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Sclerostin is a protein secreted by osteocytes that acts as an inhibitor of bone formation. It has been shown that physical activity affects sclerostin concentration and thus bone remodelling. The aim of the study was to evaluate serum concentrations of sclerostin, selected bone turnover markers (PTH, P1NP), 25(OH)D3 and the intake of calcium and vitamin D in physically active versus sedentary men. A total of 59 healthy men aged 17-37 were enrolled in the study (43 athletes and 16 non-athletes). The mean sclerostin concentration in the group of athletes (A) was significantly higher than in non-athletes (NA) (35.3±8.9 vs 28.0±5.6 pmol·l(-1), p= 0.004). A compared with NA had higher concentrations of P1NP (145.6±77.5 vs 61.2±22.3 ng·ml(-1), p= <0.0001) and 25(OH)D3 (16.9±8.4 vs 10.3±4.3 ng·ml(-1), p= 0.004) and lower concentrations of PTH (25.8±8.3 vs 38.2±11.5 pg·ml(-1), p= <0.0001). Vitamin D deficiency was found in 77% of A and 100% of NA. A and NA had similar daily energy intake. They did not differ as to the intake of calcium and vitamin D. We observed a negative correlation between the serum concentrations of sclerostin and calcium in the studied subjects. Our results suggest that regular, long-lasting physical training may be associated with higher concentration of sclerostin. It seems that increased sclerostin is not related to other bone turnover markers (PTH, P1NP).

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Vitamin D is synthesised in the skin during exposure to sunlight and its fundamental roles are the regulation of calcium and phosphate metabolism and bone mineralisation. The aim of our study was to evaluate serum levels of 25-hydroxyvitamin D3, PTH and bone turnover markers (P1NP, OC, beta-CTx, OC/beta-CTx) and the intake of calcium and vitamin D in Polish Professional Football League (Ekstraklasa) players and in young men with a low level of physical activity. Fifty healthy men aged 19 to 34 years were included in the study. We showed that 25(OH)D3 and P1NP levels and OC/beta-CTx were higher in the group of professional football players than in the group of physically inactive men. The daily vitamin D and calcium intake in the group of professional football players was also higher. We showed a significant relationship between 25(OH)D3 levels and body mass, body cell mass, total body water, fat-free mass, muscle mass, vitamin D and calcium intake. Optimum 25(OH)D3 levels were observed in a mere 16.7% of the football players and vitamin D deficiency was observed in the physically inactive men. The level of physical activity, body composition, calcium and vitamin D intake and the duration of exposure to sunlight may significantly affect serum levels of 25(OH)D3.

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Concentrations of numerous hormones decrease with age. Some authors imply that a syndrome of partial endocrine deficiency may occur in the aging men. Among many lifestyle factors that influence hormonal status is physical activity. Especially interesting are relations between physical activity and the androgenic/estrogenic status of men. The aim of this study was to evaluate age-related changes of serum androgens, estradiol and SHBG in men presenting different levels of physical activity. Hormonal parameters were measured in a cohort of 387 healthy Caucasian men (aged from 24 to 72 years) from one administrative region of Poland. Their level of physical activity was determined by means of the International Physical Activity Questionnaire (IPAQ). We have found that contrary to SHBG concentration, total testosterone, free testosterone, bioavailable testosterone, calculated free testosterone and estradiol were negatively associated with age in the investigated subjects. Apart from estradiol, physical activity did not influence concentrations of the studied parameters. In younger (24-48 years), physically active males estradiol was significantly higher than in subjects characterized by a low level of physical activity. The situation was opposite in older males (48-72 years). In this age group low level of physical activity was associated with lower concentration of estradiol. Undertaking physical effort increased the decline of estradiol level with age.

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AIM: Androgens influence human behavior. They affect sport performance, physical activity and emotional responses. CAG repeat polymorphism of androgen receptor (AR) gene is associated with transcriptional activity of AR. Decreased number of CAG repeats leads to increased androgen sensitivity. The purpose of this study was to investigate associations between AR CAG polymorphism and physical activity phenotype. METHODS: Within the framework of the HALS Study we randomly selected 900 adult Caucasian males from one administrative region of Poland (Lower Silesia). Eventually, AR CAG repeat was genotyped by a PCR based assay in 360 male subjects. International Physical Activity Questionnaire (IPAQ) was used to determine the level of physical activity of studied subjects. It was expressed as multiples of resting metabolic rate by minutes of performance during a week (METs-minute/week). RESULTS: No association between AR CAG repeat polymorphism and physical activity (P=0.2, ANOVA) was observed. Men with short CAG presented the lowest level of physical activity reaching 3.44 log (METs-minute/week) (SE 0.053; 95% CI, 3.34-3.54), while in men with medium and long CAG it was respectively 3.58 (SE 0.063; 95% CI, 3.46-3.71) and 3.52 (SE 0.039; 95% CI, 3.44-3.60) log (METs-minute/week). CONCLUSIONS: There is no association between AR CAG repeat polymorphism and the level of physical activity in healthy men.

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Physical activity is known to exert beneficial effects on general health status of young, adult and elderly populations. Exercise (aside from genetic, hormonal, nutritional and pathological factors) also influences bone mineral density (BMD). Unfortunately, the association between physical exercise and BMD in adult population is controversial. Our aim was to assess relations between recreational physical activity and BMD in middle-aged men. We performed densitometry and hormonal measurements (total testosterone, free testosterone, dehydroepiandrosterone sulfate, estradiol) in a homogenous group of 38 subjects. Among them, we distinguished 22 who had not engaged in any physical activity, and 16 who had recreationally exercised for about 10 years. Both groups did not differ in regard to hormonal status. Similarly, densitometry did not reveal any statistically significant differences in BMD between both groups of men. Upon our observation, we can hypothesize that recreational physical activity does not affect bone mineral density in middle-aged men.

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It is estimated that 80% of weight lifters and body-builders take anabolic-androgenic steroids. Their long-term use is associated with a variety of pathological conditions and premature death. Anabolic-androgenic steroid abuse may lead to changes in the presentation and progression of some conditions. It remains unclear whether anabolic steroids should be given to patients with a history of abuse of these drugs who are to undergo surgery. We report on a fatal outcome following surgery in a 48-year-old weight lifter.

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Many animal and human studies show that supraphysiological doses of dehydroepiandrosterone (DHEA) can influence body composition and carbohydrate and lipid metabolism. Most studies have concentrated on women and have not been randomized, thus creating controversial results. With this in mind, we designed a cross-over double-blind placebo-controlled study of 12 men aged 59.0 +/- 4.8 years, who received either 50 mg/24 h DHEA or placebo for 3 months to assess the influence of DHEA on the content and distribution of fat tissue and serum insulin, glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol levels, as well as testosterone, estradiol, DHEA-sulfate (S), prostate-specific antigen (PSA) concentrations and indexes of insulin sensitivity and resistance. Patients were recruited from university employees attending for periodic health checks, with normal hepatic and renal function with endogenous DHEA-S level < 1500 ng/dl. Our results did not reveal any significant changes in study parameters, apart from a statistically significant increase in DHEA-S levels after therapy with active substance.

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PRIMARY OBJECTIVE: An evaluation of relationships between bone density and blood pressure in healthy men. RESEARCH DESIGN: A cross-sectional population-based survey. METHODS AND PROCEDURES: An ethnically homogeneous sample of 208 men, aged 35-63, healthy and occupationally active inhabitants of the city of Wroclaw, Lower Silesia, Poland were studied. Trabecular, cortical and total bone mineral content (BMC) at the ultra-distal radius of the non-dominant hand were assessed by peripheral Quantitative Computed Tomography (pQCT: Stratec 960 apparatus). Body mass index (BMI) was used as a measure of general obesity. Systolic and diastolic blood pressure (BP) were measured using an MPC-350 sphygmomanometer. Multiple linear regression was used to evaluate the relationships between BP and BMC. A two-way analysis of covariance was carried out to test for the significance of inter-group differences in BMC with regard to age and BP with BMI as a contiuous covariable. Multiple logistic regression was used to verify whether some select factors (age, BMI, systolic and diastolic BP) could significantly predict male bone status. RESULTS: Systolic BP was not related to bone status at the ultra-distal radius. There were no differences in any BMC between systolic hyper- and normotensive subjects. Additionally, systolic hypertension did not affect the probability of an occurrence of male osteopenia (independently of age and BMI). In contrast, there were significant negative relationships between diastolic BP, and trabecular and total (but not cortical) BMC (even when controlled for age and BMI). Moreover, diastolic hypertensive men had reduced BMC at the ultra-distal radius when compared with normotensive subjects. It is noteworthy that Polish men of diastolic BP exceeding 90 mmHg had an approximately 1.50-fold increased relative risk of being osteopenic when compared with normotensive subjects (even when controlled for age, BMI and systolic BP). CONCLUSIONS: In the light of the inverse relationship between BMC and diastolic BP, Polish men with elevated diastolic BP seem to be more prone to the excessive age-related bone loss.

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Associations between fat accumulation and distribution and bone mineral status in men have not been comprehensively established, and available results are inconsistent. The aims of this study were as follows: (1) to evaluate relationships between anthropometric parameters of general obesity (body mass index, BMI) and fat distribution (waist/hip ratio, WHR) and bone mineral content (BMC), and (2) to compare BMC (a) between obese men (BMI >or= 27) and nonobese men and (b) between abdominally obese men (WHR >or= 0.95) and men without visceral adiposity, in a population-based sample of Polish men. The sample comprised a group of 272 men, aged 20-60, randomly selected from healthy and occupationally active inhabitants of Wroclaw, Lower Silesia, Poland. Trabecular, cortical and total BMC at the ultra-distal radius of the nondominant hand were assessed by pQCT using the Stratec 960 apparatus. BMI and WHR were used as parameters of general obesity and fat distribution, respectively. The relationships among the analysed variables were established using a multiple linear regression. The differences in BMC depending on BMI and WHR values were tested using an analysis of covariance (ancova). BMI was positively related only to trabecular BMC (r = 0.17; P = 0.03). Only trabecular BMC was higher in men with BMI >or= 27 compared to nonoverweight subjects (F = 5.38; P = 0.02). WHR was inversely related to trabecular (r = - 0.30; P < 0.001), cortical (r = - 0.30; P < 0.001) and total BMC (r = - 0.34; P < 0.001). All densitometric parameters were lower in males with WHR >or= 0.95 than in normal men (results of ancova: for trabecular BMC, F = 6.33, P = 0.01; for cortical BMC, F = 5.52, P = 0.02, and for total BMC, F = 7.73, P = 0.006). In the healthy Polish male population, BMI was of minor significance as a predictor of BMC at the ultra-distal radius, whereas visceral adiposity (assessed by WHR) was significantly linked to reduced bone mass in men.

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Age-related changes in the bone mineral content (BMC) of men are conditioned by both genetic and environmental factors distinctive for particular populations. This results in considerable differences between various populations concerning the prevalence of osteopenia and osteoporosis, and the occurrence of normal variability in BMC among adult and elderly men. The aim of the study was to evaluate the variation of BMC with age in an ethnically homogenous sample of 405 healthy men, aged 20-60 years, all occupationally active inhabitants of the city of Wroclaw, Lower Silesia, Poland. Trabecular and total BMC at the ultradistal radius of the nondominant hand were assessed by peripheral quantitative computerized tomography using the Stratec 960 densitometer. Among Polish men a distinct phase of maximal BMC values (around the age of 30) was distinguished, with a subsequent, quite rapid decline in bone mass. For example, the peak value of trabecular BMC decreased by approximately 13.2% per decade. In Polish men up to 30-34 years old trabecular and total BMC even exceeded reference values by 10%; however, from 35 years onwards their BMC was lower than standard values. This unfavourable phenomenon of BMC decline was augmented with age, and finally BMC values in men aged 55 and over were 30-35% lower than reference values. The significant discrepancies found between the data presented in this study and reference values probably result from inter-populational differences in the lifestyles of healthy ageing men. The results also confirm that bone density (with its age-related changes in the course of normal male ageing) is one of the biological features characteristic of this particular regional population.

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A case of 35-year-old woman with parathyroid cancer is presented. Five years ago she underwent surgery for follicular thyroid cancer. Parathyroid cancer was evidenced by palpable, solid, irregularly shaped cervical tumor 5 cm in diameter. The patient had severe hyperparathyroidism confirmed by biochemical findings of hypercalcemia reaching 16 mg%, hypophosphatemia and hyperphosphatasemia. Serum parathormone level was 23-fold higher than the norm. These findings were accompanied by polyuria, polidypsia, symptoms of bone damage and renal calcification. After the surgery the patient's condition improved significantly despite persistent hyperparathyroidism. The level of parathormone decreased, but was still 11 times higher than the norm. Two months after the surgery she noticed a single node on her neck. The patient was re-operated for recurrence of parathyroid cancer. Serum parathormone level was then 6-8 times above the norm. Medical treatment with furosemide, calcitonin and biphosphonate resulted in normalization of calcemia and phosphatemia. Further management will aim at localization of foci of hyperactive parathyroid tissue in order to enable radical reoperation. The case is reported because of rare occurrence of parathyroid carcinoma as well as because the carcinoma occurred in a patient who previously had follicular thyroid cancer. There are no reports of coexistence of these two neoplasms in available literature.

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We studied 40 chronic alcoholic men (aged 39 +/- 11) after alcohol withdrawal. We excluded in these patients severe internal organs disorders (first of all liver dysfunction) and seminal pathology. We analysed (in HCG test) plasma levels of: luteinizing hormone--LH, follicle stimulating hormone--FSH, total testosterone--T, free testosterone--fT, estradiol--E, 17-OH progesterone, sex hormone binding globulin--SHBG. Our results suggest: 1) decreased testicular reserve of free testosterone and normal level of total testosterone, 2) decreased initial level and functional reserve of 17-OH progesterone, 3) mild hyperoestrogenism, 4) no significant difference of LH, FSH, SHBG levels between alcoholics and controls, 5) these results were not changed after 6 months observation. These results indicate on subclinic alcoholic hypogonadism.

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Hypogonadism is one of the crucial risk factors for male osteopenia and osteoporosis. There are few studies on the effects of long-term and consistently administered testosterone substitutive therapy on bone mineral density in men with gonadal androgen deficiency, and their results have been susceptible to various interpretations. The aim of our study was an evaluation of bone mineral content in 26 men, aged 18-57 years, with hypergonadotrophic hypogonadism who underwent long-lasting androgen re-placement therapy with testosterone esters (Omnadren 250), which conditioned proper psychosomatic androgenization. The control group comprised 405 healthy men, aged 20-60 years, a representative sample of the local male population. Among all examined men and in the control group, trabecular, cortical and total bone mineral content at the distal radius of the nondominant hand were assessed by peripheral quantitative computed tomography using the Stratec 960 apparatus. In 11 hypogonadal men (42.3%), the trabecular bone mineral content was found to be within normal ranges; in 15 patients (57.7%) its values were below -1 standard deviation (SD) (osteopenia). In six patients (23.1%), the cortical bone mineral content was between +1 SD and the arithmetic mean, X; in 13 examined men (50%), the cortical bone mineral content was below X and above -1 SD. Osteopenia was diagnosed in six hypogonadal males, whereas osteoporosis was found in one man (cortical bone mineral content below -2.5 SD). Only in seven of the examined men (26.9%) was the total bone mineral content found within normal ranges, whereas in 19 men (73.1%) the total bone mineral content was below -1 SD (osteopenia). Despite the testosterone replacement in hypogonadal men, the greatest reduction of bone mineral content was found in its trabecular and total values. Among all the men examined, the trabecular and total bone mineral contents were below the mean of our own reference values. The results show that long-term and consecutively administered testosterone replacement in conventional doses, despite the normalization of serum androgen levels and the promotion of proper somatic development, does not simultaneously eliminate hypogonadal osteopenia in every case. The individually differentiated response to exogenous androgens is a characteristic feature of male hypogonadism. This study emphasizes the necessity of regular measurements of bone mineral density in hypogonadal men, as the densitometric parameters should be accepted as an osteologic (and very important) marker of androgenization of the male organism.

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Anabolic-androgenic steroid (AAS) withdrawal is established to be an important, though poorly known medical problem, because of AAS potency to cause physical and psychological dependence. Thus discontinuation of high-dose, long-term anabolic steroid use, apart from endocrine dysfunction (hypogonadotropic hypogonadism), may lead to development of withdrawal symptoms. They include mood disorders (with suicidal depression as the most life-threatening complication), insomnia, anorexia, decreased libido, fatigue, headache, muscle and joint pain, and desire to take more steroids. The withdrawal from anabolic steroids usually requires treatment. Clinical management, as with other drugs of abuse, consists of supportive therapy and pharmacotherapy. The goals of treatment are to restore endocrine (hypothalamic-pituitary-gonadal, HPG) function and to alleviate withdrawal symptoms. The endocrine medications that are targeted specifically to ameliorate HPG function include testosterone esters, human chorionic gonadotropin, synthetic analogues of gonadotropin-releasing hormone and antiestrogens. They are indicated in the presence of persistent clinical symptoms or/and laboratory evidence of HPG dysfunction. Other medications, that are targeted to provide symptomatic relief include antidepressants (especially serotonin selective re-uptake inhibitors), nonsteroidal anti-inflammatory drugs and clonidine. Notwithstanding, it should be remembered that many of the above mentioned drugs have their own potential for abuse or side-effects, so their use must be carefully weighted and optimal treatment strategies for AAS withdrawal must await further clinical research.

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Both clinical observations and in vitro studies reveal that sex steroids are essential factors affecting body fat accumulation and distribution of healthy men. An excessive adiposity and visceral obesity are frequently accompanied by an adrenal and gonadal andropenia among men aged 50 and over. The relationships between an age-related increase in BMI and WHR values and an altered androgen-estrogen activity in the course of normal male aging have not been firmly established, as not all studies have thus far produced consistent results. The effects of androgen substitutive therapy (testosterone and dehydroepiandrosterone) in elderly men suggest the possible relationship between androgens and male visceral adiposity; unfortunately the results of available studies on that issue are also not consistent. Therefore, nowadays there is an urgent need to comprehensively establish the androgen contribution in the pathogenesis of male visceral obesity.

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Basing on data from the literature authors present possible relation between seminal plasma levels of testosterone and dihydrotestosterone and disturbances of spermatogenesis. Review of the literature shows that androgens present in the seminal fluid may influence final seminal parameters and sperm fertilizing capacity. Most findings indicate that DHT is the androgen most closely related to spermquality. Many studies confirm that DHT concentration in sperm is significantly lower in infertile men affected by azoospermia or oligozoospermia and also in men with varicoceles. Improvement of seminal parameters and increase of DHT seminal plasma level was observed after varicocelectomy. The data shows that DHT values in ejaculate were lower in men with varicoceles and DHT seminal plasma levels increased in men whose sperm parameters improved after varicocelectomy. Several authors suggest that the low concentration of DHT in sperm could be a marker of azoospermia of obstructive origin. Positive correlation between DHT level in seminal plasma and sperm motility was also observed. In most of research there was no correlation between testosterone concentration in seminal fluid and sperm motility. A few authors reported that there was no difference in testosterone level in normo-, oligo- and azoospermic men, but recent studies indicate that the concentrations of both testosterone and dihydrotestosterone are significantly lower in samples from patients with abnormal sperm characteristics than in men with normozoospermia. Some investigators have suggested that an appropriate ratio of free testosterone to free estradiol in semen may be crucial in the processes that lead to fertilization and that there is no correlation between sperm density and level of testosterone in seminal plasma. Authors of the article emphasize that measurement of androgen in seminal plasma and usefulness of these parameters in clinical practice are underestimated.

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Certain elements of lifestyles (distinctive for the particular population) are presumed to influence on bone metabolism. This fact results in considerable differences between various populations, concerning both the occurrence of the normal variability of BMD (bone mineral content) among adult and elderly men and women, and also the prevalence of osteopenia or osteoporosis. The purpose of the study was to evaluate the variability of BMD in a group of healthy and occupationally active inhabitants of the city of Wroclaw, Poland (426 men aged 20-59 and 1218 women aged 20-62) and to compare our results with the reference ranges provided by the producer of the Stratec 960 apparatus. Trabecular and total BMD at the distal radius of the nondominant hand were assessed by peripheral Quantitative Computed Tomography (pQCT) using the Stratec 960 apparatus. BMD of Polish men and women significantly differ from the reference ranges of Stratec 960. The unfavourable phenomenon of the greater BMD decline with age, as compared to the standard values provided by the producer of the device, occurred. It should also be stressed that this reduction is more intense with age and it is marked among men older than 36. Taking into consideration the fact, that our material comprises only occupationally active subjects, the revealed differences would be probably greater, if they were evaluated in Polish population as a whole (our sample does not include persons, who are retired from the healthy conditions). Considering those significant discrepancies between our data and the Stratec reference population, one should be careful when using the normative database provided by Stratec for the densitometric diagnosis of osteoporosis among Polish women and men. Additionally the present study reveals that BMD (and its age-related changes during normal aging) is one of the features characteristic for the particular regional population, which is due to inter-populational differences of those elements of lifestyle, which can influence both general health condition and bone mineral density.

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