Serum DHEA and Its Sulfate Are Associated With Incident Fall Risk in Older Men: The MrOS Sweden Study

Abstract

The adrenal-derived hormones dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are the most abundant circulating hormones and their levels decline substantially with age. Many of the actions of DHEAS are considered to be mediated through metabolism into androgens and estrogens in peripheral target tissues. The predictive value of serum DHEA and DHEAS for the likelihood of falling is unknown. The aim of this study was, therefore, to assess the associations between baseline DHEA and DHEAS levels and incident fall risk in a large cohort of older men. Serum DHEA and DHEAS levels were analyzed with mass spectrometry in the population-based Osteoporotic Fractures in Men study in Sweden (n = 2516, age 69 to 81 years). Falls were ascertained every 4 months by mailed questionnaires. Associations between steroid hormones and falls were estimated by generalized estimating equations. During a mean follow-up of 2.7 years, 968 (38.5%) participants experienced a fall. High serum levels of both DHEA (odds ratio [OR] per SD increase 0.85; 95% CI, 0.78 to 0.92) and DHEAS (OR 0.88, 95% CI, 0.81 to 0.95) were associated with a lower incident fall risk in models adjusted for age, BMI, and prevalent falls. Further adjustment for serum sex steroids or age-related comorbidities only marginally attenuated the associations between DHEA or DHEAS and the likelihood of falling. Moreover, the point estimates for DHEA and DHEAS were only slightly reduced after adjustment for lean mass and/or grip strength. Also, the addition of the narrow walk test did not substantially alter the associations between serum DHEA or DHEAS and fall risk. Finally, the association with incident fall risk remained significant for DHEA but not for DHEAS after simultaneous adjustment for lean mass, grip strength, and the narrow walk test. This suggests that the associations between DHEA and DHEAS and falls are only partially mediated via muscle mass, muscle strength, and/or balance. In conclusion, older men with high DHEA or DHEAS levels have a lesser likelihood of a fall. © 2018 American Society for Bone and Mineral Research.

Dehydroepiandrosterone status and efficacy of dehydroepiandrosterone supplementation for bone health in anorexia nervosa: A systematic review and meta‐analysis

“…Since DHEA can increase IGF‐1 expression (Liang et al, 2016; Lin et al, 2019), the beneficial effect of DHEA + COC combination therapy is most likely due to this counterbalancing effect. Although lower DHEAS levels have been shown to predict increased bone resorption and low BMD in patients with AN and the elderly (Gordon et al, 2002; Miller et al, 2007; Ohlsson et al, 2017; Ohlsson et al, 2018), DHEA supplementation does not appear to have a direct beneficial effect on bone health as seen in the elderly and healthy adults. This observation has two major consequences.…”

Increased risk for hip fracture after death of a spouse—further support for bereavement frailty?

“…Increased cortisol levels in the mornings occur at least in the first 6 months after bereavement, often accompanied with decreased levels of dehydroepiandrosterone (DHEA) [3]. Studies have shown an increased risk for falls and fractures in older men with low levels of DHEA [32,33]. When compared with married ones, widows were more likely to demonstrate worse coping behaviour in terms of more smoking and drinking.…”

Adrenal Incidentaloma: Picking out the High-Risk Patients

“…Several reports have highlighted that patients with either Cushing's syndrome or ACS have lower levels of DHEA and androstenedione than subjects bearing nonfunctioning tu mors and controls, independently of age [26,27]. The relationship between sarcopenia, androgens, and risk of fall has been highlight ed in a very recent large populationbased studies, showing that lower DHEA and DHEAsulphate were associated with increased in cidence of falls [45].…”