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. 2008 May;93(5):1796-803.
doi: 10.1210/jc.2007-2358. Epub 2008 Mar 11.

Associations of serum sex hormone-binding globulin and sex hormone concentrations with hip fracture risk in postmenopausal women

Jennifer S Lee  1 , Andrea Z LaCroix, LieLing Wu, Jane A Cauley, Rebecca D Jackson, Charles Kooperberg, Meryl S Leboff, John Robbins, Cora E Lewis, Douglas C Bauer, Steven R Cummings
Affiliations

Associations of serum sex hormone-binding globulin and sex hormone concentrations with hip fracture risk in postmenopausal women

Jennifer S Lee et al. J Clin Endocrinol Metab. 2008 May.

Abstract

Context: Endogenous estradiol, testosterone, and SHBG may influence the risk of hip fracture.

Design and methods: From the Women's Health Initiative Observational Study, 39,793 eligible postmenopausal women did not have a previous hip fracture and were not using estrogen or other bone-active therapies. Of these, 400 who had a first-time nonpathological hip fracture (median follow-up, 7 yr) were matched to 400 controls by age, ethnicity, and baseline blood draw date. Estradiol, testosterone, and SHBG were measured in banked baseline serum.

Results: Compared with women in the lowest tertiles, those with bioavailable testosterone in the highest tertile had a lower risk [odds ratio (OR) = 0.62; 95% confidence interval (CI) = 0.44-0.88]; those with bioavailable estradiol in the highest tertile had a lower risk (OR = 0.44; 95% CI = 0.29-0.66), and those with SHBG in the highest tertile had a higher risk (OR = 1.90; 95% CI = 1.31-2.74) of hip fracture. In models with all three hormones and potential confounders, high SHBG remained a strong independent risk factor (OR = 1.76; 95% CI = 1.12-2.78), high bioavailable testosterone remained protective (OR = 0.64; 95% CI = 0.40-1.00), but estradiol no longer was associated (OR = 0.72; 95% CI = 0.42-1.23).

Conclusions: High serum SHBG is associated with an increased risk of subsequent hip fracture and high endogenous testosterone with a decreased risk, independent of each other, serum estradiol concentration, and other putative risk factors. But endogenous estradiol has no independent association with hip fracture.

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