卵泡刺激素与绝经后妇女的低骨量有关。
Follicle-stimulating hormone is associated with low bone mass in postmenopausal women.
机构信息
Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA.
Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
出版信息
Osteoporos Int. 2023 Apr;34(4):693-701. doi: 10.1007/s00198-023-06676-z. Epub 2023 Jan 24.
UNLABELLED
We evaluated the influence of two endogenous hormones on bone health in older women. Higher FSH was associated with bone disease, especially in lower estradiol environments. FSH attenuated the relationship between estradiol and bone. This may provide a mechanism through which future clinical research intervenes on bone loss.
INTRODUCTION/PURPOSE: Despite preclinical evidence for an inverse association of follicle-stimulating hormone (FSH) and bone mineral density (BMD), no large epidemiologic studies have evaluated the separate and joint influences of FSH and estradiol on bone in postmenopausal women.
METHODS
In a cross-sectional study of 675 postmenopausal women, we evaluated associations of serum FSH and dual X-ray absorptiometry (DXA)-classified areal BMD as well as low bone mass or osteoporosis (T-score < - 1.0) of the femoral neck and total hip. We stratified this analysis by serum estradiol (cut at the median). We tested whether FSH mediates the association of estradiol and BMD using the Sobel test.
RESULTS
In linear regression models, there was a significant inverse association of serum FSH with both femoral neck and total hip BMD (both p < 0.01) when adjusted for age, hormone therapy (HT) use, and diabetes. In fully adjusted logistic regression models, women in the highest FSH tertile had higher odds of low bone mass/osteoporosis at the femoral neck (OR = 2.98; 95% CI = 1.86-4.77) and at the total hip (OR = 1.74; 95% CI = 1.06-2.84) compared to those in the lowest FSH tertile. We report evidence of effect modification by estradiol in stratified models and an interaction term. FSH met all criteria of a mediator, including an estimated 70% attenuation of the estradiol-BMD relationship (Sobel p value < 0.001).
CONCLUSIONS
FSH is associated with higher odds of having low bone mass/osteoporosis even after accounting for HT use. FSH is a mediator of the relationship between estradiol and BMD in healthy postmenopausal women. Larger, prospective studies of FSH concentrations and bone health are needed.
目的
尽管有临床前证据表明卵泡刺激素（FSH）与骨密度（BMD）呈负相关，但尚无大型流行病学研究评估绝经后妇女中 FSH 和雌二醇对骨骼的单独和联合影响。
方法
在一项 675 名绝经后妇女的横断面研究中，我们评估了血清 FSH 和双能 X 线吸收法（DXA）分类的面积 BMD 以及股骨颈和全髋的低骨量或骨质疏松症（T 评分<−1.0）之间的相关性。我们按血清雌二醇（中位数分层）进行了此分析。我们使用 Sobel 检验测试了 FSH 是否介导了雌二醇和 BMD 的相关性。
结果
在线性回归模型中，校正年龄、激素治疗（HT）使用和糖尿病后，血清 FSH 与股骨颈和全髋 BMD 均呈显著负相关（均 p<0.01）。在完全校正的逻辑回归模型中，FSH 最高三分位的女性在股骨颈（比值比[OR] = 2.98；95%置信区间[CI] = 1.86-4.77）和全髋（OR = 1.74；95% CI = 1.06-2.84）发生低骨量/骨质疏松症的几率更高，而 FSH 最低三分位的女性则较低。我们报告了分层模型中雌激素效应修饰的证据和交互项。FSH 符合所有中介物标准，包括对雌二醇-BMD 关系的估计衰减 70%（Sobel p 值<0.001）。
结论
即使考虑到 HT 使用，FSH 与更高的低骨量/骨质疏松症几率相关。FSH 是健康绝经后妇女中雌二醇与 BMD 关系的中介物。需要更大的、前瞻性的 FSH 浓度与骨骼健康的研究。
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