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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Levels of Testosterone and Estrogen and Bone Density in Elderly Men
19 December 2000 | Volume 133 Issue 12 | Page S62
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician.
The summary below is from the full report titled "Association of Hypogonadism and Estradiol Levels with Bone Mineral Density in Elderly Men from the Framingham Study." It is in the 19 December 2000 issue of Annals of Internal Medicine (volume 133, pages 951-963). The authors are S Amin, Y Zhang, CT Sawin, SR Evans, MT Hannan, DP Kiel, PWF Wilson, and DT Felson.
What is the problem and what is known about it so far?
Osteoporosis is a condition that involves thinning of the bones and can lead to bone fractures. Osteoporosis has gained much attention in women, but older men are also at some risk for osteoporosis. The hormones estrogen and testosterone play an important role in bone health. When the testicles produce too little testosterone, the main sex hormone in men, the condition is known as hypogonadism. Young men with hypogonadism develop osteoporosis unless they are treated with testosterone supplements. Some degree of hypogonadism occurs with normal aging, but it is unclear whether the hypogonadism of aging explains the osteoporosis that can occur in elderly men. Estrogen levels are a key factor in osteoporosis in women. Men also produce small amounts of estrogen, but it is not known how much estrogen affects bone density in men.
Why did the researchers do this particular study?
To find out whether testosterone and estrogen levels are associated with bone density in elderly men.
Who was studied?
The researchers studies 405 men 68 to 96 years of age who participated in the Framingham Study, a large study in Framingham, Massachusetts, of factors that affect health.
How was the study done?
Every other year between 1981 and 1989, the researchers collected blood specimens from the men in this study; they obtained a total of four samples. To be included in the study, men must have supplied blood specimens adequate to measure hormone levels for at least three of four follow-up visits. The researchers used these samples to measure testosterone and estrogen levels, and they took the average of the three to four results for each hormone. During 1988–1989, the men in the study had bone density scans, which are special tests that measure bone thickness.
What did the researchers find?
Bone density in men with abnormally low testosterone levels did not differ significantly from bone density in men with normal testosterone levels. However, bone density was greater in men with higher estrogen levels.
What were the limitations of the study?
The researchers measured blood levels of total testosterone. Some of the testosterone in blood is bound to proteins, however. A measure of "free" testosterone (the amount not bound to proteins) would have been a more precise measure of how much testosterone is available for the body's metabolism.
What are the implications of the study?
The decreases in testosterone levels that occur in some men as they grow older do not appear to be related to thinning of the bones (osteoporosis) that develops in elderly men. However, older men with lower estrogen levels are more likely to have osteoporosis than are men with normal or high estrogen levels.
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