title: High Serum SHBG Predicts Incident Vertebral Fractures in Elderly Men.
abstract: Previous prospective cohort studies have shown that serum levels of sex steroids and sex hormone-binding globulin (SHBG) associate with nonvertebral fracture risk in men. The predictive value of sex hormones and SHBG for vertebral fracture risk specifically is, however, less studied. Elderly men (aged ≥ 65 years) from Sweden and Hong Kong participating in the Osteoporotic Fractures in Men (MrOS) study had baseline estradiol and testosterone analyzed by gas chromatography-mass spectrometry (GC-MS) and SHBG by immunoradiometric assay (IRMA). Incident clinical vertebral fractures (n = 242 cases) were evaluated in 4324 men during an average follow-up of 9.1 years. In a subsample of these men (n = 2256), spine X-rays were obtained at baseline and after an average follow-up of 4.3 years to identify incident radiographic vertebral fractures (n = 157 cases). The likelihood of incident clinical and radiographic vertebral fractures was estimated by Cox proportional hazards models and logistic regression models, respectively. Neither serum estradiol (hazard ratio [HR] per SD increase = 0.93, 95% confidence interval [CI] 0.80-1.08) nor testosterone (1.05, 0.91-1.21) predicted incident clinical vertebral fractures in age-adjusted models in the combined data set. High serum SHBG, however, associated with increased clinical vertebral fracture risk (1.24, 1.12-1.37). This association remained significant after further adjustment for FRAX with or without bone mineral density (BMD). SHBG also associated with increased incident radiographic vertebral fracture risk (combined data set; odds ratio [OR] per SD increase = 1.23, 95% CI 1.05-1.44). This association remained significant after adjustment for FRAX with or without BMD. In conclusion, high SHBG predicts incident clinical and radiographic vertebral fractures in elderly men and adds moderate information beyond FRAX with BMD for vertebral fracture risk prediction.
authors.affiliation: Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Vandenput
authors.affiliation: 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.
authors.forename: Dan
authors.initials: D
authors.lastname: Mellström
authors.affiliation: Department of Medical Sciences, University of Uppsala, Uppsala, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kindmark
authors.affiliation: Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Johansson
authors.affiliation: 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.
authors.forename: Mattias
authors.initials: M
authors.lastname: Lorentzon
authors.affiliation: Jockey Club Centre for Osteoporosis Care and Control, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Jason
authors.initials: J
authors.lastname: Leung
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
authors.forename: Inga
authors.initials: I
authors.lastname: Redlund-Johnell
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
authors.forename: Björn E
authors.initials: BE
authors.lastname: Rosengren
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
authors.forename: Magnus K
authors.initials: MK
authors.lastname: Karlsson
authors.affiliation: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Yi-Xiang
authors.initials: YX
authors.lastname: Wang
authors.affiliation: Jockey Club Centre for Osteoporosis Care and Control, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kwok
authors.affiliation: Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Claes
authors.initials: C
authors.lastname: Ohlsson
mesh_terms: D000368:Aged; D000071556:Cancellous Bone / Q000473:pathology; D006620:Hip Fractures / Q000097:blood / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D058866:Osteoporotic Fractures / Q000097:blood / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*; D016103:Spinal Fractures / Q000097:blood* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D012738:Sex Hormone-Binding Globulin
keywords: FRACTURE RISK ASSESSMENT; GENERAL POPULATION STUDIES; MEN; OSTEOPOROSIS; SEX STEROIDS