title: Randomized placebo-controlled trial of androgen effects on muscle and bone in men requiring long-term systemic glucocorticoid treatment.
abstract: Long-term glucocorticoid therapy in men is associated with loss of bone and muscle mass as well as a decrease in serum testosterone. We tested the effect of two androgens, testosterone and its minimally aromatizable analog nandrolone, on muscle mass (dual x-ray absorptiometry), muscle strength (knee flexion and extension by isokinetic dynamometry), bone mineral density (BMD), and quality of life (Qualeffo-41 questionnaire) in 51 men on a mean daily prednisone dose of 12.6 +/- 2.2 mg. Men were randomized, double blind, to testosterone (200 mg mixed esters), nandrolone decanoate (200 mg), or placebo given every fortnight by im injection for 12 months. At 12 months, both androgens increased muscle mass (mean change from baseline +3.5%, +5.8%, and -0.9% in testosterone, nandrolone, and placebo groups, respectively, P < 0.0001) and muscle strength (P < 0.05). Lumbar spine BMD increased significantly only in men treated with testosterone (4.7 +/- 1.1%, P < 0.01). There was no significant change in hip or total body BMD. Testosterone, but not nandrolone or placebo, improved overall quality of life (P < 0.001). These results suggest that androgen therapy may have a role in ameliorating adverse effects of glucocorticoid therapy such as muscle and bone loss and aromatization is necessary for androgen action on bone but not on muscle.
authors.affiliation: Department of Endocrinology, ANZAC Research Institute, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia. brcrawfo@mail.usyd.edu.au
authors.forename: Bronwyn A L
authors.initials: BA
authors.lastname: Crawford
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Liu
authors.forename: Mary T
authors.initials: MT
authors.lastname: Kean
authors.forename: Jane F
authors.initials: JF
authors.lastname: Bleasel
authors.forename: David J
authors.initials: DJ
authors.lastname: Handelsman
mesh_terms: D045930:Anabolic Agents / Q000008:administration & dosage / Q000009:adverse effects; D015519:Bone Density / Q000187:drug effects*; D004347:Drug Interactions; D005938:Glucocorticoids / Q000009:adverse effects*; D012739:Gonadal Steroid Hormones / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000187:drug effects*; D009277:Nandrolone / Q000008:administration & dosage / Q000009:adverse effects; D010919:Placebos; D011241:Prednisone / Q000009:adverse effects*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood
chemical_list: D045930:Anabolic Agents; D005938:Glucocorticoids; D012739:Gonadal Steroid Hormones; D010919:Placebos; D013739:Testosterone; D009277:Nandrolone; D011241:Prednisone