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Dilemmas in management of osteoporosis in patients with complete androgen insensitivity syndrome
  1. Tanner Slayden1,
  2. Elizabeth M Bauer2,
  3. Mohamed KM Shakir2,3 and
  4. Thanh Duc Hoang2,3
  1. 1Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  2. 2Department of Endocrinology, Diabetes & Metabolism, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  3. 3Department of Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
  1. Correspondence to Dr Thanh Duc Hoang; tdhdthanh{at}


Complete androgen insensitivity syndrome (CAIS)—resulting in 46,XY karyotype, but female phenotype—is a disorder of sex development and primary amenorrhea, but its effect on bone mineral density (BMD) is singular and difficult to manage. Androgens are an important modulator of bone remodeling and health, and the androgen receptor (AR) is pivotal for signaling within the bone cells. CAIS results in a severely disrupted AR throughout the body, causing an elevated risk of early osteoporosis. Timing of gonadectomy and hormone replacement therapy protocols are not established, creating a wide variety of treatment plans and BMD profiles. Our objective is to report a patient with CAIS status post prepubertal orchiectomy that developed early osteoporosis and to describe the lack of optimal strategies and consensus available to improve bone health in this population. Additionally, our case illustrates the fact there are no guidelines advocating the use of newer drugs for osteoporosis in this population.

  • endocrinology
  • calcium and bone
  • reproductive medicine
  • sexual and gender disorders
  • sexual health

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  • Twitter @tdhdthanh

  • Contributors TS and EMB: reviewed the manuscript. MKMS and TDH: reviewed and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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