Influence of Bone Remodeling Rate on Quantitative Ultrasound (QUS) Parameters at the Calcaneus and DXA BMDa of the Hip and Spine in Middle Aged and Elderly European Men: The European Male Ageing Study (EMAS)

Objective: To assess the influence of sex hormones on markers of bone turnover and to explore the association between these markers and bone health in middle-aged and elderly European men.Design: Cross-sectional population based survey.Methods: Men aged 40-79 years were recruited from population registers in 8 European centres. Subjects completed a postal questionnaire which included questions concerning lifestyle and were invited to attend for quantitative ultrasound (QUS) of the calcaneus and a fasting blood sample from which the bone markers serum N-terminal propeptide of type 1 procollagen (P1NP) and crosslinks (β-cTX), total testosterone (T), total oestradiol (E(2)), sex hormone-binding globulin (SHBG) and insulin-like growth factor (IGF)-I were measured. Dual energy x-ray absorptiometry (DXA) of the hip and lumbar spine was performed in two centres.Results: 3120 men, mean age 59.9 years (standard deviation [SD]=11.0) were included. After adjustment for centre, age, height, weight, lifestyle factors, season and other hormones, total and free E(2) were negatively associated with β-cTX but not P1NP while SHBG, IGF-I and PTH were positively associated with both β-cTX and P1NP. Total or free T were not independently associated with either bone marker. After the same adjustments, higher levels of both bone markers were significantly associated with lower QUS parameters and lower DXA-assessed bone density at the total hip and lumbar spine.Conclusions: Oestradiol, SHBG, IGF-I and PTH contribute significantly to the regulation / rate of bone turnover in middle-aged and older European men. Higher rates of bone remodeling are negatively associated with male bone health.status: publishe