title: Osteoporosis in hemochromatosis: iron excess, gonadal deficiency, or other factors?
abstract: OBJECTIVE
  To define the prevalence, severity, type and pathogenesis of osteopenia in idiopathic hemochromatosis.
  
  
  METHODS
  Prospective study conducted over 18 months.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Twenty-two men with idiopathic hemochromatosis and 20 age-matched controls. There were 5 hypogonadal patients, 9 eugonadal nonvenesected patients, and 8 eugonadal venesected patients.
  
  
  RESULTS
  All patients and controls were evaluated by spinal radiography, spinal and forearm bone mineral density estimations, dynamic skeletal histomorphometry, and serum biochemistry. Ten patients (45%; 95% CI, 24% to 68%) had osteoporosis as defined by spinal and forearm bone density measurements. Trabecular bone volumes were significantly reduced in the patients (the difference in means between patients and age-matched controls was 3.9%; CI, 1.3% to 6.7%). No patient had osteomalacia. Hypogonadal men had lower bone mass measurements than eugonadal men (radial bone density: beta coefficient = -20.5; CI, -29.2 to -11.8; trabecular bone volume: beta coefficient = -7.1; CI, -10.8 to -3.3). Osteoid and osteoblastic surfaces and bone formation rates were significantly greater in the eugonadal venesected compared with the eugonadal nonvenesected persons (P less than 0.05 for all measurements).
  
  
  CONCLUSIONS
  A significant decrease in bone density is seen in idiopathic hemochromatosis, particularly when hypogonadism is present. Low serum free-testosterone concentrations rather than the calciotrophic hormones determine bone mass in this condition.
authors.affiliation: Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Diamond
authors.forename: D
authors.initials: D
authors.lastname: Stiel
authors.forename: S
authors.initials: S
authors.lastname: Posen
mesh_terms: D000328:Adult; D001815:Bloodletting; D001846:Bone Development; D001862:Bone Resorption; D002112:Calcifediol / Q000097:blood; D006432:Hemochromatosis / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D006801:Humans; D007006:Hypogonadism / Q000150:complications* / Q000209:etiology; D007501:Iron / Q000378:metabolism*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology*; D011446:Prospective Studies; D013122:Spinal Diseases / Q000209:etiology
chemical_list: D007501:Iron; D002112:Calcifediol