Sex Steroids and Bone Health Status in Men

Table 1

Epidemiological studies on the relationship between sex hormones and bone health status in men.

Researcher	Study and subject involved	Findings
Khosla et al. (1998) [33]	Rochester Epidemiology Study. 280 men aged 25–85 years.	Testosterone and estrogen (estradiol and estrone) correlated significantly with BMD of subjects at multiple sites. In a multiple stepwise regression model, estrogen was the only significant predictor of proximal femoral BMD.
van den Beld et al. (2000) [34]	403 men aged 73–94 years.	Testosterone and estradiol (total, free, and bioavailable fractions) were significantly associated with total body, femoral neck, ward and trochanteric BMD.
Amin et al. (2000) [35]	Framingham Study. 405 men aged 68–96 years.	Total estradiol had a positive and significant relationship with BMD of subjects while the relationship between testosterone and BMD was not significant.
Szulc et al. (2003) [36]	MINOS Study. 792 men consisting of two groups. Group 1 aged 19–40 years and Group 2 aged 51–85 years.	The reduction of free testosterone and free testosterone index showed a significant relationship with inability to perform functional tests and risk of fall. Men with lower BMD also had lower free testosterone.
Khosla et al. (2005) [37]	Rochester Epidemiology Study. 314 men aged 22–91 years.	Sex hormones (bioavailable testosterone and estradiol) had significant relationship with several volumetric BMD and structural indices as assessed using pQCT. Subendocortical area showed significant and negative relationship with testosterone. This indicated that testosterone exhibited antiresorptive effect in subendocortical area. Estrogen exhibited significant relationship with vBMD and structural indices particularly at cortical sites.
Mellström et al. (2006) [38]	MrOS Study Sweden. 2908 men with a mean age of 75.4 years.	Free testosterone level below the overall median was predictive of fracture after 50 years of age while free estradiol level at the lowest 10th percentile could predict fracture. Free testosterone and estradiol had significant relationship with BMD of subjects at multiple sites.
Araujo et al. (2008) [39]	Boston Area Health Study. 832 men aged 30–79 years.	Only estradiol levels correlated significantly with femoral neck, hip, ultradistal radius, and spine BMD after adjustment for confounders was performed. Testosterone did not correlate with BMD significantly.
LeBlanc et al. (2009) [40]	MrOS Study USA. 1436 Caucasian and 446 minorities aged 65 years and above.	Men with low bioavailable estradiol, low bioavailable testosterone, and high SHBG had significantly higher risk for nonvertebral fracture.
Travison et al. (2009) [41]	Boston Area Health Study. 808 men aged 30–79 years.	Estradiol levels had significant relationship with several hip strength parameters, especially cross-sectional area. It was suggested that anthropometric factors were the mediating factor in this relationship.
Paller et al. (2009) [42]	The Third National Health and Nutrition Survey USA. 623 men aged 20-90 years.	Men with the lowest quartile of free testosterone had 4-time odds of suffering from osteopenia. Subjects with the lowest quartile of free estradiol had 70% odds of suffering from osteopenia. The relationship between testosterone and bone health status was more obvious in aged men, but the relationship between estradiol and bone health status was apparent in younger men.
Venkat et al. (2009) [43]	350 Indian male military recruits aged 21–55 years.	Spine BMD had significant relationships with estradiol and testosterone (total, free, and bioavailable fraction) although the strength of the relationship was lower for testosterone. Femoral BMD was associated with estradiol but not testosterone levels.
Woo et al. (2011) [44]	MrOS Hong Kong. 1158 Chinese men aged 65 years and above.	Free testosterone level correlated significantly with femoral and hip BMD, but the percentage of changes of BMD in 4 years was significantly associated with estradiol, not testosterone. Men in the lowest quartile for bioavailable and free testosterone and estrogen were more prone to fracture.