Hypogonadism

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An under-appreciated cause ofosteoporosis in patients with GI or liver disease is hypogonadism. Patients treated with glucocorticoids for any reason suppress gonadal and adrenal sex hormone production via suppression of the hypothalamic-pituitary axis. Women with CD, celiac disease or severe weight loss from any cause often do not menstruate and must be treated as if postmenopausal (Sher et al, 1994). Women that are postmenopausal and have coexistent GI diseases such as CD or celiac disease are at very high risk for osteoporosis and fractures (Clements et al, 1993). Similarly women with primary biliary cirrhosis (PBC) who are postmenopausal are at significantly higher risk than younger women for osteoporosis and fractures (Solerio et al, 2003). Estrogen replacement, especially in younger women who are not postmenopausal, should be considered. Estrogen replacement therapy has been shown to be safe and effective in patients with PBC (Monegal et al, 1997).

Men with CD, celiac disease, and liver disease may have inappropriately low levels of testosterone contributing to osteoporosis. Testosterone supplementation can be achieved through a topical gel or parenteral administration. In male liver patients in particular, hypogonadism is a principal cause of low BMD (Monegal et al, 1997). Testosterone is contraindicated, however, in patients with liver disease.

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