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

Mellstroem, Dan; Vandenput, Liesbeth; Mallmin, Hans; Holmberg, Anna H LU ; Lorentzon, Mattias; Oden, Anders; Johansson, Helena; Orwoll, Eric S.; Labrie, Fernand and Karlsson, Magnus LU , et al. (2008) In Journal of Bone and Mineral Research 23(10). p.1552-1560
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,... (More)
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 proporitional 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% 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 and 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. (Less)
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published
subject
keywords
mass spectrometry, sex steroids, fracture, men, osteoporosis
in
Journal of Bone and Mineral Research
volume
23
issue
10
pages
1552 - 1560
publisher
AMBMR
external identifiers
  • wos:000259686100004
  • scopus:52949150044
ISSN
1523-4681
DOI
10.1359/JBMR.080518
language
English
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yes
id
4bac4464-029b-4998-8942-872e11e8e160 (old id 1286035)
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2009-02-04 09:48:33
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2017-09-03 03:52:48
@article{4bac4464-029b-4998-8942-872e11e8e160,
  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 proporitional hazards regression models, adjusted for age, suggested that fE2 and SHBG (p &lt; 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% 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 and nonlinear with a strong relation &lt;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.},
  author       = {Mellstroem, Dan and Vandenput, Liesbeth and Mallmin, Hans and Holmberg, Anna H and Lorentzon, Mattias and Oden, Anders and Johansson, Helena and Orwoll, Eric S. and Labrie, Fernand and Karlsson, Magnus and Ljunggren, Osten and Ohlsson, Claes},
  issn         = {1523-4681},
  keyword      = {mass spectrometry,sex steroids,fracture,men,osteoporosis},
  language     = {eng},
  number       = {10},
  pages        = {1552--1560},
  publisher    = {AMBMR},
  series       = {Journal of Bone and Mineral Research},
  title        = {Older men with low serum estradiol and high serum SHBG have an increased risk of fractures},
  url          = {http://dx.doi.org/10.1359/JBMR.080518},
  volume       = {23},
  year         = {2008},
}