Title : The bone histomorphometry in young adult female patients with congenital hypogonadism accompanied with low bone mass
The osteopenia of hypogonadal patients could be due to a decrease in the peak bone mass achieved during skeletal maturation, an accelerated loss of established bone (post-pubertal), or both. Histomorphometric analyses of bone can be useful in assessing the mechanism of decreased bone mass in patients with osteopenia. However, analyses of bone biopsies of patients with hypogonadism mostly taken in men, very rarely in women, cause of their osteopenia depending on the patients studied. Little is known about histological pattern of bone loss in post-pubertal stage in patients (abnormal bone remodeling after puberty)with pre-pubertal congenital hypogonadism such as gonadal dysgenesis and idiopathic hypogonadotropic hypogonadism.
Post-pubertal aged 18 women cases with congenital hypogonadism (mean age 25 ± 1.7 year; age range 18-39 year) was enrolled. Ten age matched patients who were undergoing diagnostic laparoscopy for primary amenorrhea associated with müllerian anomaly served as controls. Trans-iliac bone biopsy was performed following in vivo double tetracycline labeling with time schedule (2 days on- 7-14 days off- 2 days on- 5 days off). BMD at lumbar and femur neck were measured with DEXA and measured related biochemical bone turnover markers including osteocalcin and urinary deoxypyridinoline (Dpyd)/creatinine.
We showed that a significantly lower BMD Z score and reduced bone structural parameters in both trabecular and cortical bone through DEXA scan and histomorphometric study on lumbar and femur neck in post-pubertal congenital hypogonadism patients. These results suggested that an impaired bone formation during pre-puberty and/or adolescence stage. In post-pubertal stage, there were slow bone loss with decreased bone remodeling.