[Bone involvement in endocrinopathies].
Progress in bone densitometry, particularly biphotonic absoptiometry, has made it possible to better identify the effects of endocrinopathies on bone. Both cortical and trabecular bone structures can be evaluated quantitatively and topographically revealing important information on the pathophysiology of bone loss. Sex hormones play a major role in the regulation of bone mineralization and hypogonadism, whatever the origin, can lead to deleterious effects. Bone loss is known to be significative in high performance female athletes with amenorrhoea; long-term consequences are not yet determined, but stress fractures have been reported in up to 50%. Other hypogonadisms leading to bone demineralization include anorexia nervosa, chronic intake of gonadotrophin releasing hormone analogues and anti-oestrogens, and hyperprolactinism. Hyperthyroidism leads to a negative calcium balance and demineralization with remodelling, predominantly in cortical bone. In hypothyroid states a 10% bone loss is observed in vertebrae. In both cases, bone densitometry should be performed in order to evaluate the effect of treatment. The deleterious effect of spontaneous or iatrogenic hypercortisism is well known, leading to spontaneous wedge fractures of the vertebrae due to predominating trabecular bone loss. The mechanism of action of corticosteroids on bone metabolism is complex, but the major effect is an inhibition of osteoblast maturation. Recovery may be possible, but no large long-term series have yet been reported. Hyperparathyroidism and acromegaly also affect bone mineralization. The information provided by bone densitometry is essential to properly manage patients with endocrinopathies affecting bone mineralization.
Ribot
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C
Service d'Endocrinologie, UF Maladies osseuses et métaboliques, CHU Purpan, Toulouse.
Trémollières
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F
Pouillès
J M
JM
D000172:Acromegaly / Q000150:complications; D000308:Adrenocortical Hyperfunction / Q000150:complications; D015519:Bone Density; D003720:Densitometry; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000188:drug therapy; D007006:Hypogonadism / Q000150:complications*; D007037:Hypothyroidism / Q000150:complications* / Q000188:drug therapy; D008297:Male; D010024:Osteoporosis / Q000209:etiology*; D015663:Osteoporosis, Postmenopausal / Q000209:etiology*; D013963:Thyroid Hormones / Q000009:adverse effects / Q000627:therapeutic use
D013963:Thyroid Hormones
Retentissement osseux des endocrinopathies.