Most read in this issue
- Galectins in Squamous Cell Carcinomas of the Head and Neck Cancers
- Rationality and Irrationality in the Medicine and in the Life
- Hiatal hernia and Barrett’s oesophagus Impact on symptoms occurrence and complications
- Primary B-cell pituitary lymphoma of the Burkitt type: case report of the rare clinic entity with typical clinical presentation