Summary
Androgen actions in target tissues depend on plasma concentration of bio-available androgen, on local androgen metabolism and on the presence and activity of sex steroids receptors (AR and partially ER) in association with regulatory co-factors, as well as on non-genomic pathways. As evidenced by androgen receptor insensitivity syndromes, androgens appear to play an important role in the development of the male skeletal phenotype, especially bone size. It is also probable that androgens participate in the later maintenance of adult bone remodelling/mass/structure. The old concept that androgens are responsible for skeletal abnormalities in hypogonadism is only partially erroneous. The declining sex steroid levels in the elderly may adversely affect the preservation of skeletal integrity and indicates that aromatisation of testosterone to estradiol is an important mediator of bone metabolism in the elderly. Androgens and estrogens have actions in bone development and maintenance and the complex interplay between both has only partially elucidated.
Clinical studies on the skeletal effects of hypogonadism and testosterone and non-aromatizable androgen therapy confirm the indisputable evidence of androgen action in bone. The interventional studies indicate only favorable effects in those men with pre-treatment serum testosterone levels clearly below the range of young men. Substitutive or pharmacologic treatment with androgens for the prevention or reversion of bone loss or increased fracture risk in aging men can only be considered if there is convincing evidence for androgen deficiency, although there is no precise definition of the “physiological” androgen requirements in elderly men. Avoiding side-effects and improving the dosing regimens of the presently available androgen treatments provide options for further developments. Selective androgen receptor modulators may present novel opportunities in the prevention or treatment of metabolic bone disorders.
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Goemaere, S., T’Sjoen, G., Kaufman, JM. (2010). Androgen Actions on Bone: Clinical Aspects. In: Adler, R. (eds) Osteoporosis. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-459-9_17
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