title: Testosterone, anastrozole, factor V Leiden heterozygosity and osteonecrosis of the jaws.
abstract: Our specific aim is to describe the development of thrombotic osteonecrosis of the jaws after testosterone-anastrozole therapy in a 55-year-old white man subsequently found to have previously undiagnosed factor V Leiden heterozygosity. Before the diagnosis of V Leiden heterozygosity, he was given testosterone gel, 50 mg/day, and on testosterone, serum testosterone (963 ng/dl) and estradiol were high (50 pg/ml). Anastrozole was started, and testosterone was continued. Six months later, osteonecrosis of the jaws was diagnosed. Exogenous testosterone is aromatized to estradiol and estradiol-induced thrombophilia, when superimposed on underlying familial thrombophilia, as in this case, may lead to thrombosis and osteonecrosis. We recommend that before giving testosterone, at a minimum, screening for the factor V Leiden and G20210A mutations, and factor VIII and XI activity be carried out, to avoid unanticipated thrombosis.
authors.affiliation: The Cholesterol and Metabolism Center, The Jewish Hospital, Cincinnati, Ohio, USA.
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Pandit
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Glueck
mesh_terms: D000077384:Anastrozole; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology* / Q000235:genetics; D005165:Factor V / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000009:adverse effects*; D010020:Osteonecrosis / Q000139:chemically induced* / Q000235:genetics*; D013739:Testosterone / Q000009:adverse effects*; D014230:Triazoles / Q000009:adverse effects*
chemical_list: D009570:Nitriles; D014230:Triazoles; C095381:factor V Leiden; D000077384:Anastrozole; D013739:Testosterone; D005165:Factor V