Pubertal Jinekomasti Olgularında Tamoxifen Tedavisinin Pubertal Kemik Gelişimi Üzerindeki Etkisi

Abstract

During puberty in both sexes endogeneous estrogen has a biphasic effect on epiphyses where at low levels it leads to an increase in height and bone mass whereas with higher levels this leads to closure of the epiphyses. In male adolescents the peak of pubertal bone development occurs during Tanner stage 3-4 and this is also when pubertal gynecomastia is at its highest prevalence. Tamoxifen is a selective estrogen receptor modulator, which has been shown to be successful in the treatment of pubertal gynecomastia but its effect on pubertal bone development are unknown. The aim of this study was to asses the possible positive or negative effects of tamoxifen on BMD (Bone mineral density) and skeletal maturation when used for the treatment of pubertal gynecomastia. We retrospectively evaluated the charts of 20 cases with pubertal gynecomastia that had been taking tamoxifen for at least 4 months. BMD measured with dual-energy x-ray absorptiometry at the lumbar vertebrae and left proximal femur, z-score and absolute BMD (gr/cm2) was determined at baseline and 2 months after completing tamoxifen treatment. Additionally bone age and height was evaluated before treatment and then again one year later. Using absolute BMD (g/cm2) the mean difference from baseline was significant between the two groups at both spine (p=0,002) and femur (p=0,001), but not with the z-score. This result was attributed to the expected increase during puberty according to sex and age. We found no significant effect on skeletal maturation (p=1,112). In conclusion our findings suggest bone mineralization in adolescent males is not effected by tamoxifen treatment and it does not limit growth potential, the study shows that tamoxifen is not only effective but also safe when bone development is concerned.