To determine associations for testosterone (T) and sex hormone-binding globulin (SHBG) with incident fractures in middle-aged and older men, specifically examining the role of SHBG in relation to testosterone.
Key Findings:
Lower testosterone was associated with higher fracture risk at all evaluated sites when adjusted for SHBG, highlighting the importance of SHBG.
Lower SHBG levels were strongly associated with a lower risk of hip and forearm fractures.
The relationship between testosterone and fracture risk was nonlinear and inconsistent across fracture sites, indicating a complex interaction.
Interpretation:
Circulating SHBG is a major independent biomarker of fracture risk in men, suggesting that both total testosterone and SHBG should be evaluated in relation to fracture risk to improve clinical assessments.
Limitations:
The study's observational nature limits causal inferences and may introduce biases.
Potential confounding factors not fully accounted for despite adjustments.
Conclusion:
SHBG is a more significant predictor of fracture risk than testosterone in middle-aged and older men, underscoring the need for comprehensive assessments of both hormones in clinical practice.
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
