Low Testosterone, but Not Estradiol, Is Associated With Incident Falls in Older Men: The International MrOS Study

Liesbeth Vandenput, Dan Mellström, Gail A. Laughlin, Peggy M. Cawthon, Jane A. Cauley, Andrew R. Hoffman, Magnus K. Karlsson, Björn E. Rosengren, Östen Ljunggren, Maria Nethander, Anna L. Eriksson, Mattias Lorentzon, Jason Leung, Timothy Kwok, Eric Orwoll, Claes Ohlsson

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Fracture risk is determined by bone strength and the risk of falls. The relationship between serum sex steroids and bone strength parameters in men is well known, whereas the predictive value of sex steroids for falls is less studied. The aim of this study was to assess the associations between serum testosterone (T) and estradiol (E2) and the likelihood of falls. Older men (aged ≥65 years) from the United States (n=1919), Sweden (n=2495), and Hong Kong (n=1469) participating in the Osteoporotic Fractures in Men Study had baseline T and E2 analyzed by mass spectrometry. Bioavailable (Bio) levels were calculated using mass action equations. Incident falls were ascertained every 4 months during a mean follow-up of 5.7 years. Associations between sex steroids and falls were estimated by generalized estimating equations. Fall rate was highest in the US and lowest in Hong Kong (US 0.50, Sweden 0.31, Hong Kong 0.12 fall reports/person/year). In the combined cohort of 5883 men, total T (odds ratio [OR] per SD increase=0.88, 95% confidence interval [CI] 0.86-0.91) and BioT (OR=0.86, 95% CI 0.83-0.88) were associated with incident falls in models adjusted for age and prevalent falls. These associations were only slightly attenuated after simultaneous adjustment for physical performance variables (total T: OR=0.94, 95% CI 0.91-0.96; BioT: OR=0.91, 95% CI 0.89-0.94). E2, BioE2, and sex hormone-binding globulin (SHBG) were not significantly associated with falls. Analyses in the individual cohorts showed that both total T and BioT were associated with falls in MrOS US and Sweden. No association was found in MrOS Hong Kong, and this may be attributable to environmental factors rather than ethnic differences because total T and BioT predicted falls in MrOS US Asians. In conclusion, low total T and BioT levels, but not E2 or SHBG, are associated with increased falls in older men.

Original languageEnglish (US)
JournalJournal of Bone and Mineral Research
DOIs
StateAccepted/In press - 2017

Fingerprint

Testosterone
Hong Kong
Estradiol
Odds Ratio
Sweden
Confidence Intervals
Sex Hormone-Binding Globulin
Steroids
Bone and Bones
Osteoporotic Fractures
Serum
Mass Spectrometry

Keywords

  • Falls
  • General population studies
  • Men
  • Physical performance
  • Sex steroids

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

Cite this

Vandenput, L., Mellström, D., Laughlin, G. A., Cawthon, P. M., Cauley, J. A., Hoffman, A. R., ... Ohlsson, C. (Accepted/In press). Low Testosterone, but Not Estradiol, Is Associated With Incident Falls in Older Men: The International MrOS Study. Journal of Bone and Mineral Research. https://doi.org/10.1002/jbmr.3088

Low Testosterone, but Not Estradiol, Is Associated With Incident Falls in Older Men : The International MrOS Study. / Vandenput, Liesbeth; Mellström, Dan; Laughlin, Gail A.; Cawthon, Peggy M.; Cauley, Jane A.; Hoffman, Andrew R.; Karlsson, Magnus K.; Rosengren, Björn E.; Ljunggren, Östen; Nethander, Maria; Eriksson, Anna L.; Lorentzon, Mattias; Leung, Jason; Kwok, Timothy; Orwoll, Eric; Ohlsson, Claes.

In: Journal of Bone and Mineral Research, 2017.

Research output: Contribution to journalArticle

Vandenput, L, Mellström, D, Laughlin, GA, Cawthon, PM, Cauley, JA, Hoffman, AR, Karlsson, MK, Rosengren, BE, Ljunggren, Ö, Nethander, M, Eriksson, AL, Lorentzon, M, Leung, J, Kwok, T, Orwoll, E & Ohlsson, C 2017, 'Low Testosterone, but Not Estradiol, Is Associated With Incident Falls in Older Men: The International MrOS Study', Journal of Bone and Mineral Research. https://doi.org/10.1002/jbmr.3088
Vandenput, Liesbeth ; Mellström, Dan ; Laughlin, Gail A. ; Cawthon, Peggy M. ; Cauley, Jane A. ; Hoffman, Andrew R. ; Karlsson, Magnus K. ; Rosengren, Björn E. ; Ljunggren, Östen ; Nethander, Maria ; Eriksson, Anna L. ; Lorentzon, Mattias ; Leung, Jason ; Kwok, Timothy ; Orwoll, Eric ; Ohlsson, Claes. / Low Testosterone, but Not Estradiol, Is Associated With Incident Falls in Older Men : The International MrOS Study. In: Journal of Bone and Mineral Research. 2017.
@article{03953ff8604b4f8683566f5b25337bbb,
title = "Low Testosterone, but Not Estradiol, Is Associated With Incident Falls in Older Men: The International MrOS Study",
abstract = "Fracture risk is determined by bone strength and the risk of falls. The relationship between serum sex steroids and bone strength parameters in men is well known, whereas the predictive value of sex steroids for falls is less studied. The aim of this study was to assess the associations between serum testosterone (T) and estradiol (E2) and the likelihood of falls. Older men (aged ≥65 years) from the United States (n=1919), Sweden (n=2495), and Hong Kong (n=1469) participating in the Osteoporotic Fractures in Men Study had baseline T and E2 analyzed by mass spectrometry. Bioavailable (Bio) levels were calculated using mass action equations. Incident falls were ascertained every 4 months during a mean follow-up of 5.7 years. Associations between sex steroids and falls were estimated by generalized estimating equations. Fall rate was highest in the US and lowest in Hong Kong (US 0.50, Sweden 0.31, Hong Kong 0.12 fall reports/person/year). In the combined cohort of 5883 men, total T (odds ratio [OR] per SD increase=0.88, 95{\%} confidence interval [CI] 0.86-0.91) and BioT (OR=0.86, 95{\%} CI 0.83-0.88) were associated with incident falls in models adjusted for age and prevalent falls. These associations were only slightly attenuated after simultaneous adjustment for physical performance variables (total T: OR=0.94, 95{\%} CI 0.91-0.96; BioT: OR=0.91, 95{\%} CI 0.89-0.94). E2, BioE2, and sex hormone-binding globulin (SHBG) were not significantly associated with falls. Analyses in the individual cohorts showed that both total T and BioT were associated with falls in MrOS US and Sweden. No association was found in MrOS Hong Kong, and this may be attributable to environmental factors rather than ethnic differences because total T and BioT predicted falls in MrOS US Asians. In conclusion, low total T and BioT levels, but not E2 or SHBG, are associated with increased falls in older men.",
keywords = "Falls, General population studies, Men, Physical performance, Sex steroids",
author = "Liesbeth Vandenput and Dan Mellstr{\"o}m and Laughlin, {Gail A.} and Cawthon, {Peggy M.} and Cauley, {Jane A.} and Hoffman, {Andrew R.} and Karlsson, {Magnus K.} and Rosengren, {Bj{\"o}rn E.} and {\"O}sten Ljunggren and Maria Nethander and Eriksson, {Anna L.} and Mattias Lorentzon and Jason Leung and Timothy Kwok and Eric Orwoll and Claes Ohlsson",
year = "2017",
doi = "10.1002/jbmr.3088",
language = "English (US)",
journal = "Journal of Bone and Mineral Research",
issn = "0884-0431",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Low Testosterone, but Not Estradiol, Is Associated With Incident Falls in Older Men

T2 - The International MrOS Study

AU - Vandenput, Liesbeth

AU - Mellström, Dan

AU - Laughlin, Gail A.

AU - Cawthon, Peggy M.

AU - Cauley, Jane A.

AU - Hoffman, Andrew R.

AU - Karlsson, Magnus K.

AU - Rosengren, Björn E.

AU - Ljunggren, Östen

AU - Nethander, Maria

AU - Eriksson, Anna L.

AU - Lorentzon, Mattias

AU - Leung, Jason

AU - Kwok, Timothy

AU - Orwoll, Eric

AU - Ohlsson, Claes

PY - 2017

Y1 - 2017

N2 - Fracture risk is determined by bone strength and the risk of falls. The relationship between serum sex steroids and bone strength parameters in men is well known, whereas the predictive value of sex steroids for falls is less studied. The aim of this study was to assess the associations between serum testosterone (T) and estradiol (E2) and the likelihood of falls. Older men (aged ≥65 years) from the United States (n=1919), Sweden (n=2495), and Hong Kong (n=1469) participating in the Osteoporotic Fractures in Men Study had baseline T and E2 analyzed by mass spectrometry. Bioavailable (Bio) levels were calculated using mass action equations. Incident falls were ascertained every 4 months during a mean follow-up of 5.7 years. Associations between sex steroids and falls were estimated by generalized estimating equations. Fall rate was highest in the US and lowest in Hong Kong (US 0.50, Sweden 0.31, Hong Kong 0.12 fall reports/person/year). In the combined cohort of 5883 men, total T (odds ratio [OR] per SD increase=0.88, 95% confidence interval [CI] 0.86-0.91) and BioT (OR=0.86, 95% CI 0.83-0.88) were associated with incident falls in models adjusted for age and prevalent falls. These associations were only slightly attenuated after simultaneous adjustment for physical performance variables (total T: OR=0.94, 95% CI 0.91-0.96; BioT: OR=0.91, 95% CI 0.89-0.94). E2, BioE2, and sex hormone-binding globulin (SHBG) were not significantly associated with falls. Analyses in the individual cohorts showed that both total T and BioT were associated with falls in MrOS US and Sweden. No association was found in MrOS Hong Kong, and this may be attributable to environmental factors rather than ethnic differences because total T and BioT predicted falls in MrOS US Asians. In conclusion, low total T and BioT levels, but not E2 or SHBG, are associated with increased falls in older men.

AB - Fracture risk is determined by bone strength and the risk of falls. The relationship between serum sex steroids and bone strength parameters in men is well known, whereas the predictive value of sex steroids for falls is less studied. The aim of this study was to assess the associations between serum testosterone (T) and estradiol (E2) and the likelihood of falls. Older men (aged ≥65 years) from the United States (n=1919), Sweden (n=2495), and Hong Kong (n=1469) participating in the Osteoporotic Fractures in Men Study had baseline T and E2 analyzed by mass spectrometry. Bioavailable (Bio) levels were calculated using mass action equations. Incident falls were ascertained every 4 months during a mean follow-up of 5.7 years. Associations between sex steroids and falls were estimated by generalized estimating equations. Fall rate was highest in the US and lowest in Hong Kong (US 0.50, Sweden 0.31, Hong Kong 0.12 fall reports/person/year). In the combined cohort of 5883 men, total T (odds ratio [OR] per SD increase=0.88, 95% confidence interval [CI] 0.86-0.91) and BioT (OR=0.86, 95% CI 0.83-0.88) were associated with incident falls in models adjusted for age and prevalent falls. These associations were only slightly attenuated after simultaneous adjustment for physical performance variables (total T: OR=0.94, 95% CI 0.91-0.96; BioT: OR=0.91, 95% CI 0.89-0.94). E2, BioE2, and sex hormone-binding globulin (SHBG) were not significantly associated with falls. Analyses in the individual cohorts showed that both total T and BioT were associated with falls in MrOS US and Sweden. No association was found in MrOS Hong Kong, and this may be attributable to environmental factors rather than ethnic differences because total T and BioT predicted falls in MrOS US Asians. In conclusion, low total T and BioT levels, but not E2 or SHBG, are associated with increased falls in older men.

KW - Falls

KW - General population studies

KW - Men

KW - Physical performance

KW - Sex steroids

UR - http://www.scopus.com/inward/record.url?scp=85013952140&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013952140&partnerID=8YFLogxK

U2 - 10.1002/jbmr.3088

DO - 10.1002/jbmr.3088

M3 - Article

C2 - 28135013

AN - SCOPUS:85013952140

JO - Journal of Bone and Mineral Research

JF - Journal of Bone and Mineral Research

SN - 0884-0431

ER -