Original ArticlesAssessment of Sex Hormones and Bone Mineral Density in Relation to Occurrence of Fracture in Men: A Prospective Population-Based Study
Introduction
Measurements of bone mineral density (BMD) have been shown to be of prognostic value in describing the relative risk of sustaining a fracture in the future,6, 14, 15, 23, 25, 29 but only two of these studies were done in men.15, 29 Although men lose bone mass with advancing age,8, 32 the pathophysiology of such age-related bone loss is unknown. It has previously been shown that hypogonadal men have lower BMDs than age-matched controls,10, 11, 18 and that they may be at increased risk of fracture.39, 40
It has previously been postulated that age-related skin and bone atrophy has a common genetically steered mechanism as both skin and bone are connective tissue with type I collagen in their extracellular matrix. Skinfold thickness may thus help to identify individuals at risk for osteoporosis fractures.[5]
Alcohol is known to have a number of hormonal effects that could be expected to increase bone loss; one is a drop in the level of plasma testosterone, another an elevation of free plasma cortisol.17, 24, 26 These hormonal changes could be one of the reasons why high consumers of alcohol have a lower BMD and sustain fractures more frequently.[30]
The aim of the present study was to evaluate whether measurements of BMD, alone or in combination with data on plasma testosterone, sex-hormone-binding globulin (SHBG), and skinfold thickness, can be of value in predicting forthcoming fractures. We also wanted to find out whether high consumers of alcohol can be identified by measuring BMD, serum testosterone, and SHBG.
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Materials and Methods
Measurements of BMD, testosterone, SHBG, and CDT were performed on a population-based sample of men, who were then followed for 7 years with respect to fracture. Included in the study were men of Scandinavian ethnic background, aged 50, 60, 70, and 80 years. They represented an urban population, randomly selected from the city population files of Malmö, Sweden. Of the 307 men selected, 242 decided to participate, representing an attendance rate of 73% (40 of 55) 50 year olds, 83% (53 of 64) 60
Fractures
At the time of BMD measurement and blood sampling, 91 fractures had already occurred in 57 men (Table 1), 20 with more than one fracture. In the 7 years prior to the index study, 27 fractures in 14 men had occurred. The 7 year prospective registration yielded 31 fractures in 22 men. Within this time period, 7 men with more than one fracture were encountered (Table 1). One patient sustained a bilateral cervical hip fracture. Prospectively, we found that men without fractures (see Table 3) were
Discussion
Studies of normal bone tissue have shown that the strength of bone is a function of apparent density.3, 4 The measurements of BMD reflect long-standing changes in bone metabolism. In the present study we found the BMD of the distal end of radius to be of predictive value for fractures in men, which is in accordance with earlier studies in women.1, 14, 23 Only a few prospective studies have been done in men and they also have shown a predictive capacity of BMD.15, 29 In this study we found a
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