Elsevier

Bone

Volume 22, Issue 2, February 1998, Pages 147-151
Bone

Original Articles
Assessment of Sex Hormones and Bone Mineral Density in Relation to Occurrence of Fracture in Men: A Prospective Population-Based Study

https://doi.org/10.1016/S8756-3282(97)00250-0Get rights and content

Abstract

Patients with fragility fractures have low bone mineral density (BMD)—this statement is supported mainly by data on women. In this study, including only men, the objectives were to determine whether a decline in BMD alone or in combination with data on male sex hormones and skinfold thickness could be of value in predicting forthcoming fractures. We also wanted to find out whether high consumers of alcohol can be identified by measuring BMDs and male sex hormones. A prospective, population-based study was performed in the city of Malmö, Sweden. 242 men were randomly selected; all were of Scandinavian ethnic background, and were aged 50, 60, 70, and 80 years. Forearm BMD, testosterone, sex-hormone-binding globulin (SHBG), and skinfold thickness were analyzed. In addition, alcohol consumption and carbohydrate-deficient transferrin (CDT)—a marker of alcohol abuse—were analyzed. The study group was followed prospectively for 7 years and all fractures sustained were recorded. Prospectively, for a 1 SD decrease in forearm BMD, the Cox proportional hazard model gave a relative risk (RR) of 1.75 with a 95% confidence interval of 1.08–2.83 for a forthcoming fracture and 3.88 (1.30–11.57) for a hip fracture. For a 1 SD change in skinfold thickness, measured on the dorsum of the hand, a RR of 1.69 (0.99–2.87) for a forthcoming fracture was found and the corresponding value for hip fracture was 2.34 (1.10–5.00). Testosterone and SHBG did not enhance fracture prediction. Abusers of alcohol had, retrospectively, significantly more fractures. Individuals with alcohol consumption rates in the highest quartile had significantly higher CDT levels, but we were unable to identify high consumers of alcohol by analyzing BMD or sex hormones. In this study we found that forearm BMD and skinfold thickness could be used in predicting forthcoming fractures in men.

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.

Section snippets

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

References (42)

  • S.R. Cummings et al.

    Appendicular bone density and age predict hip fracture in women

    JAMA

    (1990)
  • M. Daniel et al.

    Cigarette smoking, steroid hormones, and bone mineral density in young women

    Calcif Tissue Int

    (1992)
  • P. Fernlund et al.

    Radioimmuno assay of human sex hormone-binding globulin. Improved radio-iodinization procedure

    Scand Clin Invest

    (1985)
  • J.S. Finklestein et al.

    Increases in bone density during treatment of men with idiopathic hypogonadotropic hypogonadism

    J Clin Endocrinol Metab

    (1989)
  • J.S. Finklestein et al.

    Osteoporosis in men with idiopathic hypogonadotropic hypogonadism

    Ann Intern Med

    (1987)
  • C. Foresta et al.

    Testosterone and calcitonin plasma levels in hyopgonadal osteoporotic young men

    J Endocrinol Invest

    (1985)
  • R.M. Francis et al.

    Osteoporosis in hypogonadal menRole of decreased plasma 1,25-dihydroxyvitamin D, calcium plasma levels in hypogonadal osteoporotic young men

    J Endocrinol Invest

    (1985)
  • P. Gärdsell et al.

    Predicting fractures in women by using forearm bone densitometry

    Calcif Tissue Int

    (1989)
  • P. Gärdsell et al.

    Bone mass in an urban and rural population. A comparative, population-based study in southern Sweden

    J Bone Miner Res

    (1991)
  • G.G. Gordon et al.

    Effect of alcohol (ethanol) administration on sex hormone metabolism in normal men

    New Engl J Med

    (1976)
  • S.L. Greenspan et al.

    Osteoporosis in men with hyperprolactinemic hypogonadism

    Ann Intern Med

    (1986)
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