{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T12:35:50Z","timestamp":1778934950410,"version":"3.51.4"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2016,6,29]],"date-time":"2016-06-29T00:00:00Z","timestamp":1467158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,12,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2003<\/jats:title>\n                  <jats:p>Accentuated kyphosis is associated with adverse health outcomes, including falls and fractures. Low bone density is a risk factor for hyperkyphosis, and each vertebral fracture adds roughly 4\u00b0 to forward spine curvature. Sex steroids, in particular low bioavailable estradiol and high sex hormone\u2013binding globulin (SHBG), are associated with bone loss and high SHBG is associated with vertebral fractures in older men. We, therefore, hypothesized that low bioavailable estradiol and high SHBG would be associated with worse kyphosis. To test this hypothesis, we examined the cross-sectional associations between individual bioavailable sex hormones and SHBG with radiographically assessed kyphosis. Participants included 1500 men aged 65 and older from the Osteoporotic Fractures in Men (MrOS) Study, in whom baseline measures of kyphosis and sex hormones were available. Modified Cobb angle of kyphosis, calculated from T4 through T12, was assessed from supine lateral spine radiographs. Serum total estradiol and total testosterone were measured by mass spectrometry, and bioavailable sex steroids were calculated from mass action equations. After adjustment for age and other confounding variables, no association was found between bioavailable estradiol or testosterone and Cobb angle, either when kyphosis was analyzed as a continuous variable or dichotomized into highest versus lower three quartiles. In linear regression models adjusted for age and clinic site, there was a significant association between SHBG and kyphosis (parameter estimate\u2009=\u20090.76 per SD increase, p\u2009=\u20090.01). In the fully adjusted model, this association was weakened and of only borderline statistical significance (parameter estimate\u2009=\u20090.61 per SD, p\u2009=\u20090.05). Logistic models demonstrated similar findings. Although associated with bone loss, we did not demonstrate that low bioavailable estradiol translates into worse kyphosis in older men. High SHBG is associated with bone loss and vertebral fractures. Our results suggest that high SHBG may also be a risk factor for hyperkyphosis. \u00a9 2016 American Society for Bone and Mineral Research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/jbmr.2901","type":"journal-article","created":{"date-parts":[[2016,6,29]],"date-time":"2016-06-29T19:46:22Z","timestamp":1467229582000},"page":"2123-2128","source":"Crossref","is-referenced-by-count":10,"title":["SHBG, Sex Steroids, and Kyphosis in Older Men: The MrOS Study"],"prefix":"10.1093","volume":"31","author":[{"given":"Gina N","family":"Woods","sequence":"first","affiliation":[{"name":"University of California, San DiegoLa JollaCAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei-Hua","family":"Huang","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLALos AngelesCAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peggy M","family":"Cawthon","sequence":"additional","affiliation":[{"name":"California Pacific Medical Center Research Institute and University of California, San FranciscoSan FranciscoCAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gail A","family":"Laughlin","sequence":"additional","affiliation":[{"name":"University of California, San DiegoLa JollaCAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John T","family":"Schousboe","sequence":"additional","affiliation":[{"name":"HealthPartners Institute and Division of Health Policy and ManagementUniversity of MinnesotaMinneapolisMNUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corinne","family":"McDaniels-Davidson","sequence":"additional","affiliation":[{"name":"University of California, San DiegoLa JollaCAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane A","family":"Cauley","sequence":"additional","affiliation":[{"name":"Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Orwoll","sequence":"additional","affiliation":[{"name":"Oregon Health Sciences UniversityPortlandORUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Barrett-Connor","sequence":"additional","affiliation":[{"name":"University of California, San DiegoLa JollaCAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah M","family":"Kado","sequence":"additional","affiliation":[{"name":"University of California, San DiegoLa JollaCAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the Osteoporotic Fractures in Men (MrOS) Study Research Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2016,6,29]]},"reference":[{"issue":"5","key":"2024021014173058300_jbmr2901-bib-0001","doi-asserted-by":"crossref","first-page":"330","DOI":"10.7326\/0003-4819-147-5-200709040-00008","article-title":"Narrative review: hyperkyphosis in older persons","volume":"147","author":"Kado","year":"2007","journal-title":"Ann Intern Med"},{"issue":"1","key":"2024021014173058300_jbmr2901-bib-0002","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1002\/jbmr.1728","article-title":"Factors associated with kyphosis progression in older women: 15 years\u2019 experience in the study of osteoporotic fractures","volume":"28","author":"Kado","year":"2013","journal-title":"J Bone Miner Res"},{"issue":"4","key":"2024021014173058300_jbmr2901-bib-0003","first-page":"747","article-title":"Kyphosis does not equal vertebral fractures: the Rancho Bernardo study","volume":"31","author":"Schneider","year":"2004","journal-title":"J Rheumatol"},{"issue":"11","key":"2024021014173058300_jbmr2901-bib-0004","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1001\/archinte.159.11.1215","article-title":"Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group","volume":"159","author":"Kado","year":"1999","journal-title":"Arch Intern Med"},{"key":"2024021014173058300_jbmr2901-bib-0005","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1471-2474-15-19","article-title":"Kyphosis and paraspinal muscle composition in older men: a cross-sectional study for the Osteoporotic Fractures in Men (MrOS) research group","volume":"15","author":"Katzman","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"issue":"2","key":"2024021014173058300_jbmr2901-bib-0006","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1093\/gerona\/glr160","article-title":"Association of spinal muscle composition and prevalence of hyperkyphosis in healthy community-dwelling older men and women","volume":"67","author":"Katzman","year":"2012","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"1","key":"2024021014173058300_jbmr2901-bib-0007","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3109\/17453678608993218","article-title":"Effects of sex hormones on congenital kyphosis in Ishibashi rats","volume":"57","author":"Moritake","year":"1986","journal-title":"Acta Orthop Scand"},{"issue":"11","key":"2024021014173058300_jbmr2901-bib-0008","doi-asserted-by":"crossref","first-page":"4295","DOI":"10.1210\/endo.141.11.7765","article-title":"Estrogen deficiency, obesity, and skeletal abnormalities in follicle-stimulating hormone receptor knockout (FORKO) female mice","volume":"141","author":"Danilovich","year":"2000","journal-title":"Endocrinology"},{"issue":"6","key":"2024021014173058300_jbmr2901-bib-0009","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1210\/er.2014-1024","article-title":"Sex steroid actions in male bone","volume":"35","author":"Vanderschueren","year":"2014","journal-title":"Endocr Rev"},{"key":"2024021014173058300_jbmr2901-bib-0010","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.bone.2016.01.009","article-title":"Sex hormones, sex hormone binding globulin, and vertebral fractures in older men","volume":"84","author":"Cawthon","year":"2016","journal-title":"Bone"},{"issue":"3","key":"2024021014173058300_jbmr2901-bib-0011","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1002\/jbmr.2718","article-title":"High serum SHBG predicts incident vertebral fractures in elderly men","volume":"31","author":"Vandenput","year":"2016","journal-title":"J Bone Miner Res"},{"issue":"Suppl 1","key":"2024021014173058300_jbmr2901-bib-0012","article-title":"3 sex steroid hormones and kyphosis in older men: the Osteoporotic Fractures in Men (MrOS) Study","volume":"28","author":"Kado","year":"2013","journal-title":"J Bone Miner Res"},{"issue":"5","key":"2024021014173058300_jbmr2901-bib-0013","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.cct.2005.05.006","article-title":"Design and baseline characteristics of the Osteoporotic Fractures in Men (MrOS) Study\u2014a large observational study of the determinants of fracture in older men","volume":"26","author":"Orwoll","year":"2005","journal-title":"Contemp Clin Trials"},{"issue":"5","key":"2024021014173058300_jbmr2901-bib-0014","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.cct.2005.05.005","article-title":"Overview of recruitment for the Osteoporotic Fractures in Men Study (MrOS)","volume":"26","author":"Blank","year":"2005","journal-title":"Contemp Clin Trials"},{"issue":"4","key":"2024021014173058300_jbmr2901-bib-0015","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1097\/01.brs.0000200131.01313.a9","article-title":"Comparing a supine radiologic versus standing clinical measurement of kyphosis in older women: the Fracture Intervention Trial","volume":"31","author":"Kado","year":"2006","journal-title":"Spine (Phila\u2009Pa 1976)"},{"issue":"4","key":"2024021014173058300_jbmr2901-bib-0016","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.jocd.2013.08.003","article-title":"The official positions of the International Society for Clinical Densitometry: vertebral fracture assessment","volume":"16","author":"Rosen","year":"2013","journal-title":"J Clin Densitom"},{"key":"2024021014173058300_jbmr2901-bib-0017","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.bone.2014.06.039","article-title":"Methods and reliability of radiographic vertebral fracture detection in older men: the Osteoporotic Fractures in Men Study","volume":"67","author":"Cawthon","year":"2014","journal-title":"Bone"},{"issue":"6","key":"2024021014173058300_jbmr2901-bib-0018","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/0022-4731(82)90038-3","article-title":"Calculation of free and bound fractions of testosterone and estradiol-17 beta to human plasma proteins at body temperature","volume":"16","author":"Sodergard","year":"1982","journal-title":"J Steroid Biochem"},{"issue":"2","key":"2024021014173058300_jbmr2901-bib-0019","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0895-4356(93)90053-4","article-title":"The Physical Activity Scale for the Elderly (PASE): development and evaluation","volume":"46","author":"Washburn","year":"1993","journal-title":"J Clin Epidemiol"},{"issue":"9","key":"2024021014173058300_jbmr2901-bib-0020","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1002\/jbmr.2493","article-title":"Reproductive hormones and longitudinal change in bone mineral density and incident fracture risk in older men: the Concord Health and Aging in Men Project","volume":"30","author":"Hsu","year":"2015","journal-title":"J Bone Miner Res"},{"issue":"9","key":"2024021014173058300_jbmr2901-bib-0021","doi-asserted-by":"crossref","first-page":"4314","DOI":"10.1210\/jc.2009-2635","article-title":"Sex steroid hormones in older men: longitudinal associations with 4.5-year change in hip bone mineral density\u2014the osteoporotic fractures in men study","volume":"95","author":"Cauley","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"2024021014173058300_jbmr2901-bib-0022","doi-asserted-by":"crossref","DOI":"10.1530\/JOE-16-0070","article-title":"Plasma steroid-binding proteins: primary gatekeepers of steroid hormone action","author":"Hammond","year":"2016","journal-title":"J Endocrinol. Epub"},{"issue":"3","key":"2024021014173058300_jbmr2901-bib-0023","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/s001980170127","article-title":"Hormonal and anthropometric predictors of bone mass in healthy elderly men: major effect of sex hormone binding globulin, parathyroid hormone and body weight","volume":"12","author":"Martinez Diaz-Guerra","year":"2001","journal-title":"Osteoporos Int"},{"issue":"5","key":"2024021014173058300_jbmr2901-bib-0024","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1158\/1055-9965.EPI-06-0792","article-title":"Reproducibility of serum sex steroid assays in men by RIA and mass spectrometry","volume":"16","author":"Hsing","year":"2007","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"Suppl 1","key":"2024021014173058300_jbmr2901-bib-0025","article-title":"Factors Associated wtih Kyphosis and Kyphosis Progression in Older Men: the MrOS Study","volume":"28","author":"Kado","journal-title":"J Bone Miner Res"},{"key":"2024021014173058300_jbmr2901-bib-0026","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/978-1-4939-3182-8_12","article-title":"Direct Measurement of Free Estradiol in Human Serum and Plasma by Equilibrium Dialysis-Liquid Chromatography-Tandem Mass Spectrometry","volume":"1378","author":"Ray","year":"2016","journal-title":"Methods Mol Biol"}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjbmr.2901","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjbmr.2901","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/31\/12\/2123\/56648099\/jbmr2901.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/31\/12\/2123\/56648099\/jbmr2901.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T10:56:57Z","timestamp":1710327417000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/31\/12\/2123-2128\/7604960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6,29]]},"references-count":26,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2016,6,29]]},"published-print":{"date-parts":[[2016,12,1]]}},"URL":"https:\/\/doi.org\/10.1002\/jbmr.2901","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2016,12,1]]},"published":{"date-parts":[[2016,6,29]]}}}