The association of concurrent vitamin D and sex hormone deficiency with bone loss and fracture risk in older men: The osteoporotic fractures in men (MrOS) study

Elizabeth Barrett-Connor, Gail A. Laughlin, Hong Li, Carrie Nielson, P. Ying Wang, Tien T. Dam, Jane A. Cauley, Kristine E. Ensrud, Marcia L. Stefanick, Edith Lau, Andrew R. Hoffman, Eric Orwoll

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Low 25-hydroxyvitamin D (VitD), low sex hormones (SH), and high sex hormone binding globulin (SHBG) levels are common in older men. We tested the hypothesis that combinations of low VitD, low SH, and high SHBG would have a synergistic effect on bone mineral density (BMD), bone loss, and fracture risk in older men. Participants were a random subsample of 1468 men (mean age 74 years) from the Osteoporotic Fractures in Men Study (MrOS) plus 278 MrOS men with incident nonspine fractures studied in a case-cohort design. "Abnormal" was defined as lowest quartile for VitD (59 nM). Overall, 10% had isolated VitD deficiency; 40% had only low SH or high SHBG; 15% had both SH/SHBG and VitD abnormality; and 35% had no abnormality. Compared to men with all normal levels, those with both SH/SHBG and VitD abnormality tended to be older, more obese, and to report less physical activity. Isolated VitD deficiency, and low BioT with or without low VitD, was not significantly related to skeletal measures. The combination of VitD deficiency with low BioE and/or high SHBG was associated with significantly lower baseline BMD and higher annualized rates of hip bone loss than SH abnormalities alone or no abnormality. Compared to men with all normal levels, the multivariate-adjusted hazard ratio (95% confidence interval [CI]) for incident nonspine fracture during 4.6-year median follow-up was 1.2 (0.8-1.8) for low VitD alone; 1.3 (0.9-1.9) for low BioE and/or high SHBG alone; and 1.6 (1.1-2.5) for low BioE/high SHBG plus low VitD. In summary, adverse skeletal effects of low sex steroid levels were more pronounced in older men with low VitD levels. The presence of low VitD in the presence of low BioE/high SHBG may contribute substantially to poor skeletal health.

Original languageEnglish (US)
Pages (from-to)2306-2313
Number of pages8
JournalJournal of Bone and Mineral Research
Volume27
Issue number11
DOIs
StatePublished - Nov 2012

Fingerprint

Osteoporotic Fractures
Bone Fractures
Gonadal Steroid Hormones
Vitamin D
Sex Hormone-Binding Globulin
25-hydroxyvitamin D
Bone Density
Pelvic Bones

Keywords

  • BONE LOSS
  • FRACTURE
  • OLDER MEN
  • SEX HORMONES
  • VITAMIN D

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

The association of concurrent vitamin D and sex hormone deficiency with bone loss and fracture risk in older men : The osteoporotic fractures in men (MrOS) study. / Barrett-Connor, Elizabeth; Laughlin, Gail A.; Li, Hong; Nielson, Carrie; Wang, P. Ying; Dam, Tien T.; Cauley, Jane A.; Ensrud, Kristine E.; Stefanick, Marcia L.; Lau, Edith; Hoffman, Andrew R.; Orwoll, Eric.

In: Journal of Bone and Mineral Research, Vol. 27, No. 11, 11.2012, p. 2306-2313.

Research output: Contribution to journalArticle

Barrett-Connor, Elizabeth ; Laughlin, Gail A. ; Li, Hong ; Nielson, Carrie ; Wang, P. Ying ; Dam, Tien T. ; Cauley, Jane A. ; Ensrud, Kristine E. ; Stefanick, Marcia L. ; Lau, Edith ; Hoffman, Andrew R. ; Orwoll, Eric. / The association of concurrent vitamin D and sex hormone deficiency with bone loss and fracture risk in older men : The osteoporotic fractures in men (MrOS) study. In: Journal of Bone and Mineral Research. 2012 ; Vol. 27, No. 11. pp. 2306-2313.
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