Free testosterone is an independent predictor of BMD and prevalent fractures in elderly men: MrOS Sweden.
The role of androgens for bone health in elderly men is unclear. We show that free testosterone within the normal range is a predictor of BMD at predominantly cortical bone sites and of previous osteoporosis-related fractures in elderly Swedish men.


BACKGROUND
Osteoporosis-related fractures constitute a major health concern not only in women but also in men. Previous studies have clearly shown that serum levels of estradiol are associated with BMD, whereas more conflicting data have been presented regarding the predictive value of testosterone (T) for bone health in elderly men. The aim of this study was to investigate if serum levels of T are associated with BMD and/or prevalent fractures in a large cohort of elderly men.


METHODS
In the Swedish part of the MrOS study (n = 2908; average age, 75.4 years), bone parameters were measured using DXA, and prevalent fractures were recorded using standardized questionnaires and by vertebral X-ray analyses. Serum levels of total T, total estradiol (E2), and sex hormone-binding globulin (SHBG) were measured by radioimmunoassay, and free T (FT) and free E2 (FE2) were derived from the mass action equations. Height, weight, age, physical activity, smoking habits, and calcium intake were included together with FT and FE2 in regression models for BMD.


RESULTS
FT was an independent positive predictor of BMD in total body, total hip, femur trochanter, and arm but not in the lumbar spine. The highest independent predictive value of FT was found in the arm and the hip (with a relatively high content of cortical bone). FE2 was an independent predictor of BMD at all bone sites studied, and the highest predictive value was seen for lumbar spine (with relatively high content of trabecular bone) BMD. FT but not FE2 was a positive predictor of total body bone area and BMC. FT levels below the median were independent predictors of prevalent osteoporosis-related fractures (OR, 1.56; 95% CI, 1.14-2.14; p < 0.01) and X-ray-verified vertebral fractures (OR, 2.00; 95% CI, 1.34-2.86; p < 0.001). The predictive value of FT for prevalent fractures was not affected by adjustment for BMD.


CONCLUSIONS
These findings show that variation of FT within the normal range is an independent but modest predictor of BMD at predominantly cortical bone sites and of previous osteoporosis-related fractures in elderly men. Our data indicate that not only estrogens but also androgens are of importance for bone health in elderly men. Longitudinal studies investigating the predictive value of T for fracture risk in elderly men are required.
Mellström
Dan
D
Center for Bone Research, Departments of Internal Medicine and Geriatrics at the Sahlgrenska Academy The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
Johnell
Olof
O
Ljunggren
Osten
O
Eriksson
Anna-Lena
AL
Lorentzon
Mattias
M
Mallmin
Hans
H
Holmberg
Anna
A
Redlund-Johnell
Inga
I
Orwoll
Eric
E
Ohlsson
Claes
C
D000368:Aged; D000375:Aging / Q000097:blood / Q000502:physiology; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D050723:Fractures, Bone / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D013548:Sweden / Q000453:epidemiology; D013739:Testosterone / Q000097:blood*
D015415:Biomarkers; D013739:Testosterone