ECE2019 Poster Presentations Reproductive Endocrinology 2 (39 abstracts)
Improvement of bone microarchitecture after 30 months of testosterone substitution therapy in young patients with Klinefelter Syndrome
Anne Piot 1, , Ingrid Plotton 3, , Benoite Dancer 3 , Justine Bacchetta 6, , Sylviane Ailloud 1 , Hervé Lejeune 4, , Roland Chapurlat 1, , Pawel Szulc 9 & Cyrille Confavreux 1,
1Département de Rhumatologie, Hospices Civils de Lyon, Lyon, France; 2INSERM UMR 1033-Lyos, Université de Lyon, Lyon, France; 3Hormonologie et Endocrinologie Moleculaire et Maladies Rares, Hospices Civils de Lyon, Lyon, France; 4Départment de Médecine de la Reproduction, Hospices Civils de Lyon, Lyon, France; 5INSERM UMR 1208, Université de Lyon, Lyon, France; 6NSERM UMR 1033-Lyos, Université de Lyon, Lyon, France; 7Département de Néphrologie Pédiatrique, Hospices Civils de Lyon, Lyon, France; 8NSERM UMR 1208, Université de Lyon, Lyon, France; 9INSERM UMR 1033-Lyos, Université de Lyon, Lyon, France, Lyon, France; 10INSERM UMR 1033-Lyos, Université de Lyon, Lyon, Lyon, France.
Background: Klinefelter Syndrome (KS) patients, defined by a 47 XXY karyotype, suffer from osteoporosis, with an increased risk of mortality after femoral neck fracture. The mechanisms underlying this bone alteration remain unclear.
Patients and methods: In KS patients naïve from testosterone substitution therapy (TST), we assessed bone microarchitecture at distal radius and tibia by High Resolution peripheral Computed Quantitative Tomography, and body composition by Dual-energy X-ray absorptiometry, before and after 30 months of TST. At baseline, we measured sex steroids: total testosterone (tT) by radio immunology assay (RIA) after diethylether extraction, bioavailable testosterone (bio-T) by RIA after ammonium sulphate precipitation, and total 17β-estradiol (17βE2) by RIA.
Results: Between February 2014 and November 2015, we included 34 KS patients (mean±SD age: 23.7±7.8 years and BMI: 20.9±3.4 kg/m2). They were paired with 72 age-matched controls. We found low levels of tT (<10.4 nmol/l), bio-T (<2.25 nmol/l), and 17βE2 (<66.0 pmol/l) in respectively 10 (42%), 15 (62%) and 17 (71%) KS patients. Compared to controls, patients with KS had lower Relative Appendicular Lean Mass (RALM, 7.53±1.28 vs 8.65±1.05 kg/m2, P<0.01), and higher fat mass percentage (22.3±6.8 vs 14.1±6.2, P<0.01). They presented impaired cortical and trabecular compartments, particularly at the tibia, especially in KS patients with low levels of sex steroids or low RALM. After a median 30.4 [29.7–31.0] months of TST, 16 (67%) of KS patients were reassessed. We observed an increase of cortical volumetric Bone Mineral Density and cortical thickness, respectively at the radius 787±81 to 838±46 mg/cm3; P<0.01 and 0.75±0.25 to 0.86±0.18 mm; P<0.05 and at the tibia 847±49 to 862±44 mg/cm3; P<0.01 and 1.15±0.25 to 1.26±0.24 mm; P<0.05. Trabecular areas decreased at both radius and tibia (P<0.05).
Conclusions: Young TST naïve KS patients have an early bone impairment at both radius and tibia, which improve after 30 months of THS. KS patients should benefit from TST before the achievement of peak bone mass especially if they are hypogonadic.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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