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Sex Steroid Hormones and Fracture Risk in Older Women

J Clin Endocrinol Metab; ePub 2017 Jan 25; Cauley, et al

Higher bioavailable estradiol (BioE2) and testosterone (BioT) levels are linked with decreased fracture risk in older women, according to a nested case-control study involving more than 1,100 individuals.

Participants were from the Women’s Health Initiative Observational Study, and included blacks (n=381), Hispanics (n=192), Asians (n=112), and Native Americans (n=46). Investigators looked at non-spine fractures in this group, and also evaluated white women who experienced fracture (n=400). They measured BioE2, BioT, and sex hormone-binding globulin (SHBG), assessing the odds of experiencing fracture across tertiles of hormone.

There was no link between SHBG and fracture risk. Fracture risk was lower by:

  • 35% in participants with BioE2 >8.25 pg/ml.
  • 24% in those with BioT >13.3 pg/ml.
  • 44% in white women with higher BioE2.
  • 39% in black women with higher BioE2.
  • 35% in black women with higher BioT.


Cauley J, Danielson M, Jammy G, et al. Sex steroid hormones and fracture in a multi-ethnic cohort of women: The Women’s Health Initiative Study (WHI). [Published online ahead of print January 25, 2017]. J Clin Endocrinol Metab. doi:10.1210/jc.2016-3589.

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Sex Steroid Hormones and Fracture Risk in Older Women, J Clin Endocrinol Metab; ePub 2017 Jan 25; Cauley, et al