scholarly journals Associations Between Sex Steroids and the Development of Metabolic Syndrome: A Longitudinal Study in European Men

2015 ◽  
Vol 100 (4) ◽  
pp. 1396-1404 ◽  
Author(s):  
Leen Antonio ◽  
Frederick C. W. Wu ◽  
Terence W. O'Neill ◽  
Stephen R. Pye ◽  
Emma L. Carter ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Sex Steroids ◽  
Community Dwelling ◽  
Sex Hormone Binding Globulin ◽  
Gas Chromatography Mass Spectrometry ◽  
Model Assessment ◽  
Lower Baseline ◽  
Increased Risk

Context: Low testosterone (T) has been associated with incident metabolic syndrome (MetS), but it remains unclear if this association is independent of sex hormone binding globulin (SHBG). Estradiol (E2) may also be associated with MetS, but few studies have investigated this. Objective: To study the association between baseline sex steroids and the development of incident MetS and to investigate the influence of SHBG, body mass index (BMI) and insulin resistance on this risk. Methods: Three thousand three hundred sixty nine community-dwelling men aged 40–79 years were recruited for participation in EMAS. MetS was defined by the updated NCEP ATP III criteria. Testosterone and E2 levels were measured by liquid and gas chromatography/mass spectrometry, respectively. Logistic regression was used to assess the association between sex steroids and incident MetS. Results: One thousand six hundred fifty one men without MetS at baseline were identified. During follow-up, 289 men developed incident MetS, while 1362 men did not develop MetS. Men with lower baseline total T levels were at higher risk for developing MetS [odds ratio (OR) = 1.72, P < .001), even after adjustment for SHBG (OR = 1.43, P = .001), BMI (OR = 1.44, P < .001) or homeostasis model assessment of insulin resistance (HOMA-IR) (OR = 1.64, P < .001). E2 was not associated with development of MetS (OR = 1.04; P = .56). However, a lower E2/T ratio was associated with a lower risk of incident MetS (OR = 0.38; P < .001), even after adjustment for SHBG (OR = 0.48; P < .001), BMI (OR = 0.60; P = .001) or HOMA-IR (OR = 0.41; P < .001). Conclusions: In men, lower T levels, but not E2, are linked with an increased risk of developing MetS, independent of SHBG, BMI or insulin resistance. A lower E2/T ratio may be protective against developing MetS.

scholarly journals Metabolic syndrome and insulin resistance in pre-pubertal children with psoriasis

2021 ◽  
Author(s):  
Francesca Caroppo ◽  
Alfonso Galderisi ◽  
Laura Ventura ◽  
Anna Belloni Fortina
Keyword(s):  
Metabolic Disease ◽  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Model Assessment ◽  
Limited Data ◽  
Single Center ◽  
Increased Risk ◽  
High Prevalence ◽  
Homeostatic Model Assessment ◽  
Homeostatic Model

AbstractPsoriasis in adults is associated with an increased risk of metabolic disease. Various cardiometabolic comorbidities have been reported in childhood psoriasis, but only a few studies have analyzed the prevalence of metabolic syndrome. We performed a single-center prospective study investigating the prevalence of metabolic syndrome and insulin resistance in children with psoriasis. The prevalence of metabolic syndrome was evaluated in 60 pre-pubertal children with psoriasis (age: 3–10 years), accordingly to recently established criteria for the diagnosis of metabolic syndrome in children. Insulin resistance was considered altered when the homeostatic model assessment (HOMA-IR) for insulin resistance was ≥ 90th sex- and age-specific percentile and HOMA 2-IR was > 1.8. Eighteen (30%) children with psoriasis were found to have metabolic syndrome. Sixteen (27%) children were found to have insulin resistance.Conclusion: Our data underline the importance of assessing metabolic syndrome not only in adults and adolescents but also in young children with psoriasis. What is Known:• Psoriasis in adults is strongly associated with metabolic disease and insulin resistance.• Very limited data are available on the prevalence of metabolic syndrome and insulin resistance in pre-pubertal children with psoriasis. What is New:• This study reports that in pre-pubertal children with psoriasis, there is a high prevalence of metabolic syndrome and insulin resistance.• In children with psoriasis metabolic syndrome risk factors should be assessed.

scholarly journals Circulating Irisin in Relation to Insulin Resistance and the Metabolic Syndrome

2013 ◽  
Vol 98 (12) ◽  
pp. 4899-4907 ◽  
Author(s):  
Kyung Hee Park ◽  
Lesya Zaichenko ◽  
Mary Brinkoetter ◽  
Bindiya Thakkar ◽  
Ayse Sahin-Efe ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Body Mass Index ◽  
Body Mass ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Cvd Risk ◽  
Baseline Serum ◽  
The Metabolic Syndrome ◽  
Increased Risk

Context: Irisin, a recently identified hormone, has been proposed to regulate energy homeostasis and obesity in mice. Whether irisin levels are associated with risk of the metabolic syndrome (MetS), cardiometabolic variables, and cardiovascular disease (CVD) risk in humans remains unknown. Objective: Our objective was to assess the associations between baseline serum irisin levels and MetS, cardiometabolic variables, and CVD risk. Design, Setting, and Subjects: We conducted a comparative cross-sectional evaluation of baseline circulating levels of the novel hormone irisin and the established adipokine adiponectin with MetS, cardiometabolic variables, and CVD risk in a sample of 151 subjects. Results: Baseline irisin levels were significantly higher in subjects with MetS than in subjects without MetS. Irisin was associated negatively with adiponectin (r = −0.4, P < .001) and positively with body mass index (r = 0.22, P = .008), systolic (r = 0.17, P = .04) and diastolic (r = 0.27, P = .001) blood pressure, fasting glucose (r = 0.25, P = .002), triglycerides (r = 0.25, P = .003), and homeostasis model assessment for insulin resistance (r = 0.33, P < .001). After adjustment for potential confounders, including body mass index, subjects in the highest tertile of irisin levels were more likely to have MetS (odds ratio [OR] = 9.44, 95% confidence interval [CI] = 2.66–33.44), elevated fasting blood glucose (OR = 5.80, 95% CI = 1.72–19.60), high triglycerides (OR = 3.89, 95% CI = 1.16–13.03), and low high-density lipoprotein cholesterol (OR = 3.30, 95% CI = 1.18–9.20). Irisin was independently associated with homeostasis model assessment for insulin resistance and general Framingham risk profile in multiple linear regression analyses after adjustment for confounders. Adiponectin demonstrated the expected associations with outcomes. Conclusions: Irisin is associated with increased risk of MetS, cardiometabolic variables, and CVD in humans, indicating either increased secretion by adipose/muscle tissue and/or a compensatory increase of irisin to overcome an underlying irisin resistance in these subjects.

scholarly journals Association of hormonal dysregulation with metabolic syndrome in older women: data from the InCHIANTI study

2007 ◽  
Vol 292 (1) ◽  
pp. E353-E358 ◽  
Author(s):  
Marcello Maggio ◽  
Fulvio Lauretani ◽  
Gian Paolo Ceda ◽  
Stefania Bandinelli ◽  
Shehzad Basaria ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Older Women ◽  
Inflammatory Markers ◽  
Hormone Replacement ◽  
Sex Hormone Binding Globulin ◽  
Bilateral Oophorectomy ◽  
Age Related ◽  
Increased Risk ◽  
Igf I

Metabolic syndrome (MetS) is a strong risk factor for type 2 diabetes and cardiovascular disease. Conditions associated with hyperandrogenism are often associated with glucose intolerance and other features of MetS in young women. As the prevalence of MetS increases with age and is probably multifactorial, it is reasonable to hypothesize that age-related changes in androgens and other hormones might contribute to the development of MetS in older persons. However, this hypothesis has never been tested in older women. We hypothesized that high levels of testosterone, dehydroepiandrosterone sulfate (DHEA-S), and cortisol and low levels of sex hormone-binding globulin (SHBG) and IGF-I would be associated with MetS in a representative cohort of older Italian women independently of confounders (including inflammatory markers). After exclusion of participants on hormone replacement therapy and those with a history of bilateral oophorectomy, 512 women (≥65 yr) had complete data on testosterone, cortisol, DHEA-S, SHBG, fasting insulin, total and free IGF-I, IL-6, and C-reactive protein (CRP). MetS was defined according to ATP-III criteria. Insulin resistance was calculated according to HOMA. MetS was found in 145 women (28.3%). Participants with vs. those without MetS had higher age-adjusted levels of bioavailable testosterone ( P < 0.001), IL-6 ( P < 0.001), CRP ( P < 0.001), and HOMA ( P < 0.001) and lower levels of SHBG ( P < 0.001). After adjustment for potential confounders, participants with decreased SHBG had an increased risk of MetS ( P < 0.0001) vs. those with low SHBG. In a further model including all hormones and confounders, log SHBG was the only independent factor associated with MetS (OR: 0.44, 95% CI 0.21–0.91, P = 0.027). In older women, SHBG is negatively associated with MetS independently of confounders, including inflammatory markers and insulin resistance. Further studies are needed to support the notion that raising SHBG is a potential therapeutic target for prevention and treatment of MetS.

scholarly journals Exploring the Link between the Components of Metabolic Syndrome and the Risk of Depression

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Fang-Yih Liaw ◽  
Tung-Wei Kao ◽  
Ju-Ting Hsueh ◽  
Yi-Hsin Chan ◽  
Yaw-Wen Chang ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Blood Chemistry ◽  
Assessment Method ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Increased Risk ◽  
Patient Health ◽  
Low Hdl ◽  
Apparent Association

Background.Metabolic syndrome (MetS) has been reported with an increased risk of depression. MetS was also associated with insulin resistance. This study aimed to evaluate whether MetS components might contribute to depression in participants with insulin resistance (IR) or not.Methods.This study included 3,331 participants ≥18 years in the NHANES 2009-2010. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). MetS components were measured using blood chemistry and body measurements. IR was identified using the homeostasis model assessment method.Results.Predicted PHQ-9 scores significantly increased as the number of MetS components increased in patients with IR. The adjustedβcoefficients of the predicted PHQ-9 score with 2, 4, and 5 MetS components were 1.803, 2.081, and 3.048, respectively (Pfor trend < 0.05). Low HDL-C levels were significantly associated with higher predicted total PHQ-9 scores in fully adjusted models in the IR group (P<0.05).Conclusion.The results indicated that the presence of a greater number of components of MetS was significantly associated with higher predicted total PHQ-9 scores in participants with IR. Among the components of MetS, the most apparent association was observed between low HDL and higher predicted total PHQ-9 scores.

Lipid and lipoprotein profile in women with polycystic ovary syndromeThis article is one of a selection of papers published in the special issue Bridging the Gap: Where Progress in Cardiovascular and Neurophysiologic Research Meet.

2008 ◽  
Vol 86 (4) ◽  
pp. 199-204 ◽  
Author(s):  
Djuro Macut ◽  
Dimitrios Panidis ◽  
Biljana Glišić ◽  
Nikolaos Spanos ◽  
Milan Petakov ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Fatty Acids ◽  
Polycystic Ovary ◽  
Oxidized Ldl ◽  
Sex Hormone Binding Globulin ◽  
Ldl Oxidation ◽  
Model Assessment ◽  
Homa Index ◽  
Nonesterified Fatty Acids ◽  
Increased Risk

Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by obesity-related risk factors for cardiovascular disease. The objective of our study was to determine values of key lipid and lipoprotein fractions in PCOS, and their possible relation to insulin resistance. A total of 75 women with PCOS (aged 23.1 ± 5.1 years, BMI 24.9 ± 4.7 kg/m2), and 56 age- and BMI-matched controls were investigated. In all subjects, basal glucose, cholesterol (total, HDL, and LDL), oxidized LDL (OxLDL), triglycerides, apolipoprotein (apo)A1, apoB, and apoE, nonesterified fatty acids, insulin, testosterone, sex hormone-binding globulin, homeostasis model assessment (HOMA) index, and free androgen index were determined in the follicular phase of the cycle. PCOS patients compared with controls had increased indices of insulin resistance, basal insulin (p < 0.001), and HOMA index (p < 0.001), and worsened insulin resistance-related dyslipidemia with decreased HDL cholesterol (p < 0.01), elevated triglycerides (p = 0.010), and pronounced LDL oxidation (p < 0.001). In conclusion, characteristic dyslipidemia of insulin resistance and unfavorable proatherogenic lipoprotein ratios were present only in women with PCOS and not in controls. Elevated OxLDL and the relation of apoE and nonesterified fatty acids with insulin resistance suggest that women with PCOS are at increased risk for premature atherosclerosis.

rs1501299 Polymorphism in the Adiponectin Gene and Their Association with Total Adiponectin Levels, Insulin Resistance and Metabolic Syndrome in Obese Subjects

2016 ◽  
Vol 69 (3-4) ◽  
pp. 226-231 ◽  
Author(s):  
Daniel Antonio de Luis ◽  
Olatz Izaola ◽  
Beatriz de la Fuente ◽  
David Primo ◽  
Hilda Fernandez Ovalle ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Body Weight ◽  
Fasting Blood Glucose ◽  
Model Assessment ◽  
Adipoq Gene ◽  
Total Adiponectin ◽  
Increased Risk ◽  
Obese Subjects ◽  
And Gender

Background and Aims: The aim of this study was to determine the association of single nucleotide polymorphism rs1501299 in the ADIPOQ gene with body weight, insulin resistance, serum adipokine levels and metabolic syndrome (MetS). Methods: The study involved a population of 1,007 adult obese subjects. Parameters like body weight, fat mass, waist circumferences, blood pressure, fasting blood glucose, C-reactive protein, insulin concentration, homeostasis model assessment for insulin resistance (HOMA-IR), lipid profile and adipocytokines levels (leptin, adiponectin and resistin) were all measured. The genotype of ADIPOQ gene polymorphism (rs1501299) was evaluated. Results: Insulin levels (GG: 13.6 ± 5.1 mUI/l vs. GT: 14.1 ± 5.2 mUI/l vs. TT: 16.6 ± 5.2 mUI/l; p < 0.05) and HOMA-IR (GG: 3.3 ± 1.5 units vs. GT: 4.1 ± 1.1 units vs. TT: 4.5 ± 1.3 units; p < 0.05) were higher in T-allele carriers than they were in non-T-allele carriers. Total adiponectin levels (GG: 20.2 ± 2.4 ng/dl vs. GT: 15.8 ± 3.4 ng/dl vs. TT: 13.7 ± 1.4 ng/dl; p < 0.05) were lower in T-allele carriers than they were in non-T-allele carriers. Logistic regression analysis indicated that subjects with T allele were associated with an increased risk of MetS (OR 1.15, 95% CI 1.08-1.25, p = 0.033) and an increased risk of hyperglycemia (OR 1.99, 95% CI 1.37-2.55, p = 0.028) after adjusting by age and gender. Conclusions: These data suggest an important role of this ADIPOQ variant at position +276 on insulin resistance, total adiponectin levels and MetS.

scholarly journals Association of Metabolic Syndrome with the Adiponectin to Homeostasis Model Assessment of Insulin Resistance Ratio

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Yu-Song Ding ◽  
Shu-Xia Guo ◽  
Ru-Lin Ma ◽  
Shu-Gang Li ◽  
Heng Guo ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Operating Characteristic ◽  
Diagnostic Marker ◽  
Roc Curves ◽  
Model Assessment ◽  
Homeostasis Model Assessment ◽  
Middle Aged ◽  
Diagnostic Efficacy ◽  
Increased Risk

This study aimed at determining whether the adiponectin to HOMA-IR (A/H) ratio is associated with MetS and MetS components and comparing the diagnostic efficacy of adiponectin, HOMA-IR, and the A/H ratio in healthy, middle-aged participants. MetS was assessed in 1628 Kazakh participants (men, 768; women, 860). The associations between adiponectin, HOMA-IR, and the A/H ratio with the components of MetS and MetS were examined using logistic regression analysis and receiver operating characteristic (ROC) curves. Our results show that A/H ratio may be a better diagnostic marker for MetS than either HOMA-IR or adiponectin alone, and it may serve as an important biomarker to determine an increased risk for MetS in healthy middle-aged population.

scholarly journals Midlife insulin resistance, APOE genotype, and late-life brain amyloid accumulation

Neurology ◽  
2018 ◽  
Vol 90 (13) ◽  
pp. e1150-e1157 ◽  
Author(s):  
Laura L. Ekblad ◽  
Jarkko Johansson ◽  
Semi Helin ◽  
Matti Viitanen ◽  
Hanna Laine ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Risk Factor ◽  
Confidence Interval ◽  
Independent Risk Factor ◽  
Late Life ◽  
Control Group ◽  
Model Assessment ◽  
Amyloid Accumulation ◽  
Increased Risk

ObjectiveTo examine whether midlife insulin resistance is an independent risk factor for brain amyloid accumulation in vivo after 15 years, and whether this risk is modulated by APOE ε4 genotype.MethodsThis observational study examined 60 elderly volunteers without dementia (mean age at baseline 55.4 and at follow-up 70.9 years, 55.5% women) from the Finnish population-based, nationwide Health2000 study with [11C]Pittsburgh compound B–PET imaging in 2014–2016. The participants were recruited according to their homeostatic model assessment of insulin resistance (HOMA-IR) values in the year 2000, and their APOE ε4 genotype. The exposure group (IR+, n = 30) consisted of individuals with HOMA-IR >2.17 at baseline (highest tertile of the Health2000 study population), and the control group (IR−, n = 30) consisted of individuals with HOMA-IR <1.25 at baseline (lowest tertile). The groups were enriched for APOE ε4 carriers, resulting in 50% (n = 15) APOE ε4 carriers in both groups. Analyses were performed with multivariate logistic and linear regression.ResultsAn amyloid-positive PET scan was found in 33.3% of the IR− group and 60.0% of the IR+ group (odds ratio 3.0, 95% confidence interval 1.1–8.9, p = 0.04). The increased risk was seen in carriers and noncarriers of APOE ε4 genotype. Higher midlife, but not late-life continuous HOMA-IR was associated with a greater brain amyloid burden at follow-up after multivariate adjustments for other cognitive and metabolic risk factors (β = 0.11, 95% confidence interval 0.002–0.22, p = 0.04).ConclusionsThese results indicate that midlife insulin resistance is an independent risk factor for brain amyloid accumulation in elderly individuals without dementia.

Abstract MP73: Relationship of Insulin Resistance to Prevalence and Progression of Coronary Artery Calcification Beyond Metabolic Syndrome in a General Population

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Masahiro Yamazoe ◽  
Takashi Hisamatsu ◽  
Katsuyuki Miura ◽  
Sayaka Kadowaki ◽  
Maryam Zaid ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Coronary Artery ◽  
General Population ◽  
Coronary Artery Calcification ◽  
Science Studies ◽  
Subclinical Atherosclerosis ◽  
Population Based ◽  
Model Assessment

Introduction: Association between insulin resistance (IR) and prevalence of coronary artery calcification (CAC) has been inconsistent after adjustment for metabolic syndrome (MetS). In addition, relation of IR to progression of CAC has remained unclear. Recent basic science studies have reported that IR could promote atherosclerosis not only through the mechanisms that involve systemic factors such as dyslipidemia and hypertension, but also through the effect of perturbed insulin signaling at the cell level. Therefore we assessed the hypothesis that IR is associated with CAC prevalence or progression independently of MetS components in a general population. Methods: We conducted a population-based study in a random sample of men aged 40-79 years living in Kusatsu City, Shiga, Japan, without prior coronary heart disease (Shiga Epidemiological Study of Subclinical Atherosclerosis; SESSA). IR was determined by homeostasis model assessment of IR index (HOMA-IR). We measured CAC at baseline and five years later with noncontrast computed tomography. CAC prevalence was defined as baseline CAC score > 0, and CAC progression as a change > 2.5 between the square root transformed values of baseline and follow-up CAC scores. Multivariate logistic regression was performed to calculate adjusted odds ratios (OR) and 95% confidence intervals (95% CI) in total participants and in those without diabetes. Results: Of 1022 total participants at baseline (mean age, 64 ± 10 years), CAC prevalence was found in 658 (64.4%), and of 804 participants at follow-up (mean follow-up duration, 4.9 ± 1.3 years), CAC progression in 371 (46.1%). Even after adjustment for MetS components in addition to other confounding factors, higher HOMA-IR was independently associated with CAC prevalence (OR, 1.35; 95% CI, 1.11-1.64; P = 0.003) and CAC progression (OR, 1.44; 95% CI, 1.18-1.74; P < 0.001). In participants without diabetes (N = 807 at baseline, N = 638 at follow-up), we observed similar positive associations of HOMA-IR with CAC prevalence (OR, 1.30; 95% CI 1.05-1.61; P = 0.016) and CAC progression (OR 1.31; 95% CI 1.03-1.67; P = 0.025). In contrast, fasting glucose and hemoglobin A1c were not related to CAC prevalence and progression. Conclusion: In conclusion, higher IR was associated with CAC prevalence and progression independently of MetS components in general men and also in those without diabetes. Adding measuring of IR as routine clinical examination may provide additional predictive value beyond traditional risk assessment especially among population without diabetes.

U-Shaped Association of Plasma Testosterone, and no Association of Plasma Estradiol, with Incidence of Fractures in Men

2020 ◽  
Vol 105 (5) ◽  
pp. 1489-1500 ◽  
Author(s):  
Bu B Yeap ◽  
Helman Alfonso ◽  
S A Paul Chubb ◽  
Jacqueline R Center ◽  
Jonathan Beilin ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Data Linkage ◽  
Cox Regression ◽  
Community Dwelling ◽  
Sex Hormone Binding Globulin ◽  
Plasma Testosterone ◽  
Increased Risk ◽  
Hormone Effects ◽  
Probability Of Fracture

Abstract Purpose Whether androgens, distinct from estrogen, maintain bone health during male aging has implications for understanding osteoporosis. We assessed associations of different sex hormones with incidence of any bone fracture or hip fracture in older men. Participants and methods Analysis of 3307 community-dwelling men aged 76.8 ± 3.5 years, median follow-up period of 10.6 years. Plasma testosterone (T), dihydrotestosterone (DHT), and estradiol (E2) assayed by mass spectrometry, sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) using immunoassay. Incident fractures determined via data linkage. We analyzed probability of fracture and performed Cox regression adjusted for age, medical comorbidities, and frailty. Results Incident fractures occurred in 330 men, including 144 hip fractures. Probability plots suggested nonlinear relationships between hormones and risk of any fracture and hip fracture, with higher risk at lower and higher plasma T, lower E2, higher SHBG, and higher LH. In fully adjusted models, there was a U-shaped association of plasma T with incidence of any fracture (Quartile 2 [Q2] versus Q1: fully adjusted hazard ratio [HR] = 0.69, 95% confidence interval [CI] 0.51–0.94, P = .020; Q3: HR 0.59, 95% CI 0.42–0.83, P = .002) and hip fracture (Q2 versus Q1: HR 0.60, 95% CI 0.37–0.93, P = .043; Q3: HR 0.52, 95% CI 0.31–0.88, P = .015). DHT, E2, and LH were not associated with fracture. Higher SHBG was associated with hip fracture (Q4 versus Q1: HR 1.76, 95% CI 1.05–2.96, P = .033). Conclusions Midrange plasma T was associated with lower incidence of any fracture and hip fracture, and higher SHBG with increased risk of hip fracture. Circulating androgen rather than estrogen represents a biomarker for hormone effects on bone driving fracture risk.

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