Endocrine Abstracts

Background: Guidelines suggest treating paraphilias with androgen-deprivation therapy (ADT). However little evidence is available about the long-term impact on bone and how to manage this adverse event.

Aim: The aim of this study is to assess the impact of ADT on bone mass and bone mineral density (BMD) in men treated for hypersexuality with cyproterone acetate (CPA) and GnRH agonists (GnRHa), and to evaluate the effect of treatment with bisphosphonates.

Methods: Baseline and follow-up DXA scan data (lumbar and femoral T-scores) were retrospectively extracted from electronic medical files of hypersexual men who received CPA and/or GnRHa.

Outcomes: Lumbar (-0.39 ± 0.17, Mean ± SEM, P = 0.046), femoral neck (-0.34 ± 0.09) and total femur (-0.33 ± 0.12, P = 0.014) T-scores decreased significantly in the CPA only group (n13) during a mean follow-up of 6.0 ± 5.3 years. In the GnRHa group (n29), T-scores of all sites decreased significantly over 6.6 ± 4.4 years; (lumbar:-0.55 ± 0.12, P < 0.001, femoral neck:-0.53 ± 0.09 and total femur: -0.44 ± 0.09, P < 0.001). There however was no significant T-score change in the group who received bisphosphonates (n11) (lumbar: -0.25 ± 0.14, P = 0.106, femoral neck -0.15 ± 0.17, P = 0.402 and total femur -0.25 ± 0.14, P = 0.106) during 5.0 ± 2.8 years of follow-up.

Clinical Implications: Patients with baseline T-scores in the osteopenic range may be at risk to fall in the osteoporotic range after more than 5 years of treatment with ADT. Treatment with bisphosphonates could prevent bone loss.

Strengths & Limitations: This study is the first to assess BMD loss over a long period in a large cohort of hypersexual men treated with ADT.

Conclusion: Following a mean duration of 6 years of ADT, a significant decline in BMD of approximately half a standard deviation in T-score at spine and femur was observed, which may be prevented by bisphosphonates.