Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
Department of Biostatistics, University of Washington, Seattle, WA, United States of America.
Metabolism. 2021 Jan;114:154399. doi: 10.1016/j.metabol.2020.154399. Epub 2020 Oct 12.
Little is known about the relationships of dihydrotestosterone (DHT), a more potent androgen than testosterone (T), with bone mineral density (BMD) and fracture risk. Our objectives were to evaluate the relationships of T, DHT and sex hormone binding globulin (SHBG) with BMD, fracture risk, and lean body mass (LBM).
We evaluated 1128 older men free of cardiovascular disease in a prospective cohort study using data from the Cardiovascular Health Study. T and DHT were measured by liquid chromatography-tandem mass spectrometry and SHBG by fluoroimmunoassay. Our outcomes included incident hip fracture (n = 106) over a median of 10.2 years and BMD and LBM by dual-energy x-ray absorptiometry (n = 439).
In Cox regression models mutually adjusted for T, SHBG, and covariates, each standard deviation increment in DHT (0.23 ng/ml) was associated with a 26% lower risk of hip fracture (adjusted hazard ratio [aHR] 0.74, 95% confidence interval (CI) 0.55-1.00, p = 0.049). Similarly, SHBG was associated with fracture in mutually adjusted models (aHR HR 1.26, 95% CI, 1.01-1.58, p = 0.045). In contrast, T (aHR, 1.16, 95% CI, 0.86-1.56, p = 0.324) was not significantly associated with fracture in mutually adjusted models. T, DHT and SHBG were not associated with BMD. T and DHT were both positively associated with LBM in individual models.
In older men, DHT was inversely associated with hip fracture risk and SHBG was positively associated with hip fracture risk, while T was not. Future studies should elucidate the mechanisms by which DHT affects bone health.
二氢睾酮（DHT）比睾酮（T）更具雄激素活性，但其与骨密度（BMD）和骨折风险的关系知之甚少。我们的目的是评估 T、DHT 和性激素结合球蛋白（SHBG）与 BMD、骨折风险和瘦体重（LBM）的关系。
我们使用心血管健康研究中的数据，在一项前瞻性队列研究中评估了 1128 名无心血管疾病的老年男性。通过液相色谱-串联质谱法和荧光免疫测定法测定 T 和 DHT，通过双能 X 射线吸收法测定 SHBG。我们的结局包括中位时间为 10.2 年的髋部骨折（n=106）以及 BMD 和 LBM（n=439）。
在相互校正 T、SHBG 和协变量的 Cox 回归模型中，DHT 每增加一个标准差（0.23ng/ml），髋部骨折的风险降低 26%（校正后的危险比[aHR]0.74，95%置信区间[CI]0.55-1.00，p=0.049）。同样，SHBG 在相互校正的模型中与骨折相关（aHR 1.26，95% CI，1.01-1.58，p=0.045）。相比之下，T（aHR，1.16，95% CI，0.86-1.56，p=0.324）在相互校正的模型中与骨折无显著相关性。T、DHT 和 SHBG 与 BMD 均无关。T 和 DHT 在单独的模型中均与 LBM 呈正相关。
在老年男性中，DHT 与髋部骨折风险呈负相关，SHBG 与髋部骨折风险呈正相关，而 T 则不然。未来的研究应该阐明 DHT 影响骨骼健康的机制。
