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a Department of Internal Medicine, Cardioangiology, and Hepatology
b Division of Geriatric Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Italy
c Laboratory of Radioimmunology, Orthopedic Institutes "Rizzoli," University of Bologna, Italy
Giovanni Ravaglia, Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy E-mail: ravaglia{at}almadns.unibo.it.
William B. Ershler, MD
Background. Bone loss in elderly men is associated with changes in body composition and reduced secretion of endogenous anabolizing hormones. The independent influences of body composition and endocrine factors on male bone metabolism, however, are unclear.
Methods. Bone mass density (BMD) (bone mass content [BMC, g]/projected bone area [BA, cm2]) at different skeletal sites, skeletal muscle, and body fat mass were measured by dual-energy X-ray absorptiometry in 129 men aged 20 to 95 years. Free testosterone, 17-ß-estradiol, dehydroepiandrosterone-sulfate, and insulin-like growth factor 1 (IGF-1) serum concentrations were measured. Because BMD may fail to control for differences in skeletal size, the associations of bone mass with body composition and hormones were studied by comparing BMD regression models incorporating age and knee height only with BMC regression models also incorporating BA.
Results. Skeletal muscle had close associations ( p at least < .01) with BMD and BMC at almost all skeletal sites, but the strength of these associations was generally reduced in BMC with respect to BMD models. Weak associations ( p < .05) were found in both models for fatness with femoral bone and for 17-ß-estradiol with total body and femoral bone. The association of 17-ß-estradiol with spinal bone was significant ( p < .05) in the BMD but not in the BMC model. No association of BMC or BMD with androgens and IGF-1 reached significancy.
Conclusions. Skeletal muscle may be more important than fatness and anabolizing hormones in preserving bone mass in elderly men. In contrast to traditional belief, estrogens may be more important than androgens and IGF-1 in male bone metabolism.
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