[PHNUTR-L] Estradiol, testosterone, and the risk for hip fractures in elderly men from the Framingham Study

[Kathrynne Holden, MS, RD]

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Am J Med. 2006 May;119(5):426-33. 	
     Estradiol, testosterone, and the risk for hip fractures in elderly 
men from the Framingham Study.

     Amin S, Zhang Y, Felson DT, Sawin CT, Hannan MT, Wilson PW, Kiel DP.

     Boston University Clinical Epidemiology Research and Training Unit, 
Department of Medicine, Boston University School of Medicine, Boston, 
Mass, USA. amin.shreyasee at mayo.edu

     BACKGROUND: Low serum estradiol has been more strongly associated 
with low bone mineral density in elderly men than has testosterone, but 
its association with incident hip fracture is unknown. We examined 
whether low estradiol increases the risk for future hip fracture among 
men and explored whether testosterone levels influence this risk.

METHODS: We examined 793 men (mean age = 71 years) evaluated between 
1981 and 1983, who had estradiol measures and no history of hip 
fracture, and followed until the end of 1999. Total estradiol and 
testosterone were measured between 1981 and 1983. Hip fractures were 
identified and confirmed through medical records review through the end 
of 1999. We created 3 groups of men based on estradiol levels and 
performed a Cox-proportional hazards model to examine the risk for 
incident hip fracture, adjusted for age, body mass index, height, and 
smoking status. We performed similar analyses based on testosterone 
levels, and then based on both estradiol and testosterone levels together.

RESULTS: There were 39 men who sustained an atraumatic hip fracture over 
follow-up. Incidence rates for hip fracture (per 1000 person-years) were 
11.0, 3.4, and 3.9 for the low (2.0-18.1 pg/mL [7-67 pmol/L]), middle 
(18.2-34.2 pg/mL [67-125 pmol/L]), and high (> or =34.3 pg/mL [> or =126 
pmol/L]) estradiol groups, respectively. With adjustment for age, body 
mass index, height, and smoking status, the adjusted hazard ratios for 
men in the low and middle estradiol groups, relative to the high group, 
were 3.1 (95% confidence interval [CI], 1.4-6.9) and 0.9 (95% CI, 
0.4-2.0), respectively. In similar adjusted analyses evaluating men by 
their testosterone levels, we found no significant increased risk for 
hip fracture. However, in analyses in which we grouped men by both 
estradiol and testosterone levels, we found that men with both low 
estradiol and low testosterone levels had the greatest risk for hip 
fracture (adjusted hazard ratio: 6.5, 95% CI, 2.9-14.3).

CONCLUSION: Men with low estradiol levels are at an increased risk for 
future hip fracture. Men with both low estradiol and low testosterone 
levels seem to be at greatest risk for hip fracture.

     PMID: 16651055 [PubMed - indexed for MEDLINE]
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
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