SEX-HORMONE STATUS AND BONE-MINERAL DENSITY IN MEN WITH RHEUMATOID-ARTHRITIS

Objective. Sex hormone status has been proposed as an important determ inant of low bone mineral density (BMD) in both men and women. Our obj ective was to study the relationship between sex hormones and BMD in p atients with rheumatoid arthritis (RA), and how steroid therapy affect s both. Methods. We studied 99 men with RA to assess their BMD and sex hormone status. A comparative group of 68 age paired men was used. We made comparative tests, linear correlations, and multiple regression analysis. Results. We found significant reductions in lumbar BMD (p = 0.0005), femoral BMD (p < 0.0005), salivary testosterone (p = 0.01), a ndrostenedione (p = 0.007), and dehydroepiandrosterone sulfate (DHEAS) (p = 0.03) in patients with RA. In contrast, serum testosterone conce ntrations were normal. Salivary testosterone showed correlation with f emoral BMD (r = 0.36; p < 0.001). By multiple regression analysis, wei ght, serum testosterone concentrations, and the cumulative dose of cor ticosteroids were significant predictors of lumbar BMD (r = 0.41; p = 0.001). Weight, age, androstenedione concentrations, and the cumulativ e dose of corticosteroids were the significant predictors of femoral B MD (r = 0.79; p <0.0005). Conclusion. We confirm there is reduced BMD in men with RA; corticosteroids contribute, but are not the only facto r in the pathogenesis of low BMD in patients with RA; we found decreas ed levels of androstenedione, DHEAS, and salivary testosterone in men with RA; and salivary testosterone, as with free testosterone, is corr elated with BMD in patients with RA, with lower levels contributing to low BMD.