Age‐Related (Type II) Femoral Neck Osteoporosis in Men: Biochemical Evidence for Both Hypovitaminosis D– and Androgen Deficiency–Induced Bone Resorption

The problem of osteoporosis in men has recently been recognized as an important public health issue. To test the hypothesis that endocrine deficiency–mediated alterations in bone metabolism might contribute to osteoporotic fracture risk in elderly men, serum levels of 25‐hydroxycholecalciferol (25(OH)D), 1,25‐dihydroxycholecalciferol (1,25(OH)2D), intact parathyroid hormone (PTH), testosterone, and estradiol were measured in 40 males (mean age 73 years) who were consecutively recruited within 18 h following a fracture of the proximal femur, and in an equal number of community‐living older men (mean age 72 years) who served as controls. In addition, circulating osteocalcin and urinary excretion of (deoxy)pyridinoline were determined as markers of bone formation and resorption, respectively. No differences were observed between the mean serum concentrations of osteocalcin and estradiol. Serum levels of 25(OH)D, 1,25(OH)2D, and testosterone, however, were decreased in hip fracture patients. When correcting for differences in vitamin D binding protein, differences in 1,25(OH)2D did not persist, whereas serum 25(OH)D was still significantly lower in patients than in controls (6.1 ± 4.3 vs. 7.6 ± 2.8, p = 0.01). Similarly, a highly significant deficit was observed in the free testosterone index, calculated from total testosterone and the level of sex hormone binding globulin (2.6 ± 1.3 vs. 8.2 ± 2.9, p < 0.001). Serum PTH and urinary pyridinium cross‐links, however, were markedly increased in the fracture group. Moreover, in fracture patients, free 25(OH)D and free testosterone were both significant and mutually independent negative predictors of (deoxy)pyridinoline excretion. Although limited by its cross‐sectional design, the present study suggests that both hypovitaminosis D and androgen deficiency may predispose to bone resorption in elderly men and in turn to remodeling imbalance and fracture risk.

[1]  E. Seeman,et al.  Osteoporosis in Men , 1999, Osteoporosis International.

[2]  E. Lesaffre,et al.  Relationship Between Baseline Insulin‐Like Growth Factor‐I (IGF‐I) and Femoral Bone Density in Women Aged Over 70 Years: Potential Implications for the Prevention of Age‐Related Bone Loss , 1996, Journal of the American Geriatrics Society.

[3]  E. Baulieu,et al.  Dehydroepiandrosterone (DHEA): a fountain of youth? , 1996, The Journal of clinical endocrinology and metabolism.

[4]  A. Silman,et al.  The prevalence of vertebral deformity in European men and women: The european vertebral osteoporosis study , 1996, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[5]  D. Vanderschueren Androgens and their role in skeletal homeostasis. , 1996, Hormone research.

[6]  S. Boonen,et al.  Androgens and bone. , 2004, Calcified tissue international.

[7]  W. O'Fallon,et al.  Predictors of hip fractures in elderly men , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[8]  L. Bouter,et al.  Vitamin D status and sex hormone binding globulin: Determinants of bone turnover and bone mineral density in elderly women , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[9]  L. Bouter,et al.  Prevention of bone loss by vitamin D supplementation in elderly women: a randomized double-blind trial. , 1995, The Journal of clinical endocrinology and metabolism.

[10]  B. Riggs,et al.  Regulation of c-fos expression and TGF-β production by gonadal and adrenal androgens in normal human osteoblastic cells , 1995, The Journal of Steroid Biochemistry and Molecular Biology.

[11]  S. Winters Endocrine evaluation of testicular function. , 1994, Endocrinology and metabolism clinics of North America.

[12]  K. Khaw,et al.  Seasonal variation in 25-hydroxyvitamin D and parathyroid hormone concentrations in healthy elderly people. , 1994, Age and ageing.

[13]  D. Vanderschueren,et al.  Time-related increase of biochemical markers of bone turnover in androgen-deficient male rats. , 1994, Bone and mineral.

[14]  A. Abbasi,et al.  Low Circulating Levels of Insulin‐Like Growth Factors and Testosterone in Chronically Institutionalized Elderly Men , 1993, Journal of the American Geriatrics Society.

[15]  K. Häkkinen,et al.  Muscle strength and serum testosterone, cortisol and SHBG concentrations in middle-aged and elderly men and women. , 1993, Acta physiologica Scandinavica.

[16]  A. Prentice,et al.  Relationships between parathyroid hormone, 25-hydroxyvitamin D, and bone mineral density in elderly men. , 1993, Age and ageing.

[17]  F Duboeuf,et al.  Vitamin D3 and calcium to prevent hip fractures in elderly women. , 1992, The New England journal of medicine.

[18]  T. A. Roy,et al.  Biochemical parameters associated with low bone density in healthy men and women , 1992, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[19]  J. S. Tenover,et al.  Effects of testosterone supplementation in the aging male. , 1992, The Journal of clinical endocrinology and metabolism.

[20]  N. Orentreich,et al.  Long-term longitudinal measurements of plasma dehydroepiandrosterone sulfate in normal men. , 1992, The Journal of clinical endocrinology and metabolism.

[21]  D. Vanderschueren,et al.  Homologous radioimmunoassay of human osteocalcin. , 1992, Clinical chemistry.

[22]  R A Marottoli,et al.  Decline in Physical Function following Hip Fracture , 1992, Journal of the American Geriatrics Society.

[23]  J. Devogelaer,et al.  Low bone mass in hypogonadal males. Effect of testosterone substitution therapy, a densitometric study. , 1992, Maturitas.

[24]  F. Pecchio,et al.  Effect of testosterone on bone in hypogonadal males. , 1992, Maturitas.

[25]  M. Riggs,et al.  Testosterone Deficiency As a Risk Factor for Hip Fractures in Men: A Case‐Control Study , 1992, The American journal of the medical sciences.

[26]  D. Vanderschueren,et al.  Bone and mineral metabolism in aged male rats: short and long term effects of androgen deficiency. , 1992, Endocrinology.

[27]  J. Mckinlay,et al.  Age, disease, and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study. , 1991, The Journal of clinical endocrinology and metabolism.

[28]  R. Poses,et al.  Does Hypogonadism Contribute to the Occurrence of a Minimal Trauma Hip Fracture in Elderly Men? , 1991, Journal of the American Geriatrics Society.

[29]  A. Vermeulen Clinical review 24: Androgens in the aging male. , 1991, The Journal of clinical endocrinology and metabolism.

[30]  D. Reid,et al.  Evaluation of urinary hydroxypyridinium crosslink measurements as resorption markers in metabolic bone diseases , 1991, European journal of clinical investigation.

[31]  R. Turner,et al.  Androgen treatment prevents loss of cancellous bone in the orchidectomized rat , 1991, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[32]  P. Croucher,et al.  Low prevalence of osteomalacia in elderly patients with hip fracture. , 1991, Age and ageing.

[33]  H. Orimo,et al.  [Involutional osteoporosis]. , 1991, Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics.

[34]  C. Selby Sex Hormone Binding Globulin: Origin, Function and Clinical Significance , 1990, Annals of clinical biochemistry.

[35]  R. Turner,et al.  Differential effects of androgens on cortical bone histomorphometry in gonadectomized male and female rats , 1990, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[36]  P. Delmas,et al.  Biochemical markers of bone turnover for the clinical assessment of metabolic bone disease. , 1990, Endocrinology and metabolism clinics of North America.

[37]  R. Bouillon,et al.  Immunoradiometric assay of parathyrin with polyclonal and monoclonal region-specific antibodies. , 1990, Clinical chemistry.

[38]  R. Morris,et al.  Production and metabolic clearance of 1,25-dihydroxyvitamin D in men: effect of advancing age. , 1990, The Journal of clinical endocrinology and metabolism.

[39]  S. P. Chow,et al.  Vitamin D status among patients with fractured neck of femur in Hong Kong. , 1990, Bone.

[40]  A. Klibanski,et al.  Importance of gonadal steroids to bone mass in men with hyperprolactinemic hypogonadism. , 1989, Annals of internal medicine.

[41]  P. Garry,et al.  Age-related changes in serum immunoreactive parathyroid hormone and its biological action in healthy men and women. , 1987, The Journal of clinical endocrinology and metabolism.

[42]  R. Marcus,et al.  Age‐related rise in parathyroid hormone in man: The use of intact and midmoleeule antisera to distinguish hormone secretion from retention , 1987, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[43]  J. Auwerx,et al.  Vitamin D status in the elderly: seasonal substrate deficiency causes 1,25-dihydroxycholecalciferol deficiency. , 1987, The American journal of clinical nutrition.

[44]  J. Devogelaer,et al.  Bone mineral density in Addison's disease: evidence for an effect of adrenal androgens on bone mass. , 1987, British medical journal.

[45]  W. Crowley,et al.  Osteoporosis in Men with Idiopathic Hypogonadotropic Hypogonadism , 1987 .

[46]  J L Coolens,et al.  Clinical use of unbound plasma cortisol as calculated from total cortisol and corticosteroid-binding globulin. , 1987, Journal of steroid biochemistry.

[47]  W. Crowley,et al.  Osteoporosis in men with idiopathic hypogonadotropic hypogonadism. , 1987, Annals of internal medicine.

[48]  D. Meier,et al.  Alterations in calcium, vitamin D, and parathyroid hormone physiology in normal men with aging: relationship to the development of senile osteopenia. , 1986, The Journal of clinical endocrinology and metabolism.

[49]  B. Riggs,et al.  The influence of age on bone mineral regulating hormones. , 1986, Bone.

[50]  M. Horowitz,et al.  The relation between calcium absorption, serum dehydroepiandrosterone, and vertebral mineral density in postmenopausal women. , 1985, The Journal of clinical endocrinology and metabolism.

[51]  N. Orentreich,et al.  Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. , 1984, The Journal of clinical endocrinology and metabolism.

[52]  W. Pardridge,et al.  Critical illness and low testosterone: effects of human serum on testosterone transport into rat brain and liver. , 1983, The Journal of clinical endocrinology and metabolism.

[53]  T. K. Gray,et al.  Radioimmunoassay for 1,25-dihydroxycholecalciferol. , 1980, Clinical chemistry.

[54]  P. D. de Moor,et al.  Androgen and progestogen production in cultured interstitial cells derived from immature rat testis. , 1982, Journal of steroid biochemistry.

[55]  F. V. Van Ginkel,et al.  Histomorphometric profile and vitamin D status in patients with femoral neck fracture. , 1982, Metabolic bone disease & related research.

[56]  P. D. de Moor,et al.  Influence of the vitamin D-binding protein on the serum concentration of 1,25-dihydroxyvitamin D3. Significance of the free 1,25-dihydroxyvitamin D3 concentration. , 1981, The Journal of clinical investigation.

[57]  P. D. de Moor,et al.  Biochemical characterization of peritoneal fluid in women during the menstrual cycle. , 1980, The Journal of clinical endocrinology and metabolism.

[58]  P. D. de Moor,et al.  A radioimmunoassay for 1,25-dihydroxycholecalciferol. , 1978, Clinical chemistry.

[59]  G. Hill,et al.  Assessment of protein-calorie malnutrition in surgical patients from plasma proteins and anthropometric measurements. , 1978, The American journal of clinical nutrition.

[60]  P. D. de Moor,et al.  The measurement of the vitamin D-binding protein in human serum. , 1977, The Journal of clinical endocrinology and metabolism.

[61]  P. D. de Moor,et al.  Measurement of 25-hydroxyvitamin D3 in serum. , 1976, Clinical chemistry.

[62]  Cockcroft Dw,et al.  Prediction of Creatinine Clearance from Serum Creatinine , 1976 .

[63]  M. H. Gault,et al.  Prediction of creatinine clearance from serum creatinine. , 1975, Nephron.

[64]  R. Rubens,et al.  Testosterone secretion and metabolism in male senescence. , 1972, The Journal of clinical endocrinology and metabolism.