Terrence Diamond, MB; Daniel Stiel, MD; Solomon Posen, MD
Study Objective: To define the prevalence, severity, type and pathogenesis of osteopenia in idiopathic hemochromatosis.
Design: Prospective study conducted over 18 months.
Setting: Tertiary care center.
Subjects: 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.
Measurements and Main Results: All patients and controls were evaluated by spinal radiography, spinal and fore-arm 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 < 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.
Terrence Diamond, Daniel Stiel, Solomon Posen. Osteoporosis in Hemochromatosis: Iron Excess, Gonadal Deficiency, or Other Factors?. Ann Intern Med. 1989;110:430–436. doi: 10.7326/0003-4819-110-6-430
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Published: Ann Intern Med. 1989;110(6):430-436.
Endocrine and Metabolism, Metabolic Bone Disorders.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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