Men's Osteoporosis Support GroupEstradiol as predictor of male osteoporosis Arq Bras Endocrinol Metabol. 2009 Nov;53(8):1020-5. Total estradiol, rather than testosterone levels, predicts osteoporosis in aging men. Clapauch R and others. PMID: 20126856. This was a case-control study involving 216 men older than 50 years, 110 with osteoporosis and 106 without. Various forms of sex hormones, or their protein carrier, were measured, including, estradiol (E2), sex hormone binding globulin (SHBG), total testosterone (TT), and albumin. Calculations also derived free testosterone (FT) and bioavailable testosterone (BT). The results showed that TT was not an indicator for osteoporosis risk. However, E2 <37 pg/mL was, as were SHBG, FT, and BT. Editor's comments. This article's results vary somewhat from some others I've reviewed. Most others have shown a correlation between lower TT and osteoporosis, and some have found issues with lower E2. But the Clapauch study found no difference in TT between the tests and controls. Instead the important sex hormones as indicators of osteoporosis were E2, SHBG, FT and BT. From my reading SHBG is probably not a necessary test, the others would be adequate as determinants of osteoporosis risk, especially E2 and FT. Here is an Update that discussed several articles involving E2 and TT and their effects on bone. A previous Update has also discussed increased risk of death in the elderly with low TT and E2 levels. The authors noted, "Elderly men with low serum testosterone and estradiol have increased risk of mortality, and subjects with low values of both testosterone and estradiol have the highest risk of mortality." So it isn't just osteoporosis diagnosis that is an important issue regarding these hormones. Bottom Line. I would suggest that males older than 50 ask to have FT and E2 testing done to establish that your baseline tests are normal. If so probably ask for retests every few years.
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