An increase in bone mineral density was noted in two men after 2 years of observation. About 1 year later, obvious bone metastases developed in both. Even though all 25 men are severely androgen-deficient, their initial bone mineral density values and rates of bone loss were highly variable and not always related to duration of castration. We think it likely that some of them became hypogonadal years before castration, but since testosterone concentration and bone mineral density were not measured before castration, we cannot confirm this. In addition, the populations studied have been unusually diverse, changes in glucocorticoid doses have been frequent, and underlying diseases have contributed to bone loss.
Bone loss continues thereafter, but the rate of loss is less.
It is impossible to predict which men will be affected, although it seems logical that those with additional risk factors would be in greatest jeopardy. Given the paucity of studies in men, the approach to evaluating bone loss in men has largely been extrapolated from the approach in women. Unfortunately, men lack an early warning sign of hypogonadism comparable to menopause in women. Even impotence is not a definitive sign. Most men who are impotent are not hypogonadal, and some hypogonadal men are not impotent.