title: Sex hormones, sex hormone binding globulin, and vertebral fractures in older men.
abstract: The association between sex hormones and sex hormone binding globin (SHBG) with vertebral fractures in men is not well studied. In these analyses, we determined whether sex hormones and SHBG were associated with greater likelihood of vertebral fractures in a prospective cohort study of community dwelling older men. We included data from participants in MrOS who had been randomly selected for hormone measurement (N=1463, including 1054 with follow-up data 4.6years later). Major outcomes included prevalent vertebral fracture (semi-quantitative grade≥2, N=140, 9.6%) and new or worsening vertebral fracture (change in SQ grade≥1, N=55, 5.2%). Odds ratios per SD decrease in sex hormones and per SD increase in SHBG were estimated with logistic regression adjusted for potentially confounding factors, including age, bone mineral density, and other sex hormones. Higher SHBG was associated with a greater likelihood of prevalent vertebral fractures (OR: 1.38 per SD increase, 95% CI: 1.11, 1.72). Total estradiol analyzed as a continuous variable was not associated with prevalent vertebral fractures (OR per SD decrease: 0.86, 95% CI: 0.68 to 1.10). Men with total estradiol values ≤17pg/ml had a borderline higher likelihood of prevalent fracture than men with higher values (OR: 1.46, 95% CI: 0.99, 2.16). There was no association between total testosterone and prevalent fracture. In longitudinal analyses, SHBG (OR: 1.42 per SD increase, 95% CI: 1.03, 1.95) was associated with new or worsening vertebral fracture, but there was no association with total estradiol or total testosterone. In conclusion, higher SHBG (but not testosterone or estradiol) is an independent risk factor for vertebral fractures in older men.
authors.affiliation: Research Institute, California Pacific Medical Center, San Francisco, CA, USA. Electronic address: pcawthon@sfcc-cpmc.net.
authors.forename: Peggy M
authors.initials: PM
authors.lastname: Cawthon
authors.affiliation: Park Nicollet Institute for Research and Education, University of Minnesota, Minneapolis, MN, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: Research Institute, California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Harrison
authors.affiliation: Minneapolis Veterans Affairs Health Care System, and University of Minnesota, Minneapolis, MN, USA.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Black
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Research Institute, California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cummings
authors.affiliation: Kaiser Permanente Center for Health Research NW, Portland, OR, USA.
authors.forename: Erin S
authors.initials: ES
authors.lastname: LeBlanc
authors.affiliation: Universtity of California, San Diego, CA, USA.
authors.forename: Gail A
authors.initials: GA
authors.lastname: Laughlin
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Nielson
authors.affiliation: Research Institute, California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Augusta
authors.initials: A
authors.lastname: Broughton
authors.affiliation: Universtity of California, San Diego, CA, USA.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Kado
authors.affiliation: Stanford University, Stanford, CA, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hoffman
authors.affiliation: University of Toronto, Toronto, ON, Canada.
authors.forename: Sophie A
authors.initials: SA
authors.lastname: Jamal
authors.affiliation: Universtity of California, San Diego, CA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Orwoll
mesh_terms: D000368:Aged; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D015994:Incidence; D016013:Likelihood Functions; D008297:Male; D015995:Prevalence; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*; D016103:Spinal Fractures / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology*
chemical_list: D012739:Gonadal Steroid Hormones; D012738:Sex Hormone-Binding Globulin
keywords: Estradiol; Osteoporosis; Sex hormone binding globulin; Testosterone; Vertebral fracture