Orwoll Eric, Lambert Lori C, Marshall Lynn M, Blank Janet, Barrett-Connor Elizabeth, Cauley Jane, Ensrud Kris, Cummings Steven R
Bone and Mineral Unit, Oregon Health & Science University, Portland, USA.
Arch Intern Med. 2006 Oct 23;166(19):2124-31. doi: 10.1001/archinte.166.19.2124.
Gonadal steroid levels decline with age in men. Whether low testosterone levels affect the development of common age-related disorders, including physical functioning and falling, is unclear.
This longitudinal, observational follow-up study sought to determine whether low testosterone levels are associated with physical performance and fall risk in older men. A total of 2587 community-based men aged 65 to 99 years were selected using a stratified random sampling scheme from a study cohort of 5995 volunteers. Bioavailable testosterone and estradiol levels and physical performance measures were determined from baseline. Incident falls were ascertained every 4 months during 4 years of follow-up. Generalized estimating equations were used to estimate risk ratios for the relation of sex steroids to falls.
Fifty-six percent of the men reported at least 1 fall; many fell frequently. Lower bioavailable testosterone levels were associated with increased fall risk. Men with testosterone levels in the lowest quartile had a 40% higher fall risk than those in the highest quartile. The effect of low testosterone levels was most apparent in younger men (65-69 years) (relative risk, 1.8; 95% confidence interval, 1.2-2.7); testosterone level was not associated with falls in the oldest men (>/=80 years). Lower testosterone concentrations were associated with reduced physical performance. However, the association between low testosterone levels and fall risk persisted despite adjustment for performance.
Falls were common among older men. Fall risk was higher in men with lower bioavailable testosterone levels. The effect of testosterone level was independent of poorer physical performance, suggesting that the effect of testosterone on fall risk may be mediated by other androgen actions.
男性的性腺类固醇水平会随着年龄增长而下降。目前尚不清楚低睾酮水平是否会影响常见的与年龄相关的疾病的发生发展，包括身体机能和跌倒情况。
这项纵向观察性随访研究旨在确定低睾酮水平是否与老年男性的身体表现和跌倒风险相关。我们采用分层随机抽样方案，从5995名志愿者的研究队列中选取了2587名年龄在65至99岁之间的社区男性。在基线时测定了生物可利用睾酮和雌二醇水平以及身体表现指标。在4年的随访期间，每4个月确定一次跌倒事件。使用广义估计方程来估计性类固醇与跌倒之间关系的风险比。
56%的男性报告至少有1次跌倒；许多人经常跌倒。较低的生物可利用睾酮水平与跌倒风险增加相关。睾酮水平处于最低四分位数的男性跌倒风险比最高四分位数的男性高40%。低睾酮水平的影响在较年轻男性（65 - 69岁）中最为明显（相对风险，1.8；95%置信区间，1.2 - 2.7）；睾酮水平与最年长男性（≥80岁）的跌倒无关。较低的睾酮浓度与身体表现下降相关。然而，尽管对身体表现进行了调整，低睾酮水平与跌倒风险之间的关联仍然存在。
跌倒在老年男性中很常见。生物可利用睾酮水平较低的男性跌倒风险更高。睾酮水平的影响独立于较差的身体表现，这表明睾酮对跌倒风险的影响可能是由其他雄激素作用介导的。
