Serum Testosterone Linked to Fracture Risk in Elderly Men
Thursday, January 17th 2008
January 15, 2008 - In community-dwelling men older than 60 years, serum testosterone levels were independently associated with the risk for osteoporotic fracture, according to the results of a study reported in the January 14 issue of the Archives of Internal Medicine.
"Male aging is associated with a gradual decrease in circulating testosterone, which may be detrimental to bone," writes Christian Meier, MD, from the University Hospital Basel in Switzerland, and colleagues from The Dubbo Osteoporosis Epidemiology Study. "However, the relationship between testosterone and incident fracture risk remains unclear."
Between January 1989 and December 2005, a total of 609 men older than 60 years were evaluated and were followed up for incidence of low-trauma fracture. Median duration of follow-up was 5.8 years (range, up to 13 years). Baseline evaluation included assessment of clinical risk factors such as bone mineral density (BMD) and lifestyle factors, and serum testosterone and estradiol levels measured by tandem mass spectrometry.
During follow-up, 113 men had 1 or more low-trauma fractures, with the risk significantly increased in men with reduced testosterone levels (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.09 - 1.62). After adjustment for sex hormone-binding globulin (SHBG), serum testosterone (HR, 1.48; 95% CI, 1.22 - 1.78) and serum estradiol (HR, 1.21; 95% CI, 1.00 - 1.47) levels were associated with overall fracture risk.
Major risk factors for fractures were considered to be age, weight, BMD, fracture history, smoking status, calcium intake, and SHBG. Even after further adjustment for these risk factors, lower testosterone levels were still associated with increased risk for fracture, especially for hip fractures (HR, 1.88; 95% CI, 1.24 - 2.82) and for nonvertebral fractures (HR, 1.32; 95% CI, 1.03 - 1.68).
Limitations of the study include inability to infer any causal relationship between circulating testosterone and fracture risk, lack of generalizability to other populations, serum samples stored in the freezer for up to 13 years, and serum not collected consistently in the morning.
"In community-dwelling men older than 60 years, serum testosterone is independently associated with the risk of osteoporotic fracture and its measurement may provide additional clinical information for the assessment of fracture risk in elderly men," the study authors write. "This effect was independent of established risk factors, such as age and BMD. In contrast, there was no significant association between serum E2 [estradiol] levels and fracture in the presence of BMD and age."
The National Health and Medical Research Council of Australia and the ARUP Institute for Clinical and Experimental Pathology supported this study. Dr. Meier is supported by the Swiss National Science Foundation and the Margarete und Walter Lichtenstein Stiftung der UniversitÃ¤t Basel. Some of the other study authors have also obtained funding. The remaining study authors have disclosed no relevant financial relationships.
Arch Intern Med. 2008;168:47-54. 17/01/08
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