Background

Little is known about the relationships of dihydrotestosterone (DHT), a more potent androgen than testosterone (T), with bone mineral density (BMD) and fracture risk. Our objectives were to evaluate the relationships of T, DHT and sex hormone binding globulin (SHBG) with BMD, fracture risk, and lean body mass (LBM).

Methods

We evaluated 1128 older men free of cardiovascular disease in a prospective cohort study using data from the Cardiovascular Health Study. T and DHT were measured by liquid chromatography–tandem mass spectrometry and SHBG by fluoroimmunoassay. Our outcomes included incident hip fracture (n = 106) over a median of 10.2 years and BMD and LBM by dual-energy x-ray absorptiometry (n = 439).

Results

In Cox regression models mutually adjusted for T, SHBG, and covariates, each standard deviation increment in DHT (0.23 ng/ml) was associated with a 26% lower risk of hip fracture (adjusted hazard ratio [aHR] 0.74, 95% confidence interval (CI) 0.55–1.00, p = 0.049). Similarly, SHBG was associated with fracture in mutually adjusted models (aHR HR 1.26, 95% CI, 1.01–1.58, p = 0.045). In contrast, T (aHR, 1.16, 95% CI, 0.86–1.56, p = 0.324) was not significantly associated with fracture in mutually adjusted models. T, DHT and SHBG were not associated with BMD. T and DHT were both positively associated with LBM in individual models.

Conclusions

In older men, DHT was inversely associated with hip fracture risk and SHBG was positively associated with hip fracture risk, while T was not. Future studies should elucidate the mechanisms by which DHT affects bone health.

中文翻译：

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老年男性的睾酮、二氢睾酮、骨密度和髋部骨折风险：心血管健康研究

背景

关于二氢睾酮 (DHT)（一种比睾酮 (T) 更有效的雄激素）与骨矿物质密度 (BMD) 和骨折风险的关系知之甚少。我们的目标是评估 T、DHT 和性激素结合球蛋白 (SHBG) 与 BMD、骨折风险和瘦体重 (LBM) 的关系。

方法

我们使用心血管健康研究的数据在一项前瞻性队列研究中评估了 1128 名没有心血管疾病的老年男性。T 和 DHT 通过液相色谱-串联质谱法测量，SHBG 通过荧光免疫测定法测量。我们的结果包括中位 10.2 年的髋部骨折事件（n = 106）以及双能 X 射线吸收测定法的 BMD 和 LBM（n = 439）。

结果

在针对 T、SHBG 和协变量相互调整的 Cox 回归模型中，DHT 的每个标准差增量（0.23 ng/ml）与髋部骨折风险降低 26% 相关（调整后的风险比 [aHR] 0.74，95% 置信区间(CI) 0.55–1.00，p = 0.049)。同样，在相互调整的模型中，SHBG 与骨折相关（aHR HR 1.26, 95% CI, 1.01–1.58, p = 0.045）。相比之下，在相互调整的模型中，T (aHR, 1.16, 95% CI, 0.86–1.56, p = 0.324) 与骨折没有显着相关性。T、DHT 和 SHBG 与 BMD 无关。在单个模型中，T 和 DHT 都与 LBM 呈正相关。

结论

在老年男性中，DHT 与髋部骨折风险呈负相关，SHBG 与髋部骨折风险呈正相关，而 T 则不然。未来的研究应该阐明 DHT 影响骨骼健康的机制。