The assessment of testosterone and radioisotopic index of bone metabolism and bone mineral density in men with testosterone deficiency after one year of testosterone therapy

Background: Testosterone deficiency in men is characterized by typical symptoms of hypogonadism and negative influence on the preservation of bone mass. In this study, we analysed the relationship between testosterone concentration and bone metabolism. Moreover, we assessed the impact of one-year compensation of testosterone deficiency in elderly men on bone metabolism and bone mineral density. Radioisotopic methods of bone metabolism assessment provide new research opportunities. Materials and methods: Men with total testosterone concentration (TT) ≤ 3 ng/ml were included into this study. Patients with disorders or injuries of bone system, elevated prostate-specific antigen (PSA), enlarged prostate, disorders of thyroid and liver, diabetes mellitus or a history of chemotherapy as well as those treated for a long time with antibiotics were excluded from this study. The results of 50 men aged 57.52 ± 6.71 years obtained before the treatment (I test) and after one year of oral testosterone supplementation (test II) were analysed in this study. The following examinations and analyses were performed: interview and physical examination, orthopaedic, neurological and urological consultations, blood biochemistry, determination of hormones levels, assessment of Testosterone Deficiency Syndrome (TDS), densitometric and radioisotope assessment of bone metabolism. Moreover, radioisotopic index of bone metabolism was calculated. Testosterone therapy with oral preparation Undestor Testo Caps (Organon) containing 40 mg of testosterone lasted for 12 months. Statistical analysis was performed using Statistica 12 and Excel 2010 programs. Correlations between results before and after treatment were analysed. Results: After 12 months of treatment, testosterone concentration increased by mean 78% and the level of luteinizing hormone (LH) decreased by 62%. TDS index increased from 0.53 ± 0.21 (in test I) to 1.91 ± 0.60 (in test II). After the therapy this index was significantly higher in all men (p < 0.0001). Moreover, BMD was also improved following therapy, however, the difference between test I and II was statistically insignificant. The greatest change was found in case of IBM (Index of Bone Metabolism). We observed a positive correlation between IBM and BMD before treatment (r = 0.7991), however, its strength decreased after one-year therapy (r = 0.6757). Conclusions: In our opinion, IBM is more sensitive than other methods of the assessment of changes occurring in bone system under the influence of testosterone therapy. The observed changes in IBM were proportional to changes in testosterone concentration. Testosterone level, TDS and radioisotopic assessment of bone metabolism may be used as prognostic and therapeutic factors of osteoporosis and bone fractures in elderly men.  BACKGROUND: Testosterone deficiency in men is characterized by typical symptoms of hypogonadism and negative influ­ence on the preservation of bone mass. In this study, we analysed the relationship between testosterone concentration and bone metabolism. Moreover, we assessed the impact of one-year compensation of testosterone deficiency in elderly men on bone metabolism and bone mineral density. Radioisotopic methods of bone metabolism assessment provide new research opportunities. MATERIALS AND METHODS: Men with total testosterone concentration (TT) ≤ 3 ng/ml were included into this study. Patients with disorders or injuries of bone system, elevated prostate-specific antigen (PSA), enlarged prostate, disorders of thyroid and liver, diabetes mellitus or a history of chemotherapy as well as those treated for a long time with antibiotics were excluded from this study. The results of 50 men aged 57.52 ± 6.71 years obtained before the treatment (I test) and after one year of oral testosterone supplementation (test II) were analysed in this study. The following examinations and analyses were performed: interview and physical examination, orthopaedic, neurological and urological consultations, blood biochemistry, determination of hormones levels, assessment of Testosterone Deficiency Syndrome (TDS), densitometric and radioisotope assessment of bone metabolism. Moreover, radioisotopic index of bone metabolism was calculated. Testosterone therapy with oral preparation Undestor Testo Caps (Organon) containing 40 mg of testosterone lasted for 12 months. Statistical analysis was performed using Statistica 12 and Excel 2010 programs. Correlations between results before and after treatment were analysed. RESULTS: After 12 months of treatment, testosterone concentration increased by mean 78% and the level of luteinizing hormone (LH) decreased by 62%. TDS index increased from 0.53 ± 0.21 (in test I) to 1.91 ± 0.60 (in test II). After the therapy this index was significantly higher in all men (p &lt; 0.0001). Moreover, BMD was also improved following therapy, however, the difference between test I and II was statistically insignificant. The greatest change was found in case of IBM (Index of Bone Metabolism). We observed a positive correlation between IBM and BMD before treatment (r = 0.7991), however, its strength decreased after one-year therapy (r = 0.6757). CONCLUSIONS: In our opinion, IBM is more sensitive than other methods of the assessment of changes occurring in bone system under the influence of testosterone therapy. The observed changes in IBM were proportional to changes in testosterone concentration. Testosterone level, TDS and radioisotopic assessment of bone metabolism may be used as prognostic and therapeutic factors of osteoporosis and bone fractures in elderly men.

Multidirectional assessment of medical treatment influence on lower limb perfusion in patients suffering from obliterative atheromatosis

Wstęp. Przewlekłe niedokrwienie kończyn dolnych jest przedmiotem wielu badań, jednak w większości z nich nie dokonuje się porównania spoczynkowego i wysiłkowego przepływu naczyniowego. Medycyna nuklearna dysponuje metodami i programami pozwalającymi rozwiązać to zagadnienie. Celem pracy jest określenie za pomocą metod radioizotopowych zaburzeń perfuzji mięśni kończyn dolnych w spoczynku i po wysiłku u chorych z miażdżycą zarostową tętnic i porównanie wyników ze standardowymi metodami oceniającymi ukrwienie kończyn dolnych oraz ocena wpływu leczenia zachowawczego na analizowane parametry ukrwienia. Materiał i metody. Materiał stanowiło 35 pacjentów, leczonych zachowawczo z powodu niedokrwienia kończyn dolnych. Badaniem objęto chorych, którzy w momencie przyjęcia zgłaszali ziębniecie, drętwienie, chromanie przestankowe od 30-500 m. W celu kwalifikacji do grup u wszystkich chorych wykonano doplerowskie badanie USG kodowane kolorem. Do dalszych badań włączono chorych z drugim stopniem według klasyfikacji Foutaine&#8217;a (IIa i IIb), których dystans chromania wahał się w granicach 30÷500 m. Leczenie zachowawcze obejmowało modyfikację czynników i skojarzoną farmakoterapię oraz określenie wskaźników kostka-ramię, udo-goleń i udo-kostka. Radioizotopowe badania perfuzji mięśni kończyn dolnych w spoczynku i po wysiłku wykonywano za pomocą gamma-kamery według własnej metody i programu ALLP, określających wskaźniki perfuzji w badanych mięśniach. Wnioski. 1. Sześciomiesięczne leczenie zachowawcze, w tym skojarzone leczenie farmakologiczne, powoduje niewielką poprawę ukrwienia w zakresie krążenia w kończynach dolnych polegającą głównie na wzroście wartości wskaźnika kostka-ramię, obniżeniu wartości wskaźników udo-kostka i udo-goleń oraz poprawie prędkości przepływu we wszystkich badanych tętnicach. 2. Bardzo czułym i wartościowym badaniem określającym zmiany ukrwienia kończyn dolnych (goleni i ud) w spoczynku i po wysiłku, po zastosowaniu terapii zachowawczej, jest radioizotopowe badanie perfuzji mięśni. Uzyskane wskaźniki perfuzji precyzyjnie informują o wielkości zmian w mikrokrążeniu oraz pozwalają monitorować efekty leczenia zachowawczego. 3. Metoda radioizotopowa komplementarnie uzupełnia dotychczasową diagnostykę zaburzeń ukrwienia mięśni kończyn dolnych u chorych z miażdżycą zarostową tętnic.Background. Chronic lower-limb ischaemia has been the subject of several studies; however, most of them do not give a comparison between vascular flow at rest and vascular flow after exercise. Nuclear medicine is vested with methods and programmes allowing the solution of this matter. The aim of this study was to define, with the use of radioisotopic methods, the perfusion disturbances of lower limb muscles at rest and after exercise in patients with arterial obliterative atheromatosis, and to compare the results with the standard methods assessing lower limb perfusion, as well as to assess the influence of the medical treatment on the analyzed parameters of the perfusion. Material and methods. The material included 35 patients, medically treated because of lower limbs ischaemia. The study covered patients who, at the time of admission, reported feeling cold, numbness and intermittent claudication at 30 to 500 m For group classification, all the patients underwent USG-Doppler examination with a colour option. The patients with the second degree according to Foutaine (IIa, IIb), whose claudication distance ranged between 30 and 500 m, were included in the study. Medical treatment included modification of the factors and combined pharmacotherapy, and defining factors: ankle-brachial, femoral-tibial and femoral-ankle. Radioisotopic examinations of lower limb perfusion at rest and after exercise were performed with the use of a gamma camera according to our own method and an ALLP programme defining the perfusion indicators in the examined muscles. Conclusions. 1. A six-month period of medical treatment, including combined pharmacological treatment, causes a slight increase of lower limb perfusion, expressed mainly by an increase of the ankle-brachial index, decrease of the femoral-ankle and femoral-tibial indexes, and improvement of the speed of flow in all examined arteries. 2. Radioisotopic examination of muscle perfusion is a very precise and beneficial examination defining the changes in perfusion in the lower limbs (tibias and femora) at rest and after exercise. The obtained perfusion indexes give precise information about the scale of changes in microcirculation and allow the effects of the medical treatment to be monitored. 3. The radioisotopic method has completed previous diagnostics of lower limb perfusion disturbances in patients suffering from arterial obliterative atheromatosis

Radioisotopic assessment of bone metabolism of the operated vertebra after inter-process stabilizer implantation in the lumbar segment of the spine

Introduction: Lack of efficacy of pharmacotherapy and physiotherapy in spinal pain syndrome is an indication for intervertebral stabilizer implantation between the processes in the lumbar segment of the spine. Material and methods: The group consisted of 32 patients qualified after radioisotopic single-photon emission computed tomography/computed tomography (SPECT/CT) examinations with assessment of bone metabolism and mineral density. For comparative purposes, the L2 vertebra was defined as normal. Parameters defined in the area of operated vertebrae were comparable to L2. Imaging examinations and a pain intensity test were performed before and 12 months after the procedure. Results: In SPECT, osteotropic isotope (OI) activity in spinous bodies and processes was close to L2 values. Density assessed in CT of analysed vertebrae was close to L2. In the control examination, activity of OI in spinous bodies and processes was higher in the procedure area. Under the stabilizer, there was a strong positive correlation with the L2 parameters. The differences were statistically significant (p = 0.0002). The increase of OI activity in the elements above the stabilizer was variable. In the control examination, there was higher density of spinous processes and bodies above and under the stabilizer. The difference, compared to the L2 density, was statistically significant. Conclusions : The radioisotopic method with SPECT/CT allows for the precise assessment of bone metabolism in the spine. After the procedure, a negative correlation was observed between bone metabolism changes and pain intensity test results