Bone Health in Endocrine Diseases Associated with Androgen Excess: A Narrative Review

Introduction: Osteoporosis is humans' most common bone tissue disease that causes bone fractures. Based on the evidence, a combination of genetic and environmental factors, hormonal disorders such as estrogen deficiency, malnutrition, inflammatory factors, drugs, and physical inactivity are related to the pathogenesis of this disease. The present study aimed to review the effects of androgens and some endocrine diseases associated with androgen excess on bone health. PubMed and Scopus databases were searched to retrieve related articles, using the following keywords (“polycystic ovary syndrome” OR PCOS OR “cushing syndrome” OR “congenital adrenal hyperplasia” OR CAH) AND (Bone OR fracture OR osteoporosis OR osteopenia). Androgens are essential for the growth and maintenance of bone mass. Despite the positive effects of androgens on bone, a decrease in bone mineral density, osteoporosis, and an increased risk of fractures have been reported in patients with endocrine diseases exposed to androgen excess, including polycystic ovary syndrome, congenital adrenal hyperplasia, and cushing's syndrome. Decreased bone quality in these patients can be due to other associated factors, such as insulin resistance, obesity, increased inflammatory factors, gut microbiota dysbiosis, glucocorticoid therapy, and increased cortisol levels. In addition, long-term exposure to supraphysiologic doses of androgens may adversely affect bone health in these patients. Therefore, bone health in these patients should be carefully monitored, and preventive or therapeutic interventions should be taken for osteoporosis and fractures.