{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:55Z","timestamp":1784557075020,"version":"3.55.0"},"reference-count":23,"publisher":"Bioscientifica","issue":"2","license":[{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"\n Summary<\/jats:title>\n \n A 44-year-old athletic man presented in 2009 with severe low back pain. Dual-energy x-ray absorptiometry revealed severe osteoporosis; serum testosterone was 189 ng\/dL while serum estradiol (E\n 2<\/jats:sub>\n ) measured by liquid chromatography\/mass spectrometry was 8 pg\/mL. DNA was extracted and sequenced from a blood sample from the patient since his maternal first cousin also had low bone mass and both patients were screened for aromatase dysfunction by PCR analysis for the\n CYP19A1<\/jats:italic>\n gene, which encodes aromatase. No known pathologic mutations were observed in the coding exons, but novel single nucleotide polymorphisms were detected both in the proband and in his cousin. Treatment with topical testosterone started in August 2010. Over the next 8 years, testosterone dosage was varied and switched from topical gel to injections and maintained on depo-injections of testosterone at about 60 mg once per week. Re-examination in March 2012 included a brain MRI to exclude pituitary lesions; hyperparathyroidism was ruled out (normal serum parathyroid hormone, calcium, and calcium to phosphorous ratio) and celiac disease was excluded (negative transglutaminase antibodies). Follow-up in October 2018 showed improved bone mineral density of the lumbar spine by 29% and of the left femoral hip by 15% compared to baseline measurements. This reveals the importance of measuring serum E\n 2<\/jats:sub>\n for making the correct diagnosis, as well as for monitoring a therapeutic effect. Herein, we propose treatment of male osteoporosis where serum E\n 2<\/jats:sub>\n levels are below about 20 pg\/mL with testosterone to reverse osteoporosis.\n <\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Estrogen deficiency in the diagnosis of male idiopathic osteoporosis.<\/jats:p>\n <\/jats:list-item>\n \n Importance of serum estradiol in male osteoporosis.<\/jats:p>\n <\/jats:list-item>\n \n Role of polymorphisms in aromatase gene on bone health.<\/jats:p>\n <\/jats:list-item>\n \n Reversal of osteoporosis.<\/jats:p>\n <\/jats:list-item>\n \n Tailored testosterone treatment for bone health.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-22-0407","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T06:38:22Z","timestamp":1681886302000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["Reversibility in male idiopathic osteoporosis possible"],"prefix":"10.1530","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1437-2281","authenticated-orcid":true,"given":"Ijaz S","family":"Jamall","sequence":"first","affiliation":[{"name":"Risk-Based Decisions, Inc. 1540 River Park Drive, Suite 203, Sacramento, California, USA"},{"name":"Theodor-Billroth-Academy\u00ae, Munich \u2013 Sacramento, CA, Germany, USA"},{"name":"INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy\u00ae, Germany, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C","family":"Ullery","sequence":"additional","affiliation":[{"name":"Primary Care Physician, Heart and Vascular Medical Associates, 500 University Avenue, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Rocchietti March","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Faculty of Medicine and Psychology, University of Rome \"Sapienza\", Sant'Andrea Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Pignatti","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Rochira","sequence":"additional","affiliation":[{"name":"Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy"},{"name":"UOC of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn L D M","family":"Br\u00fccher","sequence":"additional","affiliation":[{"name":"Theodor-Billroth-Academy\u00ae, Munich \u2013 Sacramento, CA, Germany, USA"},{"name":"INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy\u00ae, Germany, USA"},{"name":"Department of Surgery, Carl-Thiem-Klinikum, Cottbus, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Endokrinologie","first-page":"152","article-title":"Total and free testosterone in plasma of hypo- and agonadal men","volume":"66","author":"Stahl","year":"1975","unstructured":"Stahl FD\u00f6rner GKnappe G & Schnorr D. 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(https:\/\/doi.org\/10.1186\/bcr2813)"}],"container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2023\/2\/EDM22-0407.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2023\/2\/EDM22-0407.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2023\/2\/EDM22-0407.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:48:08Z","timestamp":1784555288000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3668"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,1]]},"references-count":23,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.1530\/edm-22-0407","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,1]]}}}