title: Clinical Review: Sex steroids and the periosteum--reconsidering the roles of androgens and estrogens in periosteal expansion.
abstract: BACKGROUND
  Traditionally, differences in periosteal bone formation between men and women have been assumed to reflect two diverging endocrine effects: stimulatory effects of androgens in men and inhibitory effects of estrogens in women. In line with this concept, it is tempting to speculate that men experience more periosteal bone expansion than women because they are exposed to more endogenous androgens and less estradiol. However, recent data challenge this traditional concept.
  
  
  METHODS
  A PubMed search was conducted for relevant most recent findings in both humans and animals in the context of an intriguing observation of ongoing periosteal expansion after estrogen treatment in an aromatase-deficient boy.
  
  
  RESULTS
  Human experiments of nature have provided evidence that androgens and estrogens are both required for the process of pubertal periosteal bone expansion typically associated with the male bone phenotype. Androgens alone appear insufficient to drive male periosteal bone formation. In both sexes, androgens may stimulate periosteal bone formation, but low levels of estrogen may increase the mechanical sensitivity of the periosteum. Higher concentrations of endogenous estrogen, however, inhibit periosteal bone apposition and/or its interaction with mechanical loading. This biphasic action of estrogen on the periosteum may result from a direct effect on its receptor, either alpha or beta, but may also depend on changes in serum IGF-I.
  
  
  CONCLUSIONS
  Simple concepts of the roles of sex steroids in periosteal apposition have to be reconsidered in the context of these recent findings.
authors.affiliation: Laboratory for Experimental Medicine and Endocrinology, Gasthuisberg, Onderwijs and Navorsing, Herestraat 49, B-3000 Leuven, Belgium. dirk.vanderschueren@uz.kuleuven.ac.be
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.forename: Katrien
authors.initials: K
authors.lastname: Venken
authors.forename: Jill
authors.initials: J
authors.lastname: Ophoff
authors.forename: Roger
authors.initials: R
authors.lastname: Bouillon
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
mesh_terms: D000728:Androgens / Q000502:physiology*; D000818:Animals; D047628:Estrogen Receptor alpha / Q000502:physiology; D047629:Estrogen Receptor beta / Q000502:physiology; D004967:Estrogens / Q000502:physiology*; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000502:physiology; D008297:Male; D010521:Periosteum / Q000502:physiology*
chemical_list: D000728:Androgens; D047628:Estrogen Receptor alpha; D047629:Estrogen Receptor beta; D004967:Estrogens; D007334:Insulin-Like Growth Factor I