High Luteinizing Hormone and Lower Levels of Sex Hormones in Younger Men With Distal Radius Fracture

Abstract

This study investigates the sex steroid hormone profile in younger men with distal radius fracture (DRF) in order to elucidate if this could explain the low bone density and osteoporosis previously observed. In a case-control study 73 men with DRF (mean age 38±9; range 20-51) was compared to 194 age-matched, population controls. Performed assays: total testosterone (TT), calculated free testosterone (cFT), luteinizing hormone (LH), follicle stimulating hormone (FSH), sex hormone binding globulin (SHBG), and total estradiol (E2). BMD hip and spine were measured. Fracture cases had lower cFT (298 vs 329 pmol/l; p=0.008) but not TT, compared to controls. FSH and SHBG were not statistically different. LH was almost 30% higher (5.7 vs 4.5 IU/l; p<0.001) and a lower E2 was observed (80.0 vs 87.1, p=0.098). Men with DRF had lower E2/SHBG ratio compared to controls (2.3 vs 2.9, p=0.013). A higher proportion of the fracture group had low TT (<10.5 nmol/L) 21% vs 11%, p=0.052, low cFT (<220 pmol/L) 18% vs 8%, p=0.017 and low E2 (<73 pmol/l) 48% vs 35%, p=0.044). Odds ratio for fracture when having low cFT was 2.3 (95% CI 1.02-5.49, p=0.044) and with low E2 1.7 (95% CI 0.96-2.96). In this study in young men with distal radius fracture exploring sex hormone levels, we find that sex hormone profiles may be disturbed with lower E2/SHBG ratio, lower cFT and higher luteinizing hormone. Estrogen is a strong determinant of bone mass also in men; hence, low levels of estradiol may be contributing to the observed lower BMD and these differences may be relevant to fracture risk.

Association of Plasma Sex-Related Hormones Levels with Bone Mineral Densities and Risk of Osteoporosis and Osteopenia in Men and Menopausal Women with Type 2 Diabetes Mellitus

“…Some studies have shown that estradiol is a crucial sex hormone in bone health and bone homeostasis, 26 positively related to BMD and negatively associated with risk of fractures in men. [13][14][15] But there were still some other studies which have reported that estradiol had no contribution to provide clinically useful improvement in fracture risk discrimination and was limited to predict risk of fracture. 27,28 Woo et al reported that Chinese men with low serum estradiol levels showed elevated bone loss and increased risk of fractures which was similar to findings in Caucasians.…”

“…Therefore, the relationship of sex-related hormones with osteoporosis and fracture risk remains unclear, especially in terms of gender-specific association between them. [13][14][15][16] Furthermore, previous studies showed the levels of sex hormones in T2DM patients were different as compared to healthy individuals. 17,18 Therefore, future study is warranted to clarify the gender-specific associations of sex-related hormones with BMD and risk of osteoporosis or osteopenia, especially for postmenopausal women with T2DM.…”