Sex hormones and frailty in older men: the osteoporotic fractures in men (MrOS) study.
BACKGROUND
As men age, the prevalence of frailty increases whereas levels of androgens decline. Little is known about the relation between these factors.


OBJECTIVE
The aim of this study was to assess cross-sectional and longitudinal associations of estradiol, bioavailable estradiol, testosterone, bioavailable testosterone (bioT), and SHBG with frailty status.


METHODS
The Osteoporotic Fractures in Men (MrOS) study was conducted at six U.S. clinical centers.


METHODS
A total of 1469 community-dwelling men at least 65 yr old with baseline data participated; 1245 men had frailty status reassessed 4.1 yr later.


METHODS
Proportional odds models estimated the likelihood of greater frailty status. Frail men had at least three of the following: weakness, slowness, low activity, exhaustion, and shrinking/sarcopenia; intermediate men had one or two criteria; and robust men had none. At follow-up, death was included as an additional ordinal outcome. Sex hormones were assayed by spectrometry/chromatographic methods.


RESULTS
In cross-sectional analyses, men in the lowest quartile of bioT had 1.39-fold (95% confidence interval, 1.02, 1.91) increased odds of greater frailty status compared to men in the highest quartile after adjustment for covariates including age, body size, health status, and medical conditions. In age-adjusted longitudinal analyses, men in the lowest quartile of bioT had 1.51-fold (95% confidence interval, 1.10, 2.07) increased odds of greater frailty status 4.1 yr later. This association was largely attenuated by adjustment for covariates. No other hormones were associated in a cross-sectional or longitudinal manner with frailty status after adjustment.


CONCLUSIONS
Low levels of bioT were independently associated with worse baseline frailty status. Frailty status should be considered as an outcome in trials of testosterone supplementation.
Cawthon
Peggy M
PM
Research Institute, California Pacific Medical Center, San Francisco, California 94107-1728, USA. pcawthon@sfcc-cpmc.net
Ensrud
Kristine E
KE
Laughlin
Gail A
GA
Cauley
Jane A
JA
Dam
Thuy-Tien L
TT
Barrett-Connor
Elizabeth
E
Fink
Howard A
HA
Hoffman
Andrew R
AR
Lau
Edith
E
Lane
Nancy E
NE
Stefanick
Marcia L
ML
Cummings
Steven R
SR
Orwoll
Eric S
ES
D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D001682:Biological Availability; D003430:Cross-Sectional Studies; D004958:Estradiol / Q000097:blood*; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000097:blood / Q000209:etiology*; D005598:Fractures, Spontaneous / Q000209:etiology; D016330:Frail Elderly / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010024:Osteoporosis / Q000097:blood / Q000150:complications*; D015995:Prevalence; D012111:Residence Characteristics; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*; D013739:Testosterone / Q000097:blood*
D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol