Bone mineral density in complete androgen insensitivity syndrome and the timing of gonadectomy

Abstract

Objective

Low bone mineral density (BMD) has been reported in complete androgen insensitivity syndrome (CAIS), but the impact of timing of gonadectomy is not known. We aimed to assess the relationship between age of gonadectomy and BMD in women with CAIS.

Design

Retrospective analysis of pre- and post-gonadectomy parameters in women with CAIS attending an adult Disorders of Sex Development (DSD) clinic in a tertiary centre.

Patients

One hundred and thirteen women with CAIS.

Measurements

Dual-energy x-ray absorptiometry (DXA) before and after gonadectomy; and pre-gonadectomy hormone profile.

Results

Mean BMD was reduced (95%CI); T-score -1.34 (-1.55 to -1.13; P < 0.001) at the lumbar spine and -0.3 (-0.49 to -0.12; P = 0.001) at the hip. There was no relationship between age of gonadectomy and BMD. Thirty-two subjects had BMD measured before or within 2 years of gonadectomy, and mean BMD was reduced (95%CI) at the lumbar spine; T-score: -1.05 (-1.54 to -0.57; P < 0.001), but was normal at the hip; T-score -0.04 (-0.35 to 0.28; P = 0.8). There was no relationship between BMD and history of hernia, testosterone, oestradiol or follicle stimulating hormone levels. Twelve subjects had DXA both before and after gonadectomy, and after 4.3 (1.7 to 12.8) years there was no change in BMD.

Conclusions

We found reduced BMD at the spine and hip in subjects with CAIS. We found no relationship between age of gonadectomy and BMD, and we also found no drop in BMD in subjects followed up after gonadectomy.

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