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Low Serum DHEAS Predicts Increased Fracture Risk in Older Men: The MrOS Sweden Study.
J Bone Miner Res. 2017 Aug; 32(8):1607-1614.JB

Abstract

The adrenal-derived hormones dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are the most abundant circulating hormones and their levels decline substantially with age. DHEAS is considered an inactive precursor, which is converted into androgens and estrogens via local metabolism in peripheral target tissues. The predictive value of serum DHEAS for fracture risk is unknown. The aim of this study was, therefore, to assess the associations between baseline DHEAS levels and incident fractures in a large cohort of older men. Serum DHEAS levels were analyzed with mass spectrometry in the population-based Osteoporotic Fractures in Men study in Sweden (n = 2568, aged 69 to 81 years). Incident X-ray validated fractures (all, n = 594; non-vertebral major osteoporotic, n = 255; hip, n = 175; clinical vertebral, n = 206) were ascertained during a median follow-up of 10.6 years. DHEAS levels were inversely associated with the risk of any fracture (hazard ratio [HR] per SD decrease = 1.14, 95% confidence interval [CI] 1.05-1.24), non-vertebral major osteoporotic fractures (HR = 1.31, 95% CI 1.16-1.48), and hip fractures (HR = 1.18, 95% CI 1.02-1.37) but not clinical vertebral fractures (HR = 1.09, 95% CI 0.95-1.26) in Cox regression models adjusted for age, body mass index (BMI) and prevalent fractures. Further adjustment for traditional risk factors for fracture, bone mineral density (BMD), and/or physical performance variables as well as serum sex steroid levels only slightly attenuated the associations between serum DHEAS and fracture risk. Similarly, the point estimates were only marginally reduced after adjustment for FRAX estimates with BMD. The inverse association between serum DHEAS and all fractures or major osteoporotic fractures was nonlinear, with a substantial increase in fracture risk (all fractures 22%, major osteoporotic fractures 33%) for those participants with serum DHEAS levels below the median (0.60 μg/mL). In conclusion, low serum DHEAS levels are a risk marker of mainly non-vertebral fractures in older men, of whom those with DHEAS levels below 0.60 μg/mL are at highest risk. © The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

Authors+Show Affiliations

Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.Bioinformatics Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.Department of Medical Sciences, University of Uppsala, Uppsala, Sweden.Department of Medical Sciences, University of Uppsala, Uppsala, Sweden.Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study

Language

eng

PubMed ID

28276592

Citation

Ohlsson, Claes, et al. "Low Serum DHEAS Predicts Increased Fracture Risk in Older Men: the MrOS Sweden Study." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 32, no. 8, 2017, pp. 1607-1614.
Ohlsson C, Nethander M, Kindmark A, et al. Low Serum DHEAS Predicts Increased Fracture Risk in Older Men: The MrOS Sweden Study. J Bone Miner Res. 2017;32(8):1607-1614.
Ohlsson, C., Nethander, M., Kindmark, A., Ljunggren, Ö., Lorentzon, M., Rosengren, B. E., Karlsson, M. K., Mellström, D., & Vandenput, L. (2017). Low Serum DHEAS Predicts Increased Fracture Risk in Older Men: The MrOS Sweden Study. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 32(8), 1607-1614. https://doi.org/10.1002/jbmr.3123
Ohlsson C, et al. Low Serum DHEAS Predicts Increased Fracture Risk in Older Men: the MrOS Sweden Study. J Bone Miner Res. 2017;32(8):1607-1614. PubMed PMID: 28276592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low Serum DHEAS Predicts Increased Fracture Risk in Older Men: The MrOS Sweden Study. AU - Ohlsson,Claes, AU - Nethander,Maria, AU - Kindmark,Andreas, AU - Ljunggren,Östen, AU - Lorentzon,Mattias, AU - Rosengren,Björn E, AU - Karlsson,Magnus K, AU - Mellström,Dan, AU - Vandenput,Liesbeth, Y1 - 2017/03/30/ PY - 2016/12/23/received PY - 2017/03/03/revised PY - 2017/03/06/accepted PY - 2017/3/10/pubmed PY - 2018/4/26/medline PY - 2017/3/10/entrez KW - DHEAS KW - FRACTURE RISK ASSESSMENT KW - GENERAL POPULATION STUDIES KW - MEN KW - SEX STEROIDS SP - 1607 EP - 1614 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 - 32 IS - 8 N2 - The adrenal-derived hormones dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are the most abundant circulating hormones and their levels decline substantially with age. DHEAS is considered an inactive precursor, which is converted into androgens and estrogens via local metabolism in peripheral target tissues. The predictive value of serum DHEAS for fracture risk is unknown. The aim of this study was, therefore, to assess the associations between baseline DHEAS levels and incident fractures in a large cohort of older men. Serum DHEAS levels were analyzed with mass spectrometry in the population-based Osteoporotic Fractures in Men study in Sweden (n = 2568, aged 69 to 81 years). Incident X-ray validated fractures (all, n = 594; non-vertebral major osteoporotic, n = 255; hip, n = 175; clinical vertebral, n = 206) were ascertained during a median follow-up of 10.6 years. DHEAS levels were inversely associated with the risk of any fracture (hazard ratio [HR] per SD decrease = 1.14, 95% confidence interval [CI] 1.05-1.24), non-vertebral major osteoporotic fractures (HR = 1.31, 95% CI 1.16-1.48), and hip fractures (HR = 1.18, 95% CI 1.02-1.37) but not clinical vertebral fractures (HR = 1.09, 95% CI 0.95-1.26) in Cox regression models adjusted for age, body mass index (BMI) and prevalent fractures. Further adjustment for traditional risk factors for fracture, bone mineral density (BMD), and/or physical performance variables as well as serum sex steroid levels only slightly attenuated the associations between serum DHEAS and fracture risk. Similarly, the point estimates were only marginally reduced after adjustment for FRAX estimates with BMD. The inverse association between serum DHEAS and all fractures or major osteoporotic fractures was nonlinear, with a substantial increase in fracture risk (all fractures 22%, major osteoporotic fractures 33%) for those participants with serum DHEAS levels below the median (0.60 μg/mL). In conclusion, low serum DHEAS levels are a risk marker of mainly non-vertebral fractures in older men, of whom those with DHEAS levels below 0.60 μg/mL are at highest risk. © The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc. SN - 1523-4681 UR - https://www.unboundmedicine.com/medline/citation/28276592/Low_Serum_DHEAS_Predicts_Increased_Fracture_Risk_in_Older_Men:_The_MrOS_Sweden_Study_ L2 - https://doi.org/10.1002/jbmr.3123 DB - PRIME DP - Unbound Medicine ER -