Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Department of Urology, Juntendo University School of Medicine, Tokyo, Japan; Department of Urology, Teikyo University School of Medicine, Tokyo, Japan.
J Am Med Dir Assoc. 2014 Jan;15(1):30-5. doi: 10.1016/j.jamda.2013.11.003.
While several studies have cited a potential association between testosterone deficiency and risk of falls among community-dwelling older men, evidence for such an association is conflicting. Depressive symptoms, which occasionally accompany testosterone deficiency but which are often neglected as associated symptoms, may actually provoke falls independent of or jointly with testosterone deficiency. We examined the association between testosterone levels, depressive symptoms, and falls, and assessed the joint effect of testosterone levels and depressive symptoms on falls among older men.
DESIGN, SETTING, AND PARTICIPANTS: Data for this cross-sectional study were obtained from 869 men aged over 60 years who participated in health check-ups conducted in 2010 from 2 Japanese municipalities. Salivary testosterone (sT) levels were measured using an enzyme-linked immunosorbent assay, and depressive symptoms were assessed via the short form of the Center for Epidemiologic Studies Depression Scale.
Self-reported "any fall" over the 1-month period.
Among the total of 482 participants analyzed (median age, 70 years), 10.8% reported any fall. On comparison between 90th percentile sT levels and lower levels, our logistic regression model with restricted cubic splines showed that lower sT levels were associated with an increased likelihood of suffering any fall after adjustment for sociodemographic characteristics, comorbidities, and mobility function. For example, 5th percentile sT was associated with any fall [adjusted odds ratio (OR), 4.23; 95% confidence interval (CI), 1.66-10.8]. Depressive symptoms were also strongly associated with any fall [adjusted OR, 3.49 (95% CI, 1.52-8.04)]. We noted no apparent interaction of sT and depressive symptoms with falls (P = .079), suggesting that the joint effect of testosterone deficiency and depressive symptoms on falls was multiplicative. Indeed, compared with a combination of 90th percentile sT values and no depressive symptoms, adjusted OR for any fall in a combination involving 5th percentile sT and depressive symptoms was 14.8-fold (95% CI, 3.76-58.0).
Our findings indicated that both relatively low testosterone levels and presence of depressive symptoms were independently associated with falls among older men. Causality of these associations should be confirmed in future prospective studies.
虽然有几项研究指出睾丸激素缺乏与社区居住的老年男性跌倒风险之间存在潜在关联，但相关证据存在矛盾。伴随睾丸激素缺乏出现的抑郁症状，常被忽视，但可能会独立或与睾丸激素缺乏共同引发跌倒。我们研究了睾丸激素水平、抑郁症状与跌倒之间的关系，并评估了睾丸激素水平和抑郁症状对老年男性跌倒的联合影响。
设计、地点和参与者：本横断面研究的数据来自于参加 2010 年日本两个市健康检查的 869 名年龄在 60 岁以上的男性。使用酶联免疫吸附测定法测量唾液睾丸激素（sT）水平，采用流行病学研究中心抑郁量表的简短形式评估抑郁症状。
1 个月内的“任何跌倒”自报告情况。
在总共 482 名分析对象中（中位年龄 70 岁），10.8%报告有任何跌倒。使用受限立方样条的逻辑回归模型进行比较后，我们发现，在调整社会人口学特征、合并症和移动功能后，较低的 sT 水平与跌倒风险增加相关。例如，第 5 百分位数 sT 与任何跌倒相关[校正优势比（OR），4.23；95%置信区间（CI），1.66-10.8]。抑郁症状也与任何跌倒强烈相关[校正 OR，3.49（95% CI，1.52-8.04)]。我们没有发现 sT 和抑郁症状与跌倒之间存在明显的交互作用（P=0.079），这表明睾丸激素缺乏和抑郁症状对跌倒的联合作用是相乘的。事实上，与第 90 百分位数 sT 值和无抑郁症状的组合相比，涉及第 5 百分位数 sT 和抑郁症状的组合的任何跌倒校正 OR 为 14.8 倍（95% CI，3.76-58.0）。
我们的研究结果表明，睾丸激素水平相对较低和抑郁症状的存在与老年男性跌倒独立相关。在未来的前瞻性研究中，应确定这些关联的因果关系。
