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Older men with low serum estradiol and high serum SHBG have an increased risk of fractures.

Abstract

Osteoporosis-related fractures constitute a major health concern not only in women but also in men. To study the predictive role of serum sex steroids for fracture risk in men, serum sex steroids were analyzed by the specific gas chromatography-mass spectrometry technique at baseline in older men (n = 2639; mean, 75 yr of age) of the prospective population-based MrOS Sweden cohort. Fractures occurring after baseline were validated (average follow-up of 3.3 yr). The incidence for having at least one validated fracture after baseline was 20.9/1000 person-years. Estradiol (E2; hazard ratio [HR] per SD decrease, 1.34; 95% CI, 1.22-1.49), free estradiol (fE2; HR per SD decrease, 1.41; 95% CI, 1.28-1.55), testosterone (T; HR per SD decrease, 1.27; 95% CI, 1.16-1.39), and free testosterone (fT; HR per SD decrease, 1.32; 95% CI, 1.21-1.44) were all inversely, whereas sex hormone-binding globulin (SHBG; HR per SD increase, 1.41; 95% CI, 1.22-1.63) was directly related to fracture risk. Multivariable proportional hazards regression models, adjusted for age, suggested that fE2 and SHBG (p < 0.001), but not fT, were independently associated with fracture risk. Further subanalyses of fracture type showed that fE2 was inversely associated with clinical vertebral fractures (HR per SD decrease, 1.57; 95% CI, 1.36-1.80), nonvertebral osteoporosis fractures (HR per SD decrease, 1.42; 95% CI, 1.23-1.65), and hip fractures (HR per SD decrease, 1.44; 95% CI, 1.18-1.76). The inverse relation between serum E2 and fracture risk was nonlinear with a strong relation <16 pg/ml for E2 and 0.3 pg/ml for fE2. In conclusion, older Swedish men with low serum E2 and high SHBG levels have an increased risk of fractures.

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  • Authors+Show Affiliations

    ,

    Center for Bone Research, Sahlgrenska Academy, Department of Internal Medicine, University of Gothenburg, Gothenburg, Sweden.

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    Source

    MeSH

    Absorptiometry, Photon
    Aged
    Aged, 80 and over
    Bone Density
    Cohort Studies
    Estradiol
    Fractures, Bone
    Gas Chromatography-Mass Spectrometry
    Humans
    Male
    Osteoporosis
    Prospective Studies
    Reproducibility of Results
    Risk Factors
    Sex Hormone-Binding Globulin

    Pub Type(s)

    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    18518773

    Citation

    Mellström, Dan, et al. "Older Men With Low Serum Estradiol and High Serum SHBG Have an Increased Risk of Fractures." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 23, no. 10, 2008, pp. 1552-60.
    Mellström D, Vandenput L, Mallmin H, et al. Older men with low serum estradiol and high serum SHBG have an increased risk of fractures. J Bone Miner Res. 2008;23(10):1552-60.
    Mellström, D., Vandenput, L., Mallmin, H., Holmberg, A. H., Lorentzon, M., Odén, A., ... Ohlsson, C. (2008). Older men with low serum estradiol and high serum SHBG have an increased risk of fractures. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 23(10), pp. 1552-60. doi:10.1359/jbmr.080518.
    Mellström D, et al. Older Men With Low Serum Estradiol and High Serum SHBG Have an Increased Risk of Fractures. J Bone Miner Res. 2008;23(10):1552-60. PubMed PMID: 18518773.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Older men with low serum estradiol and high serum SHBG have an increased risk of fractures. AU - Mellström,Dan, AU - Vandenput,Liesbeth, AU - Mallmin,Hans, AU - Holmberg,Anna H, AU - Lorentzon,Mattias, AU - Odén,Anders, AU - Johansson,Helena, AU - Orwoll,Eric S, AU - Labrie,Fernand, AU - Karlsson,Magnus K, AU - Ljunggren,Osten, AU - Ohlsson,Claes, PY - 2008/6/4/pubmed PY - 2008/12/30/medline PY - 2008/6/4/entrez SP - 1552 EP - 60 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J. Bone Miner. Res. VL - 23 IS - 10 N2 - Osteoporosis-related fractures constitute a major health concern not only in women but also in men. To study the predictive role of serum sex steroids for fracture risk in men, serum sex steroids were analyzed by the specific gas chromatography-mass spectrometry technique at baseline in older men (n = 2639; mean, 75 yr of age) of the prospective population-based MrOS Sweden cohort. Fractures occurring after baseline were validated (average follow-up of 3.3 yr). The incidence for having at least one validated fracture after baseline was 20.9/1000 person-years. Estradiol (E2; hazard ratio [HR] per SD decrease, 1.34; 95% CI, 1.22-1.49), free estradiol (fE2; HR per SD decrease, 1.41; 95% CI, 1.28-1.55), testosterone (T; HR per SD decrease, 1.27; 95% CI, 1.16-1.39), and free testosterone (fT; HR per SD decrease, 1.32; 95% CI, 1.21-1.44) were all inversely, whereas sex hormone-binding globulin (SHBG; HR per SD increase, 1.41; 95% CI, 1.22-1.63) was directly related to fracture risk. Multivariable proportional hazards regression models, adjusted for age, suggested that fE2 and SHBG (p < 0.001), but not fT, were independently associated with fracture risk. Further subanalyses of fracture type showed that fE2 was inversely associated with clinical vertebral fractures (HR per SD decrease, 1.57; 95% CI, 1.36-1.80), nonvertebral osteoporosis fractures (HR per SD decrease, 1.42; 95% CI, 1.23-1.65), and hip fractures (HR per SD decrease, 1.44; 95% CI, 1.18-1.76). The inverse relation between serum E2 and fracture risk was nonlinear with a strong relation <16 pg/ml for E2 and 0.3 pg/ml for fE2. In conclusion, older Swedish men with low serum E2 and high SHBG levels have an increased risk of fractures. SN - 1523-4681 UR - https://www.unboundmedicine.com/medline/citation/18518773/Older_men_with_low_serum_estradiol_and_high_serum_SHBG_have_an_increased_risk_of_fractures_ L2 - https://doi.org/10.1359/jbmr.080518 DB - PRIME DP - Unbound Medicine ER -