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Review
. 2014;20(19):3119-48.
doi: 10.2174/13816128113196660062.

Multiple hormonal dysregulation as determinant of low physical performance and mobility in older persons

Marcello Maggio, Fulvio Lauretani, Francesca De Vita, Shehzad Basaria, Giuseppe Lippi, Valeria Butto, Michele Luci, Chiara Cattabiani, Graziano Ceresini, Ignazio Verzicco, Luigi Ferrucci, Gian Paolo Ceda  1
Affiliations
Review

Multiple hormonal dysregulation as determinant of low physical performance and mobility in older persons

Marcello Maggio et al. Curr Pharm Des. 2014.

Abstract

Mobility-disability is a common condition in older individuals. Many factors, including the age-related hormonal dysregulation, may concur to the development of disability in the elderly. In fact, during the aging process it is observed an imbalance between anabolic hormones that decrease (testosterone, dehydroepiandrosterone sulphate (DHEAS), estradiol, insulin like growth factor-1 (IGF-1) and Vitamin D) and catabolic hormones (cortisol, thyroid hormones) that increase. We start this review focusing on the mechanisms by which anabolic and catabolic hormones may affect physical performance and mobility. To address the role of the hormonal dysregulation to mobility-disability, we start to discuss the contribution of the single hormonal derangement. The studies used in this review were selected according to the period of time of publication, ranging from 2002 to 2013, and the age of the participants (≥65 years). We devoted particular attention to the effects of anabolic hormones (DHEAS, testosterone, estradiol, Vitamin D and IGF-1) on both skeletal muscle mass and strength, as well as other objective indicators of physical performance. We also analyzed the reasons beyond the inconclusive data coming from RCTs using sex hormones, thyroid hormones, and vitamin D (dosage, duration of treatment, baseline hormonal values and reached hormonal levels). We finally hypothesized that the parallel decline of anabolic hormones has a higher impact than a single hormonal derangement on adverse mobility outcomes in older population. Given the multifactorial origin of low mobility, we underlined the need of future synergistic optional treatments (micronutrients and exercise) to improve the effectiveness of hormonal treatment and to safely ameliorate the anabolic hormonal status and mobility in older individuals.

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Figures

Fig. (1)
Fig. (1)
The imbalance between the decrease of anabolic hormones and the relative or net increase of catabolic hormones leads to so called multiple hormonal dysregulation of aging. This dysregulation has an impact of mobility by different mechanisms listed in the figure.
Fig. (2)
Fig. (2)
The figure depicts the combined effects of Vitamin D, Testosterone and Insulin-like Growth Factor 1 (IGF-1) on mobility based on the current evidence of Clinical Trials. Each rectangle represents an anabolic hormone. The arrows in the opposite direction between the rectangles indicate the profound interrelationship of these 3 anabolic hormones. Each horizontal arrow describes the impact of a single anabolic hormone and the additive effects of multiple hormones on different objective measures of physical performance. SPPB: Short Physical Performance Battery; ADL: Activities of Daily Living; PASE: Physical Activity Scale for the Elderly; LBM=lean Body Mass; 30 MWT: 30- minute- walking test; ASMM: appendicular skeletal muscle mass.
Fig. (3)
Fig. (3)
The hormonal derangement occurring with aging has a profound interaction with the pro-inflammatory milieu in determining mobility limitations.
See this image and copyright information in PMC

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