Sex hormones, sex hormone binding globulin, and vertebral fractures in older men

Peggy M. Cawthon, John T. Schousboe, Stephanie L. Harrison, Kristine E. Ensrud, Dennis Black, Jane A. Cauley, Steven R. Cummings, Erin S. LeBlanc, Gail A. Laughlin, Carrie M. Nielson, Augusta Broughton, Deborah M. Kado, Andrew R. Hoffman, Sophie A. Jamal, Elizabeth Barrett-Connor, Eric S. Orwoll

Research output: Contribution to journalArticlepeer-review

44 Scopus citations

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 4.6 years 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 ≤ 17 pg/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.

Original languageEnglish (US)
Pages (from-to)271-278
Number of pages8
JournalBone
Volume84
DOIs
StatePublished - Mar 1 2016

Bibliographical note

Funding Information:
The authors report no conflict of interests directly related to this work. JS has received personal fees from Merck, Inc. PC has received grant support from Merck, Eli Lilly, and GlaskoSmithKline as well as personal fees from Eli Lilly. EO reports consulting for Eli Lilly. KE, JS, SH, DB, JA, SC, EL, GL, CN, AB, DK, AH, SJ, and EBC report no other conflicts.

Funding Information:
The Osteoporotic Fractures in Men (MrOS) Study is supported by the National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA) , the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) , the National Center for Advancing Translational Sciences (NCATS) , and the NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810 , U01 AG042124 , U01 AG042139 , U01 AG042140 , U01 AG042143 , U01 AG042145 , U01 AG042168 , U01 AR066160 , and UL1 TR000128 . The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Publisher Copyright:
© 2016 Elsevier Inc.

Keywords

  • Estradiol
  • Osteoporosis
  • Sex hormone binding globulin
  • Testosterone
  • Vertebral fracture

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