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DOI: 10.1055/s-2004-829013
© Georg Thieme Verlag Stuttgart · New York
Einfluss des Immunsuppressiva-induzierten Hypogonadismus auf den Knochenmetabolismus nach Herztransplantation
Role of immunosuppression induced hypogonadism on bone metabolism after cardiac transplantationPublication History
eingereicht: 15.10.2003
akzeptiert: 29.4.2004
Publication Date:
23 July 2004 (online)

Hintergrund und Fragestellung: Nach Herztransplantation (HTx) kommt es gehäuft zu einer Osteoporose. In wie weit das Auftreten eines Cyclosporin-induzierten Hypogonadismus die Posttransplantations-Osteoporose fördert und welche Therapiemaßnahmen geeignet sind, ist bislang unklar. Ziel dieser Studie war es zu untersuchen, wie häufig bei Männern nach HTx ein Hypogonadismus auftritt und inwiefern dieser sich auf die Knochendichte auswirkt. Des weiteren sollte der Effekt einer Testosteronsubstitution auf die Knochendichte hypogonadaler Patienten überprüft werden.
Patienten und Methode: Anhand des Hormonstatus wurden 88 Herztransplantierte einer normogonadalen bzw. hypogonadalen Gruppe zugeteilt. Bei Einschluss sowie nach 1 (n = 76) und 2 (n = 38) Jahren wurde die Knochendichte der Lendenwirbelsäule mittels Dual Energy X-Ray Absorptiometrie (DEXA) (g/cm2, T-Score) untersucht. Alle Patienten erhielten als Basismedikation Kalzium und Vitamin D, hypogonadale Patienten wurden zusätzlich mit Testosteron substituiert.
Ergebnisse: 21 Patienten (24 %) zeigten unabhängig vom Alter einen Hypogonadismus. Die Knochendichte hypogonadaler Patienten (BMD = 0,8070 g/cm 2, T-Wert = -2,6514) war gegenüber der normogonadaler (BMD = 0,9882 g/cm 2, T-Wert = -1,0568) zusätzlich signifikant vermindert (p < 0,001). Obwohl hypogonadale Patienten mit Testosteron substituiert wurden, zeigte sich bei den im Verlauf nach 1 bzw. 2 Jahren untersuchten Patienten keine signifikant stärkere Zunahme der Knochendichte gegenüber normogonadalen Patienten.
Folgerung: Bei männlichen Herztransplantierten fand sich gehäuft ein Hypogonadismus, welcher mit einer signifikant verminderten Knochendichte einherging. Unter einer additiven Testosteronsubstitution war keine signifikante Steigerung der Knochendichte zu beobachten.
Background and objective: Accelerated bone loss is a well recognized complication after cardiac transplantation (HTx). The role of an immunosuppressive-induced hypogonadism, a well-known cause of osteoporosis in men and its prevention are less defined after HTx. The aim of this study was first, to evaluate the incidence of hypogonadism after HTx and its influence on bone mineral metabolism and second, to assess the effect of a testosterone replacement therapy in hypogonadal transplants.
Patients and methods: Due to hormonal status, 88 male cardiac transplants were randomised to a normogonadal or hypogonadal group. At baseline as well as after 1 and 2 years bone mineral density (BMD g/cm2, T-score) was measured at the lumbar spine with DEXA. All patients received a basic therapy of calcium and vitamin D. The hypogonadal patients received additional testosterone.
Results: 21 patients (24 %) showed an age-independent hypogonadism. Hypogonadal transplants showed a significant lower BMD (p < 0,001) (BMD = 0,8070 g/cm2, T-value = -2,6514) than normogonadal patients (BMD = 0,9882 g/cm 2, T-value = -1,0568). Despite testosterone replacement hypogonadal patients showed no significant additional increase in BMD over 1 - 2 years compared with the normogonadal.
Conclusion: Male cardiac transplants in all age groups show an high prevalence of hypogonadism (˜25 %) which contributes to a significant bone loss. An additional testosterone substitution did not significantly increase BMD.
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Priv.-Doz. Dr. H. U. Stempfle
Abteilung Kardiologie, Medizinische Poliklinik Klinikum Innenstadt, Ludwig-Maximilians
Universität München
Ziemssenstraße 1
80336 München
Phone: +49/89/51602316
Fax: +49/89/51604483
Email: stempfle@medinn.med.uni-muenchen.de