Long-Term Impact of Primary Medical and Surgical Therapy on Bone Mineral Density in Men versus Women with Prolactinomas

Aims: Studies on the prevalence of pathological bone mineral densities (pBMD) in large cohorts of men and women with prolactinomas treated either primary surgically or medically are scarce. In the present study, we aimed at comparing the impact of the two therapeutic approaches on bone density in both sexes.

Methods: This cohort study included all consecutive prolactinoma patients with osteodensitometric data at study entry and at long-term follow-up (≥ 12 months). BMD was assessed by dual-energy X-ray absorptiometry. The primary end point was the impact of either approach on the prevalence of pBMD in both sexes. The secondary end point was the assessment of risk factors for long-term pBMD.

Results: One hundred patients (40 men, 60 women) met inclusion criteria. At baseline, men had a significantly higher prevalence of pBMD than women (28 vs 2%, p < 0.001). Primary medical therapy was considered in 47 and first-line surgery in 53 patients. Median duration of follow-up was 79 months (range, 13–408 months). Long-term prolactin values significantly decreased in both groups regardless of the primary treatment, with a persistent need for DA-agonists in 75% of men compared with 42% of the women (p = 0.001). The prevalence of pBMD in men remained significantly higher than in women (37% vs 7%, p < 0.001), independent of the primary treatment strategy. Persistent hyperprolactinemia and male sex were independent risk factors for pBMD at last follow-up in prolactinoma patients.

Conclusions: The prevalence of pBMD in men remains significantly higher than in women, independent of the primary treatment strategy. Osteoporosis prevention and treatment mainly focus on women, but bone loss in men with prolactinomas should not be underestimated. A pBMD as “end organ damage” reflects the full range of the disease and might become a surrogate marker for the severity of long-lasting hyperprolactinemia.