Treatments given to cancer patients can cause negative side effects. For example, a treatment known as androgen deprivation therapy – which is used to reduce male sex hormone levels in prostate cancer patients – can lead to increased body fat percentage and decreased bone density. These adverse effects can have further negative impacts on patient health, such as increasing the risk of cardiovascular disease and fractures from falls from standing height or less, respectively. Understanding how androgen deprivation therapy contributes to these negative side effects may help clinicians better manage care and outcomes for patients with prostate cancer.

Follicle stimulating hormone (or FSH for short) has roles in male and female reproduction but has also been linked to changes in body composition. For example, elevated FSH levels are associated with higher total fat body mass in post-menopausal women. While androgen deprivation therapy is known to alter FSH blood levels, the impact of this change in prostate cancer patients was not well understood.

To investigate the effect of androgen deprivation therapy on FSH levels and body composition, Bergamini et al. used X-ray technology to measure total fat body mass in prostate cancer patients before and after undergoing 12 months of androgen deprivation therapy. The findings showed that patient FSH blood levels significantly decreased after 12 months of treatment. Higher FSH blood levels strongly correlated with increased total fat body mass after 12 months of treatment.

The findings of this clinical trial suggest that FSH blood levels impact the body composition of patients undergoing androgen deprivation therapy. As a result, FSH blood levels may be a suitable biomarker for identifying patients that are more likely to develop obesity and are therefore at greater risk of complications such as cardiovascular disease.

Recent preclinical and clinical studies have shown that follicle-stimulating hormone (FSH) exerts effects beyond those on gonadal tissue, which have been known for a long time (Lizneva et al., 2019). In the animal model, FSH has been observed to stimulate osteoclastic activity and therefore to exert a negative role on bone mass (Sun et al., 2006; Zaidi et al., 2023; Gera et al., 2022). Furthermore, FSH was found to have a positive action on adipocytes and the blockade of FSH induced by antibodies against FSH receptor caused an increase in bone mass and a reduction of body fat (Liu et al., 2017; Rojekar et al., 2023). These preclinical data were confirmed in clinical studies. Large epidemiologic data have shown significant reductions in bone mineral density (BMD) and high resorption rates 2–3 years prior to menopause, when FSH serum levels are increasing, which is also associated with increased body weight and visceral adiposity (Thurston et al., 2009; Senapati et al., 2014). A longitudinal study involving post-menopausal women has shown that increases in circulating FSH levels were associated with greater increases in the percentage of total body fat, total body fat mass, and subcutaneous adipose tissue (Mattick et al., 2022). Moreover, clinical studies have found that FSH is also involved in the modulation of lean mass. A large cohort study of perimenopausal women showed that increased FSH concentrations were associated with increasing fat mass and decreasing lean mass measured by bioelectrical impedance analysis (Sowers et al., 2007). Another recent prospective study showed that the indicators of sarcopenia were strongly associated with gonadotropins levels, especially in older men (Guligowska et al., 2021). The impact of FSH on body composition may at least partially explain the observed correlation between FSH levels and the risk of cardiovascular events (Munir et al., 2012; Silva et al., 2013; El Khoudary et al., 2016).

Studies clarifying the relationship among FSH, body composition measures, and BMD in prostate cancer (PC) patients are lacking. Likewise, the interaction between the variation of FSH serum levels and the modification of these parameters in PC patients undergoing androgen deprivation therapy (ADT) is not known.

We recently conducted the BLADE study (Bone mineraL mAss Dexa dEgarelix), a prospective phase IV study designed to obtain explorative information on dual-energy x-ray absorptiometry (DXA) measurement changes in lean body mass (LBM) and fat body mass (FBM) in patients with non-metastatic PC treated with degarelix, an LHRH (luteinizing hormone-releasing hormone) antagonist that has been developed to achieve effective long-term medical castration without the risk of testosterone surge and its associated flare. Data on changes in total LBM and FBM and on the impact of degarelix on BMD and bone turnover markers were recently published (Palumbo et al., 2021; Palumbo et al., 2022).

Here, we analyse the association of FSH with DXA-assessed FBM, LBM, and BMD and bone turnover markers at baseline and after degarelix administration in the patients enrolled in the BLADE study.

Twenty-nine patients were included in the BLADE study and their characteristics have been described elsewhere (Palumbo et al., 2022). The consort diagram is reported in supplementary material (Figure 1—figure supplement 1). An outlier value of FSH after 12 months was removed from the analysis. Mean FSH serum levels at baseline conditions were 11.9 UI/l (95% confidence intervals [CIs]: 7.6–16.3). Mean FSH serum levels significantly decreased to 1.45 UI/l (95% CIs: 1.01–1.89) after 6 months of degarelix treatment and to 2.4 UI/l (95% CIs: 1.4–3.4) after 12 months. The corresponding percent changes were −77.59% (95% CIs: −86.20 to −68.87) and −59.7% (95% CIs: −80.3 to −39.1, p < 0.001) (Figure 1). Data on changes in body composition parameters, BMD, and bone turnover markers have been published elsewhere (Palumbo et al., 2021; Palumbo et al., 2022; Dalla Volta et al., 2024). Correlations between FSH changes and changes in body composition parameters, BMD, and bone turnover markers were not statistically significant, so these data are not presented.

Figure 1 with 1 supplement see all

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Figure 1—source data 1

Data are from BLADE study database.

https://cdn.elifesciences.org/articles/92655/elife-92655-fig1-data1-v1.xls

Download elife-92655-fig1-data1-v1.xls

Relationship between FSH serum levels and body composition, BMD, and bone turnover markers after 12 months of degarelix treatment

The correlation between circulating FSH levels at 6 and 12 months, bone turnover markers evaluated at the same time, BMD and body composition parameters assessed after 12 months is shown in Table 2. FSH serum levels assessed after 6 months of degarelix administration showed a direct relationship with total FBM (r = 0.49, p = 0.008) and with fat mass evaluated at arms (r = 0.53, p = 0.004), trunk (r = 0.48, p = 0.009), and legs (r = 0.45, p = 0.015). In contrast, FSH serum levels after 6 months of treatment showed an inverse relationship with ALMI/FBM ratio (r = −0.58, p = 0.001). FSH measured after 12 months maintained a significant relationship with total FBM (r = 0.52, p = 0.006) (Figure 2a), fat mass at arms (r = 0.54, p = 0.004) (Figure 2b), and fat mass at trunk (r = 0.45, p = 0.018) (Figure 2c). The relationship between FSH and fat mass at legs lost the statistical significance (r = 0.33, p = 0.089), while the inverse relationship with ALMI/FBM ratio was confirmed (r = −0.64, p = 0.001) (Figure 2d).

Figure 2

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Table 2

FSH at 6 months			FSH at 12 months
	Correlation coefficient	p	Correlation coefficient	p
TOT BMD	−0.039	0.843	−0.107	0.595
BMD L2–L4	0.102	0.604	−0.040	0.844
BMD LEFT HIP	0.030	0.881	−0.044	0.829
CTX	0.051	0.796	0.055	0.785
BONE ALP	0.174	0.376	0.227	0.256
TOT fat (g)	0.490	0.008	0.518	0.006
Arm fat (g)	0.532	0.004	0.541	0.004
Leg fat (g)	0.454	0.015	0.328	0.089
Head fat (g)	0.187	0.341	0.093	0.644
Trunk fat (g)	0.483	0.009	0.452	0.018
TOT lean (g)	0.029	0.885	−0.036	0.859
Arm lean (g)	0.041	0.837	0.028	0.889
Leg lean (g)	−0.176	0.371	−0.285	0.149
Head lean (g)	0.086	0.663	−0.006	0.977
Trunk lean (g)	0.161	0.414	0.021	0.916
ALMI (appendicular lean/Ht2)	−0.229	0.241	−0.265	0.181
ALMI/FBM	−0.581	0.001*	−0.604	0.001*
Android/gynoid ratio	0.142	0.472	0.231	0.246

1. Data are Spearman R.

2. Bold values are those attaining statistical significance.

3. *

   Still significant after Bonferroni correction.

4. FSH: follicle-stimulating hormone; TOT: total; BMD: bone mineral density; CTX: C-terminal telopeptide of type I collagen; ALP: alkaline phosphatase; ALMI: appendicular lean mass index; Ht²: height squared; FBM: fat body mass.

ADT in PC patients leads to an increase in fat mass and to a decrease in lean mass, thus increasing the risk of sarcopenic obesity. In addition, ADT has also a negative impact on skeletal fragility, which increases the risk of fractures. During the recent years, there has been consistent evidence that alterations in body composition could contribute to determine skeletal fragility in patients under ADT, such as well demonstrated in other forms of male hypogonadism (Vena et al., 2023). However, the determinants of altered body composition in male hypogonadism and in ADTs have not been completely defined. As a matter of fact, low testosterone values do not seem to be the only determinant of sarcopenic obesity in males with hypogonadism. In this context, FSH values might play a role. In fact, among its extragonadal effects, FSH directly affects adipogenesis, lean mass and bone turnover (Liu et al., 2017; Rojekar et al., 2023; Zaidi et al., 2023; Gera et al., 2022).

As demonstrated in other studies prospectively evaluating circulating FSH levels after treatment with LHRH agonists and antagonists (Klotz et al., 2008), degarelix administration consistently reduced FSH values, although values might be variable among individuals under ADT. In this context, it is reasonable to hypothesize that variable values of FSH might directly influence body composition and skeletal fragility.

This ancillary analysis of the BLADE study shows that higher serum levels of FSH during degarelix treatment were significantly associated with higher total, limbs, and trunk fat mass. Moreover, higher FSH values under ADT were associated with lower ALMI/FBM ratio, a parameter that identifies patients at high risk for sarcopenic obesity. We can infer therefore that the effect was caused by the direct relationship of FBM since there was no correlation between lean mass and FSH in this study. These associations were not significant before starting degarelix, suggesting that sex hormones might counteract FSH effect on body composition at baseline conditions, whereas this effect becomes more evident after ADT. According to these data, small changes in FSH can result in significant changes in body composition in a condition of androgen and estrogen deprivation. However, since sex hormones were not measured in our patients, it was unclear whether the possible variability in testosterone values during degarelix treatment (Kamada et al., 2024) might have influenced the detrimental effects of FSH and body composition. Indeed, the protocol of BLADE study did not include measurement of testosterone values, since radioimmunoassay and chemiluminescence assay used in clinical practice could overestimate testosterone levels in majority of patients under ADTs, leaving a concern of misdiagnosing truly castrate patients as being inadequately treated (Tiwari et al., 2022).

It is known that one of the most noticeable differences of LHRH antagonists compared to LHRH agonists are FSH levels during therapy, which are mildly higher with LHRH agonists compared to LHRH antagonists. According to our data, PC patients treated with LHRH antagonists may experience less body composition changes due to lower FSH residual values (Klotz et al., 2008; Margel et al., 2019; Abufaraj et al., 2021).

Unlike other settings, FSH values before and after degarelix did not correlate with either BMD or bone turnover markers.

To our knowledge, this is the first study showing an association between circulating FSH levels and body composition in PC patients undergoing ADT. However, this study suffers from all the limitations of ancillary studies. Therefore, the results obtained are to be considered as hypothesis generating and cannot be generalized.

In conclusion, the findings of this study suggest that FSH serum levels after ADT could impact body composition – FBM in particular – in PC patients undergoing ADT.

Of course further investigation is required to establish the association between FSH serum levels, measured during ADT, and sarcopenic obesity risk in PC patients. However, this is an area of great interest.

FSH could be a promising marker in monitoring PC patients during ADT in order to identify those who are more vulnerable and at greater risk of alterations in body composition, which can be captured and measured reliably by DXA (Mazziotti et al., 2024).

All data generated or analysed during this study are included in the manuscript. Source data have been provided in an excel file labelled Source data 1.

1. 1. Abufaraj M
   2. Iwata T
   3. Kimura S
   4. Haddad A
   5. Al-Ani H
   6. Abusubaih L
   7. Moschini M
   8. Briganti A
   9. Karakiewicz PI
   10. Shariat SF

   (2021) Differential impact of gonadotropin-releasing hormone antagonist versus agonist on clinical safety and oncologic outcomes on patients with metastatic prostate cancer: A meta-analysis of randomized controlled trials

   European Urology 79:44–53.

   https://doi.org/10.1016/j.eururo.2020.06.002

   • PubMed
   • Google Scholar
2. 1. Buckinx F
   2. Landi F
   3. Cesari M
   4. Fielding RA
   5. Visser M
   6. Engelke K
   7. Maggi S
   8. Dennison E
   9. Al-Daghri NM
   10. Allepaerts S
   11. Bauer J
   12. Bautmans I
   13. Brandi ML
   14. Bruyère O
   15. Cederholm T
   16. Cerreta F
   17. Cherubini A
   18. Cooper C
   19. Cruz-Jentoft A
   20. McCloskey E
   21. Dawson-Hughes B
   22. Kaufman JM
   23. Laslop A
   24. Petermans J
   25. Reginster JY
   26. Rizzoli R
   27. Robinson S
   28. Rolland Y
   29. Rueda R
   30. Vellas B
   31. Kanis JA

   (2018) Pitfalls in the measurement of muscle mass: a need for a reference standard

   Journal of Cachexia, Sarcopenia and Muscle 9:269–278.

   https://doi.org/10.1002/jcsm.12268

   • PubMed
   • Google Scholar
3. 1. Cornford P
   2. Bellmunt J
   3. Bolla M
   4. Briers E
   5. De Santis M
   6. Gross T
   7. Henry AM
   8. Joniau S
   9. Lam TB
   10. Mason MD
   11. van der Poel HG
   12. van der Kwast TH
   13. Rouvière O
   14. Wiegel T
   15. Mottet N

   (2017) Eau-estro-siog guidelines on prostate cancer: part ii: treatment of relapsing, metastatic, and castration-resistant prostate cancer

   European Urology 71:630–642.

   https://doi.org/10.1016/j.eururo.2016.08.002

   • PubMed
   • Google Scholar
4. 1. Dalla Volta A
   2. Palumbo C
   3. Zamboni S
   4. Mazziotti G
   5. Triggiani L
   6. Zamparini M
   7. Maffezzoni F
   8. Rinaudo L
   9. Bergamini M
   10. Di Meo N
   11. Caramella I
   12. Valcamonico F
   13. Borghetti P
   14. Guerini A
   15. Farina D
   16. Antonelli A
   17. Simeone C
   18. Berruti A

   (2024) Heterogeneity in regional changes in body composition induced by androgen deprivation therapy in prostate cancer patients: potential impact on bone health-the BLADE study

   Journal of Endocrinological Investigation 47:335–343.

   https://doi.org/10.1007/s40618-023-02150-z

   • PubMed
   • Google Scholar
5. 1. El Khoudary SR
   2. Santoro N
   3. Chen HY
   4. Tepper PG
   5. Brooks MM
   6. Thurston RC
   7. Janssen I
   8. Harlow SD
   9. Barinas-Mitchell E
   10. Selzer F
   11. Derby CA
   12. Jackson EA
   13. McConnell D
   14. Matthews KA

   (2016) Trajectories of estradiol and follicle-stimulating hormone over the menopause transition and early markers of atherosclerosis after menopause

   European Journal of Preventive Cardiology 23:694–703.

   https://doi.org/10.1177/2047487315607044

   • PubMed
   • Google Scholar
6. 1. Gera S
   2. Kuo TC
   3. Gumerova AA
   4. Korkmaz F
   5. Sant D
   6. DeMambro V
   7. Sudha K
   8. Padilla A
   9. Prevot G
   10. Munitz J
   11. Teunissen A
   12. van Leent MMT
   13. Post T
   14. Fernandes JC
   15. Netto J
   16. Sultana F
   17. Shelly E
   18. Rojekar S
   19. Kumar P
   20. Cullen L
   21. Chatterjee J
   22. Pallapati A
   23. Miyashita S
   24. Kannangara H
   25. Bhongade M
   26. Sengupta P
   27. Ievleva K
   28. Muradova V
   29. Batista R
   30. Robinson C
   31. Macdonald A
   32. Hutchison S
   33. Saxena M
   34. Meseck M
   35. Caminis J
   36. Iqbal J
   37. New MI
   38. Ryu V
   39. Kim SM
   40. Cao JJ
   41. Zaidi N
   42. Fayad ZA
   43. Lizneva D
   44. Rosen CJ
   45. Yuen T
   46. Zaidi M

   (2022) FSH-blocking therapeutic for osteoporosis

   eLife 11:e78022.

   https://doi.org/10.7554/eLife.78022

   • PubMed
   • Google Scholar
7. 1. Guligowska A
   2. Chrzastek Z
   3. Pawlikowski M
   4. Pigłowska M
   5. Pisarek H
   6. Winczyk K
   7. Kostka T

   (2021) Gonadotropins at advanced age - perhaps they are not so bad? Correlations between gonadotropins and sarcopenia indicators in older adults

   Frontiers in Endocrinology 12:797243.

   https://doi.org/10.3389/fendo.2021.797243

   • PubMed
   • Google Scholar
8. 1. Kamada S
   2. Sakamoto S
   3. Kinoshita R
   4. Zhao X
   5. Kamasako T
   6. Yamase R
   7. Junryo R
   8. Saito S
   9. Sangjon P
   10. Takei A
   11. Yamada Y
   12. Goto Y
   13. Imamura Y
   14. Iguchi T
   15. Mizokami A
   16. Suzuki H
   17. Akakura K
   18. Ichikawa T

   (2024) Testosterone bounce predicts favorable prognoses for prostate cancer patients treated with degarelix

   The Prostate 01:4679.

   https://doi.org/10.1002/pros.24679

   • PubMed
   • Google Scholar
9. 1. Klotz L
   2. Boccon-Gibod L
   3. Shore ND
   4. Andreou C
   5. Persson BE
   6. Cantor P
   7. Jensen JK
   8. Olesen TK
   9. Schröder FH

   (2008) The efficacy and safety of degarelix: a 12-month, comparative, randomized, open-label, parallel-group phase III study in patients with prostate cancer

   BJU International 102:1531–1538.

   https://doi.org/10.1111/j.1464-410X.2008.08183.x

   • PubMed
   • Google Scholar
10. 1. Liu P
    2. Ji Y
    3. Yuen T
    4. Rendina-Ruedy E
    5. DeMambro VE
    6. Dhawan S
    7. Abu-Amer W
    8. Izadmehr S
    9. Zhou B
    10. Shin AC
    11. Latif R
    12. Thangeswaran P
    13. Gupta A
    14. Li J
    15. Shnayder V
    16. Robinson ST
    17. Yu YE
    18. Zhang X
    19. Yang F
    20. Lu P
    21. Zhou Y
    22. Zhu LL
    23. Oberlin DJ
    24. Davies TF
    25. Reagan MR
    26. Brown A
    27. Kumar TR
    28. Epstein S
    29. Iqbal J
    30. Avadhani NG
    31. New MI
    32. Molina H
    33. van Klinken JB
    34. Guo EX
    35. Buettner C
    36. Haider S
    37. Bian Z
    38. Sun L
    39. Rosen CJ
    40. Zaidi M

    (2017) Blocking FSH induces thermogenic adipose tissue and reduces body fat

    Nature 546:107–112.

    https://doi.org/10.1038/nature22342

    • PubMed
    • Google Scholar
11. 1. Lizneva D
    2. Rahimova A
    3. Kim SM
    4. Atabiekov I
    5. Javaid S
    6. Alamoush B
    7. Taneja C
    8. Khan A
    9. Sun L
    10. Azziz R
    11. Yuen T
    12. Zaidi M

    (2019) Fsh beyond fertility

    Frontiers in Endocrinology 10:136.

    https://doi.org/10.3389/fendo.2019.00136

    • PubMed
    • Google Scholar
12. 1. Margel D
    2. Peer A
    3. Ber Y
    4. Shavit-Grievink L
    5. Tabachnik T
    6. Sela S
    7. Witberg G
    8. Baniel J
    9. Kedar D
    10. Duivenvoorden WCM
    11. Rosenbaum E
    12. Pinthus JH

    (2019) Cardiovascular morbidity in a randomized trial comparing gnrh agonist and gnrh antagonist among patients with advanced prostate cancer and preexisting cardiovascular disease

    The Journal of Urology 202:1199–1208.

    https://doi.org/10.1097/JU.0000000000000384

    • PubMed
    • Google Scholar
13. 1. Mattick LJ
    2. Bea JW
    3. Singh L
    4. Hovey KM
    5. Banack HR
    6. Wactawski-Wende J
    7. Manson JE
    8. Funk JL
    9. Ochs-Balcom HM

    (2022) Serum follicle-stimulating hormone and 5-year change in adiposity in healthy postmenopausal women

    The Journal of Clinical Endocrinology and Metabolism 107:e3455–e3462.

    https://doi.org/10.1210/clinem/dgac238

    • PubMed
    • Google Scholar
14. 1. Mazziotti G
    2. Lania AG
    3. Laganà M
    4. Berruti A

    (2024) Prediction of fragility fractures in men with prostate cancer under androgen deprivation therapy: the importance of a multidisciplinary approach using a mini-invasive diagnostic tool

    Endocrine 83:594–596.

    https://doi.org/10.1007/s12020-023-03613-2

    • PubMed
    • Google Scholar
15. 1. Mottet N
    2. Bellmunt J
    3. Bolla M
    4. Briers E
    5. Cumberbatch MG
    6. De Santis M
    7. Fossati N
    8. Gross T
    9. Henry AM
    10. Joniau S
    11. Lam TB
    12. Mason MD
    13. Matveev VB
    14. Moldovan PC
    15. van den Bergh RCN
    16. Van den Broeck T
    17. van der Poel HG
    18. van der Kwast TH
    19. Rouvière O
    20. Schoots IG
    21. Wiegel T
    22. Cornford P

    (2017) Eau-estro-siog guidelines on prostate cancer part 1: screening, diagnosis, and local treatment with curative intent

    European Urology 71:618–629.

    https://doi.org/10.1016/j.eururo.2016.08.003

    • PubMed
    • Google Scholar
16. 1. Munir JA
    2. Wu H
    3. Bauer K
    4. Bindeman J
    5. Byrd C
    6. Feuerstein IM
    7. Villines TC
    8. Taylor AJ

    (2012) The perimenopausal atherosclerosis transition: relationships between calcified and noncalcified coronary, aortic, and carotid atherosclerosis and risk factors and hormone levels

    Menopause 19:10–15.

    https://doi.org/10.1097/gme.0b013e318221bc8d

    • PubMed
    • Google Scholar
17. 1. Palumbo C
    2. Antonelli A
    3. Triggiani L
    4. Dalla Volta A
    5. Maffezzoni F
    6. Zamboni S
    7. Borghetti P
    8. Rinaudo L
    9. Valcamonico F
    10. Maroldi R
    11. Magrini SM
    12. Simeone C
    13. Berruti A
    14. Francavilla S
    15. Furlan M
    16. Gheza A
    17. Veccia A
    18. Guerini A
    19. Collaborators

    (2021) Changes in body composition and lipid profile in prostate cancer patients without bone metastases given degarelix treatment: the blade prospective cohort study

    Prostate Cancer and Prostatic Diseases 24:852–859.

    https://doi.org/10.1038/s41391-021-00345-0

    • PubMed
    • Google Scholar
18. 1. Palumbo C
    2. Dalla Volta A
    3. Zamboni S
    4. Mazziotti G
    5. Zamparini M
    6. Triggiani L
    7. Borghetti P
    8. Maffezzoni F
    9. Bresciani R
    10. Rinaudo L
    11. Valcamonico F
    12. Farina D
    13. Magrini SM
    14. Antonelli A
    15. Simeone C
    16. Berruti A

    (2022) Effect of degarelix administration on bone health in prostate cancer patients without bone metastases: the blade study

    The Journal of Clinical Endocrinology and Metabolism 107:3398–3407.

    https://doi.org/10.1210/clinem/dgac489

    • PubMed
    • Google Scholar
19. 1. Perneger TV

    (1998) What’s wrong with bonferroni adjustments

    BMJ 316:1236–1238.

    https://doi.org/10.1136/bmj.316.7139.1236

    • PubMed
    • Google Scholar
20. 1. Rojekar S
    2. Pallapati AR
    3. Gimenez-Roig J
    4. Korkmaz F
    5. Sultana F
    6. Sant D
    7. Haeck CM
    8. Macdonald A
    9. Kim SM
    10. Rosen CJ
    11. Barak O
    12. Meseck M
    13. Caminis J
    14. Lizneva D
    15. Yuen T
    16. Zaidi M

    (2023) Development and biophysical characterization of a humanized FSH-blocking monoclonal antibody therapeutic formulated at an ultra-high concentration

    eLife 12:e88898.

    https://doi.org/10.7554/eLife.88898

    • PubMed
    • Google Scholar
21. 1. Senapati S
    2. Gracia CR
    3. Freeman EW
    4. Sammel MD
    5. Lin H
    6. Kim C
    7. Schwab RJ
    8. Pien GW

    (2014) Hormone variations associated with quantitative fat measures in the menopausal transition

    Climacteric 17:183–190.

    https://doi.org/10.3109/13697137.2013.845876

    • PubMed
    • Google Scholar
22. 1. Silva D
    2. Cerqueira JCM
    3. Oliveira Cipriano Torres D
    4. Santos A
    5. Costa L

    (2013)

    Endogenous sex hormones are not associated with subclinical atherosclerosis in menopausal women

    Minerva Ginecologica 01:297–302.

    • Google Scholar
23. 1. Sowers M
    2. Zheng H
    3. Tomey K
    4. Karvonen-Gutierrez C
    5. Jannausch M
    6. Li X
    7. Yosef M
    8. Symons J

    (2007) Changes in body composition in women over six years at midlife: ovarian and chronological aging

    The Journal of Clinical Endocrinology and Metabolism 92:895–901.

    https://doi.org/10.1210/jc.2006-1393

    • PubMed
    • Google Scholar
24. 1. Sun L
    2. Peng Y
    3. Sharrow AC
    4. Iqbal J
    5. Zhang Z
    6. Papachristou DJ
    7. Zaidi S
    8. Zhu LL
    9. Yaroslavskiy BB
    10. Zhou H
    11. Zallone A
    12. Sairam MR
    13. Kumar TR
    14. Bo W
    15. Braun J
    16. Cardoso-Landa L
    17. Schaffler MB
    18. Moonga BS
    19. Blair HC
    20. Zaidi M

    (2006) FSH directly regulates bone mass

    Cell 125:247–260.

    https://doi.org/10.1016/j.cell.2006.01.051

    • PubMed
    • Google Scholar
25. 1. Thurston RC
    2. Sowers MR
    3. Sternfeld B
    4. Gold EB
    5. Bromberger J
    6. Chang Y
    7. Joffe H
    8. Crandall CJ
    9. Waetjen LE
    10. Matthews KA

    (2009) Gains in body fat and vasomotor symptom reporting over the menopausal transition: the study of women’s health across the nation

    American Journal of Epidemiology 170:766–774.

    https://doi.org/10.1093/aje/kwp203

    • PubMed
    • Google Scholar
26. 1. Tiwari R
    2. Lajkosz K
    3. Berjaoui M
    4. Qaoud Y
    5. Kenk M
    6. Woffendin C
    7. Caron P
    8. Guillemette C
    9. Fleshner N

    (2022) Variability in testosterone measurement between radioimmunoassay (RIA), chemiluminescence assay (CLIA) and liquid chromatography-tandem mass spectrometry (MS) among prostate cancer patients on androgen deprivation therapy (ADT)

    Urologic Oncology 40:193.

    https://doi.org/10.1016/j.urolonc.2022.03.011

    • PubMed
    • Google Scholar
27. 1. Vena W
    2. Carrone F
    3. Delbarba A
    4. Akpojiyovbi O
    5. Pezzaioli LC
    6. Facondo P
    7. Cappelli C
    8. Leonardi L
    9. Balzarini L
    10. Farina D
    11. Pizzocaro A
    12. Lania AG
    13. Mazziotti G
    14. Ferlin A

    (2023) Body composition, trabecular bone score and vertebral fractures in subjects with klinefelter syndrome

    Journal of Endocrinological Investigation 46:297–304.

    https://doi.org/10.1007/s40618-022-01901-8

    • PubMed
    • Google Scholar
28. 1. Visser M
    2. Fuerst T
    3. Lang T
    4. Salamone L
    5. Harris TB

    (1999) Validity of fan-beam dual-energy x-ray absorptiometry for measuring fat-free mass and leg muscle mass: health, aging, and body composition study--dual-energy x-ray absorptiometry and body composition working group

    Journal of Applied Physiology 87:1513–1520.

    https://doi.org/10.1152/jappl.1999.87.4.1513

    • PubMed
    • Google Scholar
29. 1. Zaidi M
    2. Kim SM
    3. Mathew M
    4. Korkmaz F
    5. Sultana F
    6. Miyashita S
    7. Gumerova AA
    8. Frolinger T
    9. Moldavski O
    10. Barak O
    11. Pallapati A
    12. Rojekar S
    13. Caminis J
    14. Ginzburg Y
    15. Ryu V
    16. Davies TF
    17. Lizneva D
    18. Rosen CJ
    19. Yuen T

    (2023) Bone circuitry and interorgan skeletal crosstalk

    eLife 12:e83142.

    https://doi.org/10.7554/eLife.83142

    • PubMed
    • Google Scholar

Author details

1. Marco Bergamini

   Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

   Contribution

   Data curation, Investigation, Methodology, Writing – original draft

   Competing interests

   No competing interests declared

   "This ORCID iD identifies the author of this article:" 0000-0001-6161-707X

2. Alberto Dalla Volta

   Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

   Contribution

   Data curation, Investigation, Methodology, Writing – review and editing

   For correspondence

   alberto.dallavolta@gmail.com

   Competing interests

   No competing interests declared

   "This ORCID iD identifies the author of this article:" 0000-0001-8009-7663

3. Carlotta Palumbo

   Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy

   Contribution

   Investigation, Methodology

   Competing interests

   No competing interests declared

4. Stefania Zamboni

   Urology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

   Contribution

   Investigation, Methodology

   Competing interests

   No competing interests declared

5. Luca Triggiani

   Radiation Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

   Contribution

   Investigation, Methodology

   Competing interests

   No competing interests declared

6. Manuel Zamparini

   Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

   Contribution

   Data curation, Formal analysis

   Competing interests

   No competing interests declared

7. Marta Laganà

   Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

   Contribution

   Investigation

   Competing interests

   No competing interests declared

8. Luca Rinaudo

   Tecnologie Avanzate S.r.l, Turin, Italy

   Contribution

   Validation, Investigation, Methodology

   Competing interests

   L Rinaudo is affiliated with Tecnologie Avanzate S.r.l. The author has no financial interests to declare

9. Nunzia Di Meo

   Radiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

   Contribution

   Investigation

   Competing interests

   No competing interests declared

10. Irene Caramella

    Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Contribution

    Investigation

    Competing interests

    No competing interests declared

11. Roberto Bresciani

    Division of Biotechnology, Department of Molecular and Translational Medicine (DMTM), University of Brescia, Brescia, Italy

    Contribution

    Conceptualization, Writing – review and editing

    Competing interests

    No competing interests declared

12. Francesca Valcamonico

    Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Contribution

    Investigation

    Competing interests

    No competing interests declared

13. Paolo Borghetti

    Radiation Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Contribution

    Investigation

    Competing interests

    No competing interests declared

14. Andrea Guerini

    Radiation Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Contribution

    Investigation

    Competing interests

    No competing interests declared

15. Davide Farina

    Radiology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Contribution

    Conceptualization, Investigation, Methodology, Writing – review and editing

    Competing interests

    No competing interests declared

    "This ORCID iD identifies the author of this article:" 0000-0003-4075-0001

16. Alessandro Antonelli

    Urology Unit, AOUI Verona, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy

    Contribution

    Investigation

    Competing interests

    No competing interests declared

17. Claudio Simeone

    Urology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Contribution

    Conceptualization, Writing – original draft

    Competing interests

    No competing interests declared

18. Gherardo Mazziotti

    1. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Milan, Italy
    2. Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital,, Milan, Italy

    Contribution

    Conceptualization, Supervision, Writing – review and editing

    For correspondence

    gherardo.mazziotti@hunimed.eu

    Competing interests

    No competing interests declared

    "This ORCID iD identifies the author of this article:" 0000-0001-5458-701X

19. Alfredo Berruti

    Medical Oncology Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Contribution

    Conceptualization, Data curation, Supervision, Funding acquisition, Writing – review and editing

    Competing interests

    No competing interests declared

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