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High Serum SHBG Predicts Incident Vertebral Fractures in Elderly Men.

Journal article
Authors Liesbeth Vandenput
Dan Mellström
Andreas Kindmark
Helena Johansson
Mattias Lorentzon
Jason Leung
Inga Redlund-Johnell
Björn E Rosengren
Magnus K Karlsson
Yi-Xiang Wang
Timothy Kwok
Claes Ohlsson
Published in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
Volume 31
Issue 3
Pages 683-689
ISSN 1523-4681
Publication year 2016
Published at Centre for Bone and Arthritis Research
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Pages 683-689
Language en
Subject categories Endocrinology


Previous prospective cohort studies have shown that serum levels of sex steroids and sex hormone-binding globulin (SHBG) associate with non-vertebral fracture risk in men. The predictive value of sex hormones and SHBG for vertebral fracture risk specifically is, however, less studied. Elderly men (aged ≥65 years) from Sweden and Hong Kong participating in the MrOS study had baseline estradiol and testosterone analyzed by GC-MS and SHBG by IRMA. Incident clinical vertebral fractures (n = 242 cases) were evaluated in 4324 men during an average follow-up of 9.1 years. In a subsample of these men (n = 2256), spine X-rays were obtained at baseline and after an average follow-up of 4.3 years to identify incident radiographic vertebral fractures (n = 157 cases). The likelihood of incident clinical and radiographic vertebral fractures was estimated by Cox proportional hazards models and logistic regression models, respectively. Neither serum estradiol (HR per SD increase, 95% CI: 0.93, 0.80-1.08) nor testosterone (1.05, 0.91-1.21) predicted incident clinical vertebral fractures in age-adjusted models in the combined data set. High serum SHBG, however, associated with increased clinical vertebral fracture risk (1.24, 1.12-1.37). This association remained significant after further adjustment for FRAX® with or without BMD. SHBG also associated with increased incident radiographic vertebral fracture risk (combined data set; OR per SD increase, 95% CI: 1.23, 1.05-1.44). This association remained significant after adjustment for FRAX® with or without BMD. In conclusion, high SHBG predicts incident clinical and radiographic vertebral fractures in elderly men and adds moderate information beyond FRAX® with BMD for vertebral fracture risk prediction. This article is protected by copyright. All rights reserved.

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