Submitted to: Osteoporosis International
Publication Type: Peer reviewed journal
Publication Acceptance Date: 12/3/2007
Publication Date: 9/3/2008
Citation: Bischoff-Ferrari, H.A., Orav, E.J., Dawson-Hughes, B. 2008. Additive benefit of higher testosterone levels and vitamin D plus calcium supplementation in regard to fall risk reduction among older men and women. Osteoporosis International. 19:1307-1314. Interpretive Summary: Testosterone levels decline with age in both men and women and testosterone replacement may increase lean body mass and muscle strength. Reduced muscle strength is a well known risk factor for falls in the elderly. This study was done to determine whether the natural level of testosterone in the circulation influences risk of falling in older men and women, and if so, whether that risk is affected by the level of calcium and vitamin D intake. We measured testosterone levels at the beginning of a trial in which 369 elderly men and women were treated with either calcium plus vitamin D or placebo daily for three years. Compared to those with the lowest testosterone levels, men and women with the highest sex-specific testosterone levels had a 78% and 66% decreased risk of falling, respectively, over the three year period. In those individuals took calcium plus vitamin D the anti-fall effect was enhanced to 84% among men and 85% among women. In conclusion, higher natural levels of testosterone may be advantageous for fall prevention in older men and women, and fall prevention may be further improved by providing calcium and vitamin D supplements.
Technical Abstract: Both testosterone and vitamin D levels affect muscle and thus may also affect risk of falling. The aim of this study was to investigate the association between sex hormone levels and the risk of falling in older men and women. 199 men and 246 women age 65 or older living at home followed for 3 years after baseline assessment of sex hormones. Analyses controlled for age, BMI, baseline 25-hydroxyvitamin D, sex hormone binding globulin, physical activity, smoking, alcohol use, number of co-morbidities, maximal follow-up, and vitamin D plus calcium treatment. Compared to the lowest quartile, men and women in the highest sex-specific quartile of total testosterone had a 78% and 66% decreased risk of falling (men: OR = 0.22; 95% CI [0.07,0.72]/ women: OR = 0.34; 95% CI [0.14,0.83]); in those individuals also took calcium plus vitamin D the anti-fall effect was enhanced to 84% among men and 85% among women (men: OR = 0.16; 95% CI [0.03,0.90] / women: OR = 0.15; 95% CI [0.04,0.57]). Women in the top quartile of dihydroepiandrosterone sulfate (DHEA-S) had a significant 61% lower risk of falling compared to those in the lowest quartile (OR = 0.39; 95% CI [0.16,0.93]). Other sex hormones and SHBG did not predict falling in men or women. We conclude that physiologic total testosterone in both genders and higher DHEA-S levels in women predicted a more than 60% lower risk of falling. The anti-fall benefit of higher physiologic testosterone levels is enhanced to over 80% by additional calcium and vitamin D supplementation.