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Additive benefit of higher testosterone levels and vitamin D plus calcium supplementation in regard to fall risk reduction among older men and women

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Abstract

Summary

Higher physiologic testosterone levels among community dwelling older men and women may protect against falls, and this benefit may be further increased among those taking additional vitamin D plus calcium.

Introduction

The aim of this study is to investigate sex hormone levels and fall risk in older men and women.

Methods

One hundred and ninety-nine men and 246 women age 65+ living at home were followed for 3 years after baseline assessment of sex hormones. Analyses controlled for several covariates, including baseline 25-hydroxyvitamin D, sex hormone binding globulin, and vitamin D plus calcium treatment (vitD+cal).

Results

Compared to the lowest quartile, men and women in the highest quartile of total testosterone had a decreased odds of falling (men: OR = 0.22; 95% CI [0.07,0.72]/ women: OR = 0.34; 95% CI [0.14,0.83]); if those individuals also took vitD+cal, the fall reduction was enhanced (men: OR = 0.16; 95% CI [0.03,0.90] / women: OR = 0.15; 95% CI [0.04,0.57]). Similarly, women in the top quartile of dihydroepiandrosterone sulfate (DHEA-S) had a lower risk of falling (OR = 0.39; 95% CI [0.16,0.93]). Other sex hormones and SHBG did not predict falling in men or women.

Conclusions

Higher testosterone levels in both genders and higher DHEA-S levels in women predicted a more than 60% lower risk of falling. With vitD+cal, the anti-fall benefit of higher physiologic testosterone levels is enhanced from 78% to 84% among men and from 66% to 85% among women.

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References

  1. Amin S, Zhang Y, Felson DT, Sawin CT, Hannan MT, Wilson PW, Kiel DP (2006) Estradiol, testosterone, and the risk for hip fractures in elderly men from the Framingham Study. Am J Med 119(5):426–433

    Article  PubMed  CAS  Google Scholar 

  2. Fink HA, Ewing SK, Ensrud KE, Barrett-Connor E, Taylor BC, Cauley JA, Orwoll ES (2006) Association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men. J Clin Endocrinol Metab 91(10):3908–3915. Epub 2006 Jul 18

    Article  PubMed  CAS  Google Scholar 

  3. Mellstrom D, Johnell O, Ljunggren O, Eriksson AL, Lorentzon M, Mallmin H, Holmberg A, Redlund-Johnell I, Orwoll E, Ohlsson C (2006) Free testosterone is an independent predictor of BMD and prevalent fractures in elderly men: MrOS Sweden. J Bone Miner Res 21(4):529–535. Epub 2006 Apr 5

    Article  PubMed  Google Scholar 

  4. Riggs BL, Khosla S, Melton LJ, 3rd (2002) Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev 23(3):279–302

    Article  PubMed  CAS  Google Scholar 

  5. Pfeilschifter J, Scheidt-Nave C, Leidig-Bruckner G, Woitge HW, Blum WF, Wuster C, Haack D, Ziegler R (1996) Relationship between circulating insulin-like growth factor components and sex hormones in a population-based sample of 50- to 80-year-old men and women. J Clin Endocrinol Metab 81(7):2534–2540

    Article  PubMed  CAS  Google Scholar 

  6. Bhasin S, Harman SM, Blackman MR, Wittert GA, Chapman IM, Haren MT, Mackintosh S, Coates P, Morley JE, Crawford BA, Liu PY, Kean MT, Bleasel JF, Handelsman DJ (2003) Testosterone supplementation for aging-associated sarcopenia. J Gerontol A Biol Sci Med Sci 58(11):1002–1008

    PubMed  Google Scholar 

  7. Giannoulis MG, Sonksen PH, Umpleby M, Breen L, Pentecost C, Whyte M, McMillan CV, Bradley C, Martin FC (2005) The effects of growth hormone and/or testosterone in healthy elderly men: a randomized controlled trial. J Clin Endocrinol Metab 6:6

    Google Scholar 

  8. Blackman MR, Sorkin JD, Munzer T, Bellantoni MF, Busby-Whitehead J, Stevens TE, Jayme J, O’Connor KG, Christmas C, Tobin JD, Stewart KJ, Cottrell E, St Clair C, Pabst KM, Harman SM (2002) Growth hormone and sex steroid administration in healthy aged women and men: a randomized controlled trial. Jama 288(18):2282–2292

    Article  PubMed  CAS  Google Scholar 

  9. Wittert GA, Chapman IM, Haren MT, Mackintosh S, Coates P, Morley JE (2003) Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low-normal gonadal status. J Gerontol A Biol Sci Med Sci 58(7):618–625

    PubMed  Google Scholar 

  10. Ottenbacher KJ, Ottenbacher ME, Ottenbacher AJ, Acha AA, Ostir GV (2006) Androgen treatment and muscle strength in elderly men: a meta-analysis. J Am Geriatr Soc 54(11):1666–1673

    Article  PubMed  Google Scholar 

  11. Orwoll E, Lambert LC, Marshall LM, Blank J, Barrett-Connor E, Cauley J, Ensrud K, Cummings SR (2006) Endogenous testosterone levels, physical performance, and fall risk in older men. Arch Intern Med 166(19):2124–2131

    Article  PubMed  Google Scholar 

  12. Schaap LA, Pluijm SM, Smit JH, van Schoor NM, Visser M, Gooren LJ, Lips P (2005) The association of sex hormone levels with poor mobility, low muscle strength and incidence of falls among older men and women. Clin Endocrinol (Oxf) 63(2):152–160

    Article  CAS  Google Scholar 

  13. Orwoll E, Lambert LC, Marshall LM, Phipps K, Blank J, Barrett-Connor E, Cauley J, Ensrud K, Cummings S, Mellstrom D, Johnell O, Ljunggren O, Eriksson AL, Lorentzon M, Mallmin H, Holmberg A, Redlund-Johnell I, Ohlsson C (2006) Testosterone and estradiol among older men. J Clin Endocrinol Metab 91(4):1336–1344. Epub 2005 Dec 20.

    Article  PubMed  CAS  Google Scholar 

  14. Taaffe DR, Newman AB, Haggerty CL, Colbert LH, de Rekeneire N, Visser M, Goodpaster BH, Nevitt MC, Tylavsky FA, Harris TB (2005) Estrogen replacement, muscle composition, and physical function: The Health ABC Study. Med Sci Sports Exerc 37(10):1741–1747

    Article  PubMed  CAS  Google Scholar 

  15. Taaffe DR, Sipila S, Cheng S, Puolakka J, Toivanen J, Suominen H (2005) The effect of hormone replacement therapy and/or exercise on skeletal muscle attenuation in postmenopausal women: a yearlong intervention. Clin Physiol Funct Imaging 25(5):297–304

    Article  PubMed  CAS  Google Scholar 

  16. Kenny AM, Dawson L, Kleppinger A, Iannuzzi-Sucich M, Judge JO (2003) Prevalence of sarcopenia and predictors of skeletal muscle mass in nonobese women who are long-term users of estrogen-replacement therapy. J Gerontol A Biol Sci Med Sci 58(5):M436–M440

    PubMed  Google Scholar 

  17. Bemben DA, Langdon DB (2002) Relationship between estrogen use and musculoskeletal function in postmenopausal women. Maturitas 42(2):119–127

    Article  PubMed  CAS  Google Scholar 

  18. Valenti G, Denti L, Maggio M, Ceda G, Volpato S, Bandinelli S, Ceresini G, Cappola A, Guralnik JM, Ferrucci L (2004) Effect of DHEAS on skeletal muscle over the life span: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 59(5):466–472

    PubMed  Google Scholar 

  19. Kostka T, Arsac LM, Patricot MC, Berthouze SE, Lacour JR, Bonnefoy M (2000) Leg extensor power and dehydroepiandrosterone sulfate, insulin-like growth factor-I and testosterone in healthy active elderly people. Eur J Appl Physiol 82(1—2):83—90

    Article  PubMed  CAS  Google Scholar 

  20. Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18(2):343—351

    Article  PubMed  CAS  Google Scholar 

  21. Bischoff-Ferrari HA, Dawson-Hughes B, Willett CW, Staehelin HB, Bazemore MG, Zee RY, Wong JB (2004) Effect of vitamin D on falls: a meta-analysis. JAMA 291(16):1999–2006

    Article  PubMed  CAS  Google Scholar 

  22. Flicker L, MacInnis RJ, Stein MS, Scherer SC, Mead KE, Nowson CA, Thomas J, Lowndes C, Hopper JL, Wark JD (2004) Should all older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. JBMR 19(Suppl. 1) abstract F459:S99

  23. Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B (2006) Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled trial. Arch Intern Med 166(4):424–430

    Article  PubMed  CAS  Google Scholar 

  24. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337(10):670–676

    Article  PubMed  CAS  Google Scholar 

  25. Buchner DM, Hornbrook MC, Kutner NG, Tinetti ME, Ory MG, Mulrow CD, Schechtman KB, Gerety MB, Fiatarone MA, Wolf SL et al (1993) Development of the common data base for the FICSIT trials. J Am Geriatr Soc 41(3):297–308

    PubMed  CAS  Google Scholar 

  26. Washburn RA, Smith KW, Jette AM, Janney CA (1993) The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 46(2):153–162

    Article  PubMed  CAS  Google Scholar 

  27. Johnson J, Dawson-Hughes B (1991) Precision and stability of dual-energy x-ray absorptiometry measurements. Calcif Tissue Int (49):174–178

  28. Preece MA, O’Riordan JL, Lawson DE, Kodicek E (1974) A competitive protein-binding assay for 25-hydroxycholecalciferol and 25-hydroxyergocalciferol in serum. Clin Chim Acta 54(2):235–242

    Article  PubMed  CAS  Google Scholar 

  29. Hammond GL, Nisker JA, Jones LA, Siiteri PK (1980) Estimation of the percentage of free steroid in undiluted serum by centrifugal ultrafiltration-dialysis. J Biol Chem 255(11):5023–5026

    PubMed  CAS  Google Scholar 

  30. Pfeifer M, Begerow B, Minne HW, Abrams C, Nachtigall D, Hansen C (2000) Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 15(6):1113–1118

    Article  PubMed  CAS  Google Scholar 

  31. Flicker L, MacInnis RJ, Stein MS, Scherer SC, Mead KE, Nowson CA, Thomas J, Lowndes C, Hopper JL, Wark JD (2005) Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. J Am Geriatr Soc 53(11):1881–1888

    Article  PubMed  Google Scholar 

  32. Gallagher JC, Fowler SE, Detter JR, Sherman SS (2001) Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss. J Clin Endocrinol Metab 86(8):3618–3628

    Article  PubMed  CAS  Google Scholar 

  33. Gennari L, Merlotti D, Martini G, Gonnelli S, Franci B, Campagna S, Lucani B, Dal Canto N, Valenti R, Gennari C, Nuti R (2003) Longitudinal association between sex hormone levels, bone loss, and bone turnover in elderly men. J Clin Endocrinol Metab 88(11):5327–5333

    Article  PubMed  CAS  Google Scholar 

  34. Cauley JA, Robbins J, Chen Z, Cummings SR, Jackson RD, LaCroix AZ, LeBoff M, Lewis CE, McGowan J, Neuner J, Pettinger M, Stefanick ML, Wactawski-Wende J, Watts NB (2003) Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. Jama 290(13):1729–1738

    Article  PubMed  CAS  Google Scholar 

  35. Miller KK, Rosner W, Lee H, Hier J, Sesmilo G, Schoenfeld D, Neubauer G, Klibanski A (2004) Measurement of free testosterone in normal women and women with androgen deficiency: comparison of methods. J Clin Endocrinol Metab 89(2):525–533

    Article  PubMed  CAS  Google Scholar 

  36. Cummings SR, Browner WS, Bauer D, Stone K, Ensrud K, Jamal S, Ettinger B (1998) Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of osteoporotic fractures research group. N Engl J Med 339(11):733–738

    Article  PubMed  CAS  Google Scholar 

  37. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of osteoporotic fractures research group. N Engl J Med 332(12):767–773

    Article  PubMed  CAS  Google Scholar 

  38. Szulc P, Beck TJ, Marchand F, Delmas PD (2005) Low skeletal muscle mass is associated with poor structural parameters of bone and impaired balance in elderly men-the MINOS study. J Bone Miner Res 20(5):721–729

    Article  PubMed  Google Scholar 

  39. Longcope C, Feldman HA, McKinlay JB, Araujo AB (2000) Diet and sex hormone-binding globulin. J Clin Endocrinol Metab 85(1):293–296

    Article  PubMed  CAS  Google Scholar 

  40. Szulc P, Duboeuf F, Marchand F, Delmas PD (2004) Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr 80(2):496–503

    PubMed  CAS  Google Scholar 

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Conflicts of interest

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Disclosures

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Funding/Support

This study was supported by a grant from the Charles H. Farnsworth Trust, Boston, Mass (US Trust Company, trustee), and by grant AG10353 from the National Institutes of Health, Bethesda, Md, and a Swiss National Foundation Professorship Grant.

Role of the Sponsors: No sponsors participated in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Department of Rheumatology and Institute for Physical Medicine, University Hospital Zurich, Gloriastrasse, 258091, Zurich, Switzerland

    H. A. Bischoff-Ferrari

  2. Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, USA

    B. Dawson-Hughes

  3. Department of Biostatistics, Harvard School of Public Health, Boston, USA

    E. J. Orav

  4. Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, USA

    E. J. Orav

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  1. H. A. Bischoff-Ferrari
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Correspondence to H. A. Bischoff-Ferrari.

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Bischoff-Ferrari, H.A., Orav, E.J. & Dawson-Hughes, B. Additive benefit of higher testosterone levels and vitamin D plus calcium supplementation in regard to fall risk reduction among older men and women. Osteoporos Int 19, 1307–1314 (2008). https://doi.org/10.1007/s00198-008-0573-7

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