Frailty and bone health in European men

© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. Background: frailty is associated with an increased risk of fragility fractures. Less is known, however, about the association between frailty and bone health.Methods: men aged 40-79 years were recruited from population registers in eight European centres for participation in the European Male Aging Study. Subjects completed a comprehensive assessment which included quantitative ultrasound (QUS) scan of the heel (Hologic-SAHARA) and in two centres, dual-energy bone densitometry (dual-energy x-ray absorptiometry, DXA). Frailty was defined based on an adaptation of Fried's phenotype criteria and a frailty index (FI) was constructed. The association between frailty and the QUS and DXA parameters was determined using linear regression, with adjustments for age, body mass index and centre.Results: in total, 3,231 subjects contributed data to the analysis. Using the Fried categorisation of frailty, pre-frail and frail men had significantly lower speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) compared to robust men (P 0.35) was associated with lower lumbar spine BMD (P < 0.05) when compared to those with low (FI < 0.2), but not lower femoral neck BMD. When analysed as a continuous variable, higher FI was linked with lower SOS, BUA and QUI (P < 0.05).Conclusions: optimisation of bone health as well as prevention of falls should be considered as strategies to reduce fractures in frail older people

Impaired quality of life and sexual function in overweight and obese men: the European Male Ageing Study

&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: Few published data link overweight and obesity with measures of quality of life including sexual health in men.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To assess the association of overweight/obesity with impairment of physical and psychological quality of life (QoL) and sexual functions in men.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Design and setting&lt;/b&gt;: Cross-sectional, multi-centre survey of 3,369 community-dwelling men aged 40-79 (mean±SD, 60±11) years, randomly selected from eight European centres.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Outcomes:&lt;/b&gt; Adiposity was assessed by body mass index (BMI) and by waist circumference (WC), QoL and functional impairments by physical and psychological function domains of the Short Form-36 questionnaire, Beck’s Depression Inventory and the EMAS sexual function questionnaire.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; Complete data on sexual activities and erectile function were available in 2,734 (92%) and 3,193 (95%) of participants, respectively. From the population studied, 814 men were obese (BMI&#x2265;30kg/m&lt;sup&gt;2&lt;/sup&gt;) and 1171 had WC&#x2265;102 cm, 25% of all men were unable to do vigorous activity and 2-13% reported depressive symptoms. Symptoms of sexual dysfunction ranged between 22% (low sexual desire) and 40% (infrequent morning erections). Among obese men with both BMI&#x2265;30kg/m&lt;sup&gt;2&lt;/sup&gt; and WC&#x2265;102cm, at least one symptom of impaired physical, psychological and sexual function was reported by 41%, 43% and 73%, respectively. Compared to the reference group of non-obese men (BMI&#x3C;30 kg/m&lt;sup&gt;2&lt;/sup&gt; and WC&#x3C;102cm), men with BMI&#x3C;30 kg/m&lt;sup&gt;2&lt;/sup&gt; and WC&#x3C;102 cm more frequently reported at least one symptom of impaired physical function (OR=2.67; CI:2.07-3.45, P&#x3C;0.001), of impaired psychological function (OR=1.48; CI:1.14-1.90, P&#x3C;0.01) and of impaired sexual function (OR=1.45; CI:1.14-1.85, P&#x3C;0.01). These functional impairments were also more prevalent in men who had WC&#x2265;102cm even with BMI &#x3C;30kg/m2, but those with BMI&#x2265;30kg/m2 and WC&#x3C;102cm generally did not suffer increased impaired physical or sexual health. Men with high BMI and WC were at even greater likelihood of having a composite of two or more or three or more symptoms, compared to those with normal BMI and WC.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Men with high WC, including those who are “non-obese” with BMI&#x3C;30 kg/m&lt;sup&gt;2&lt;/sup&gt;, have poor QoL with symptoms of impaired physical, psychological and sexual functions. Health promotion to improve QoL should focus on prevention of obesity and central fat accumulation.&lt;/p&gt

The relationships between sex hormones and sexual function in middle-aged and older European men

&lt;p&gt;&lt;b&gt;Context:&lt;/b&gt; Limited data are available exploring the associations between sex hormones, multiple domains of sexual functioning, and sexual function-related distress in nonpatient samples in Europe.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Objectives:&lt;/b&gt; The aim of the study was to investigate the relationships between serum testosterone (T), estradiol (E2), and dihydrotestosterone (DHT) and sexual function in a multicenter population-based study of aging in men.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Design:&lt;/b&gt; Using stratified random sampling, 2838 men aged 40-79 yr completed the European Male Ageing Study-Sexual Function Questionnaire and provided a blood sample for hormone measurements. T, E2, and DHT were measured using gas chromatography-mass spectrometry.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Setting:&lt;/b&gt; We conducted a community-based population survey in eight European centers.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Main Outcome Measures:&lt;/b&gt; Self-reported sexual function (overall sexual function, sexual function-related distress, erectile dysfunction, masturbation) was measured.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; Total and free T, but not E2 or DHT, was associated with overall sexual function in middle-aged and older men. E2 was the only hormone associated with sexual function-related distress such that higher levels were related to greater distress. Free T levels were associated with masturbation frequency and erectile dysfunction in the fully adjusted models, such that higher T was associated with less dysfunction and greater frequency. Moreover, there was a T threshold for the relationship between total T, sexual function, and erectile dysfunction. At T concentrations of 8 nmol/liter or less, T was associated with worse sexual functioning, whereas at T levels over 8 nmol/liter, the relationship came to a plateau.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; These findings suggest that different hormonal mechanisms may regulate sexual functioning (T) vs. the psychological aspects (E2) of male sexual behavior. Moreover, there was a T threshold for overall sexual function such that at levels greater than 8 nmol/liter the relationship between T and sexual function did not become stronger.&lt;/p&gt

Comparison of serum testosterone and estradiol measurements in 3174 European men using platform immunoassay and mass spectrometry; relevance for the diagnostics in aging men

Background: The limitations of serum testosterone and estradiol (E2) measurements using non-extraction platform immunoassays (IAs) are widely recognized. Switching to more specific mass spectrometry (MS)-based methods has been advocated, but directly comparative data on the two methods are scarce. &lt;p/&gt;Methods: We compared serum testosterone and E2 measurements in a large sample of middle-aged/elderly men using a common platform IA and a gas chromatography (GC)–MS method, in order to assess their limitations and advantages, and to diagnose male hypogonadism. Of subjects from the European Male Aging Study (n=3174; age 40–79 years), peripheral serum testosterone and E2 were analyzed using established commercial platform IAs (Roche Diagnostics E170) and in-house GC–MS methods. &lt;p/&gt;Results: Over a broad concentration range, serum testosterone concentration measured by IA and MS showed high correlation (R=0.93, P&#60;0.001), which was less robust in the hypogonadal range (&#60;11 nmol/l; R=0.72, P&#60;0.001). The IA/MS correlation was weaker in E2 measurements (R=0.32, P&#60;0.001, at E2 &#60;40.8 pmol/l, and R=0.74, P&#60;0.001, at E2 &#62;40.8 pmol/l). Using MS as the comparator method, IA ascertained low testosterone compatible with hypogonadism (&#60;11 nmol/l), with 75% sensitivity and 96.3% specificity. The same parameters with IA for the detection of low E2 (&#60;40.7 pmol/l) were 13.3 and 99.3%, and for high E2 (&#62;120 pmol/l) 88.4 and 88.6%. &lt;p/&gt;Conclusion: A validated platform IA is sufficient to detect subnormal testosterone concentrations in the diagnosis of male hypogonadism. The IA used for E2 measurements showed poor correlation with MS and may only be suitable for the detection of high E2 in men

Association of hypogonadism with vitamin D status: the European Male Ageing Study

&lt;p&gt;Objective: Interrelationships between hormones of the hypothalamic–pituitary–testicular (HPT) axis, hypogonadism, vitamin D and seasonality remain poorly defined. We investigated whether HPT axis hormones and hypogonadism are associated with serum levels of 25-hydroxyvitamin D (25(OH)D) in men.&lt;/p&gt; &lt;p&gt;Design and methods: Cross-sectional survey of 3369 community-dwelling men aged 40–79 years in eight European centres. Testosterone (T), oestradiol (E2) and dihydrotestosterone were measured by gas chromatography–mass spectrometry; LH, FSH, sex hormone binding globulin (SHBG), 25(OH)D and parathyroid hormone by immunoassay. Free T was calculated from total T, SHBG and albumin. Gonadal status was categorised as eugonadal (normal T/LH), secondary (low T, low/normal LH), primary (low T, elevated LH) and compensated (normal T, elevated LH) hypogonadism. Associations of HPT axis hormones with 25(OH)D were examined using linear regression and hypogonadism with vitamin D using multinomial logistic regression.&lt;/p&gt; &lt;p&gt;Results: In univariate analyses, free T levels were lower (P=0.02) and E2 and LH levels were higher (P&#60;0.05) in men with vitamin D deficiency (25(OH)D &#60;50 nmol/l). 25(OH)D was positively associated with total and free T and negatively with E2 and LH in age- and centre-adjusted linear regressions. After adjusting for health and lifestyle factors, no significant associations were observed between 25(OH)D and individual hormones of the HPT axis. However, vitamin D deficiency was significantly associated with compensated (relative risk ratio (RRR)=1.52, P=0.03) and secondary hypogonadism (RRR=1.16, P=0.05). Seasonal variation was only observed for 25(OH)D (P&#60;0.001).&lt;/p&gt; &lt;p&gt;Conclusions: Secondary and compensated hypogonadism were associated with vitamin D deficiency and the clinical significance of this relationship warrants further investigation.&lt;/p&gt