Skip to main content
SpringerLink
Log in

Prevalence of osteopenia in men with prolactinoma

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

The aim of this cross-sectional study was to analyze bone mineral density (BMD) and prevalence of osteopenia and osteoporosis in 30 men with prolactinoma, and compare them to 22 control subjects. BMD of lumbar spine and femur was evaluated by dual-energy X-ray absorptiometry. PRL, testosterone, estradiol, sexual hormone-binding globulin and free androgen and estrogen indexes (FAI and FEI, respectively) were measured in all the subjects. In patients with prolactinoma, mean values of PRL and testosterone were calculated for the 12-month period that preceded the study. The mean T-score of the four sites analyzed by bone densitometry was lower in men with prolactinoma than in controls (p-values: lumbar spine=0.015, femoral neck >0.0001, trochanter=0.037, total femur=0.036), and 55.6% of the former presented osteopenia or osteoporosis at one or more sites (p = 0.035). The lumbar spine was the most seriously affected site, where 29.6% had osteopenia and 14.8% had osteoporosis. By the time of BMD determination, significant associations were found between BMD and PRL, testosterone, FAI, estradiol, FEI, and duration of hypogonadism. Considering the period of 12 months that preceded BMD evaluation, trochanter BMD was associated with mean PRL levels, while there was an association between lumbar spine BMD and mean testosterone levels. However, the multiple regression analysis showed that estradiol was the main determinant of BMD. In conclusion, men with prolactinoma have high prevalence of osteopenia and osteoporosis. Bone loss in such patients is associated with hyperprolactinemia and hypogonadism, and mainly influenced by estrogen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vartej P, Poiana C, Vartej I. Effects of hyperprolactinemia on osteoporotic fracture risk in premenopausal women. Gynecol Endocrinol 2001, 15: 43–7.

    Article  PubMed  CAS  Google Scholar 

  2. Klibanski A, Greenspan S. Increase in bone mass after treatment of hyperprolactinemic amenorrhea. N Engl J Med 1986, 315: 542–6.

    Article  PubMed  CAS  Google Scholar 

  3. Biller B, Baum H, Rosenthal D, Saxe V, Charpie P, Klibanski A. Progressive trabecular osteopenia in women with hyperprolactinemic amenorrhea. J Clin Endocrinol Metab 1992, 75: 692–7.

    PubMed  CAS  Google Scholar 

  4. Greenspan S, Neer R, Ridgway E, Klibanski A. Osteoporosis in men with hyperprolactinemic hypogonadism. Ann Intern Med 1986, 104: 777–82.

    Article  PubMed  CAS  Google Scholar 

  5. Greenspan SL, Oppenheim D S, Klibanski A. Importance of gonadal steroids to bone mass in men with hyperprolactinemic hypogonadism. Ann Intern Med 1989, 110: 526–31.

    Article  PubMed  CAS  Google Scholar 

  6. Di Somma C, Colao A, Di Sarno A, et al. Bone marker and bone density responses to dopamine agonist therapy in hyperprolactinemic males. J Clin Endocrinol Metab 1998, 83: 807–13.

    Article  PubMed  Google Scholar 

  7. Colao A, Di Somma C, Loche S, et al. Prolactinomas in adolescents: Persistance of bone loss after 2 years of prolactin normalization. Clin Endocrinol (Oxf) 2000, 52: 319–27.

    Article  CAS  Google Scholar 

  8. Jackson J, Kleerekoper M, Parfitt M. Symptomatic osteoporosis in a man with hyperprolactinemic hypogonadism. Ann Intern Med 1986, 105: 543–5.

    Article  PubMed  CAS  Google Scholar 

  9. Prelevic G. Osteoporosis in men. J R Soc Med 2001, 94: 620–3.

    PubMed Central  PubMed  CAS  Google Scholar 

  10. Cummings S, Black D, Nevitt M, et al. Bone density at various sites for prediction of hip fractures. Lancet 1993, 341: 72–5.

    Article  PubMed  CAS  Google Scholar 

  11. Bonnick SL. Densitometric anatomy. In: Bonnick SL eds. Bone densitometry in clinical practice. Totowa, New Jersey: Humana Press Inc. 1998, 31–64.

    Google Scholar 

  12. Schlechte J, El-Khoury G, Kathol M, Walkner L. Forearm and vertebral bone mineral in treated and untreated hyperprolactinemic amenorrhea. J Clin Endocrinol Metab 1987, 64: 1021–6.

    Article  PubMed  CAS  Google Scholar 

  13. Benito M, Gomberg B, Wehrli F, et al. Deterioration of trabecular architecture in hypogonadal men. J Clin Endocrinol Metab 2003, 88: 1497–502.

    Article  PubMed  CAS  Google Scholar 

  14. Seeman E, Melton III L, O’Fallon W, Riggs B. Risk factors for spinal osteoporosis in men. Am J Med 1983, 75: 977–83.

    Article  PubMed  CAS  Google Scholar 

  15. Vestergaard P, Jorgensen J, Hagen C, et al. Fractures risk is increased in patients with deficiency or untreated prolactinomas — a case-control study. Clin Endocrinol (Oxf) 2002, 56: 159–67.

    Article  Google Scholar 

  16. Colao A, Di Somma C, Piovonello R, et al. Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism. J Clin Endocrinol Metab 1999, 84: 1919–24.

    Article  PubMed  CAS  Google Scholar 

  17. Byers R, Hoyland J, Braidman I. Osteoporosis in men: a cellular endocrine perspective of an increasingly common clinical problem. J Endocrinol 2001, 168: 353–62.

    Article  PubMed  CAS  Google Scholar 

  18. Holmes S, Economou G, Whitehouse R, Adams J, Shalet S. Reduced bone mineral density in patients with adult onset growth hormone deficiency. J Clin Endocrinol Metab 1994, 78: 669–74.

    PubMed  CAS  Google Scholar 

  19. Ciccarelli E, Savino L, Carlevatto V, Bertagna A, Isaia G, Camanni F. Vertebral bone density in non-amenorrheic hyperprolactinaemic women. Clin Endocrinol (Oxf) 1988, 28: 1–6.

    Article  CAS  Google Scholar 

  20. Klibanski A, Biller B, Rosenthal D, Schoenfeld D, Saxe V. Effects of prolactin and estrogen deficiency in amenorrheic bone loss. J Clin Endocrinol Metab 1988, 67: 124–30.

    Article  PubMed  CAS  Google Scholar 

  21. Nystrom E, Leman J, Lundberg P, et al. Bone mineral content in normally menstruating women with hyperprolactinaemia. Horm Res 1988, 29: 214–7.

    Article  PubMed  CAS  Google Scholar 

  22. Finkelstein J, Klibanski A, Neer R. A longitudinal evaluation of bone mineral density in adult men histories of delayed puberty. J Clin Endocrinol Metab 1996, 81: 1152–5.

    PubMed  CAS  Google Scholar 

  23. Guo C, Jones T, Eastell R. Treatment of isolated hypogonadotropic hypogonadism effect on bone mineral density & bone turnover. J Clin Endocrinol Metab 1997, 82: 658–65.

    Article  PubMed  CAS  Google Scholar 

  24. Mittan D, Lee S, Miller E, Perez R, Basler J, Bruder J. Bone loss following hypogonadism in men with prostate cancer treated with GnRH analogs. J Clin Endocrinol Metab 2002, 87: 3656–61.

    Article  PubMed  CAS  Google Scholar 

  25. Carter J, Tyson J, Tolis G, Van Vliet S, Faiman C, Friesen H. Prolactin- secreting tumors and hypogonadism in 22 men. N Engl J Med 1978, 299: 847–52.

    Article  PubMed  CAS  Google Scholar 

  26. Pinzone J, Katznelson L, Danila D, Pauler D, Miller C, Klibanski A. Primary medical therapy of micro- and macroprolactinomas in men. J Clin Endocrinol Metab 2000, 85: 3053–7.

    PubMed  CAS  Google Scholar 

  27. Kayath M, Lengyel A, Vieira J. Prevalence and magnitude of osteopenia in patients with prolactinoma. Braz J Med Biol Res 1993, 26: 933–41.

    PubMed  CAS  Google Scholar 

  28. Klibanski A, Neer R, Beitins I, Ridgway C, Zervas N, McArthur J. Decreased bone density in hyperprolactinemic women. N Engl J Med 1980, 303: 1511–4.

    Article  PubMed  CAS  Google Scholar 

  29. Braidman I, Baris C, Wood L, et al. Preliminary evidence for impaired estrogen receptor-alpha protein expression in osteoblasts and osteocytes from men with idiopathic osteoporosis. Bone 2000, 26: 423–7.

    Article  PubMed  CAS  Google Scholar 

  30. Morishima A, Grumbach M, Simpson E, Fisher C, Qin K. Aromatase deficiency in male and female siblings caused by a novel mutation and the physiological role of estrogens. J Clin Endocrinol Metab 1995, 80: 3689–98.

    PubMed  CAS  Google Scholar 

  31. Ohgphipadhanakul B, Rajatanavin R, Chanprasertyothin S, Oiaseu N, Chailurkit L. Serum oestradiol and oestrogenreceptor gene polymorphism are associated with bone mineral density independently of serum testosterone in normal males. Clin Endocrinol (Oxf) 1998, 49: 803–9.

    Article  Google Scholar 

  32. Center JR, Nguyen TV, Sambrook PN, Eisman JA. Hormonal and biochemical parameters in the determination of osteoporosis in elderly men. J Clin Endocrinol Metab 1999, 84: 3626–35.

    PubMed  CAS  Google Scholar 

  33. Carlsen CG, Soerensen TH, Eriksen EF. Prevalence of low serum estradiol levels in male osteoporosis. Osteoporos Int 2000, 11: 697–701.

    Article  PubMed  CAS  Google Scholar 

  34. Khosla S, Melton III L, Atkinson E, O’Fallon W. Relationship of serum sex steroid levels to longitudinal changes in bone density in young versus elderly men. J Clin Endocrinol Metab 2001, 86: 3555–61.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Department of Internal Medicine, Federal University of Rio de Janeiro (UFRJ) and University Hospital Clementino Fraga Filho (HUCFF), Av Lucio Meira 670 sala 517, Centro, Teresópolis/RJ, 25953-003, Brazil

    E. C. O. Naliato MD, M. L. F. Farias, G. R. Braucks, F. S. R. Costa, D. Zylberberg & A. H. D. Violante

Authors
  1. E. C. O. Naliato MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. L. F. Farias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. R. Braucks
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. S. R. Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Zylberberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. H. D. Violante
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. C. O. Naliato MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Naliato, E.C.O., Farias, M.L.F., Braucks, G.R. et al. Prevalence of osteopenia in men with prolactinoma. J Endocrinol Invest 28, 12–17 (2005). https://doi.org/10.1007/BF03345523

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03345523

Key-words

Search

Navigation