Clinical Scorecard: Links Between Serum Testosterone and SHBG Levels and the Risk of Fractures in Middle-aged and Older Men
At a Glance
Category
Detail
Condition
Fracture risk associated with circulating testosterone and SHBG levels in men
Key Mechanisms
Age-related decrease in testosterone and increase in SHBG; SHBG as an independent biomarker for fracture risk
Target Population
Middle-aged and older men
Care Setting
Community and clinical settings assessing fracture risk and hormone levels
Key Highlights
Low circulating SHBG is strongly associated with a lower risk of fractures at hip and forearm sites.
Associations between circulating testosterone and fracture risk are nonlinear, inconsistent by fracture site, and influenced by SHBG adjustment.
Testosterone treatment increases bone mineral density but its effect on fracture risk is unclear and may increase fracture incidence in some populations.
Guideline-Based Recommendations
Diagnosis
Assess both total testosterone and SHBG levels when evaluating fracture risk in middle-aged to older men.
Management
Consider testosterone treatment in hypogonadal men to improve bone mineral density, recognizing that fracture risk impact is uncertain.
Monitor estradiol changes during testosterone therapy as it predicts bone density improvements.
Monitoring & Follow-up
Regularly monitor bone mineral density and fracture incidence in men receiving testosterone therapy.
Adjust fracture risk assessment models for comorbidities and SHBG levels.
Risks
Testosterone treatment may increase fracture risk in men with low testosterone and high cardiovascular risk.
Men have higher post-fracture mortality and are often undertreated for fracture risk.
Patient & Prescribing Data
Middle-aged and older men, including those with hypogonadism, impaired glucose tolerance, or type 2 diabetes
Testosterone therapy increases bone mineral density but may not reduce fracture risk; fracture risk may increase in certain high-risk groups.
Clinical Best Practices
Evaluate both total testosterone and SHBG levels to accurately assess fracture risk.
Consider patient comorbidities and fracture site when interpreting hormone-fracture associations.
Use calculated free testosterone (cFT) for more precise fracture risk assessment.
Monitor bone health closely during testosterone therapy, especially in men with cardiovascular risk factors.
by Louise Grahnemo, Ross J Marriott, Kevin Murray, Lauren T Tyack, Maria Nethander, Alvin M Matsumoto, Eric S Orwoll, Dirk Vanderschueren, Bu B Yeap, Claes Ohlsson
