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Tue Nov 07, 2006 8:02 pm

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WebMD October 30, 2006
Low Testosterone Levels Predict Risk of Falling in Older Men
News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP

Older men with lower testosterone levels are at higher risk for falls, with older men falling more frequently than younger men, according to the results of an observational follow-up study reported in the October 23 issue of the Archives of Internal Medicine.

"Gonadal steroid levels decline with age in men," write Eric Orwoll, MD, of the Oregon Health & Science University in Portland, and colleagues. "Whether low testosterone levels affect the development of common age-related disorders, including physical functioning and falling, is unclear."

The Osteoporotic Fractures in Men (MrOS) Study, a longitudinal, observational follow-up cohort study of men 65 years and older, is designed primarily to identify risk factors for falls and fractures.

From a study cohort of 5995 volunteers, 2587 community-based men aged 65 to 99 years were selected using a stratified random sampling scheme. Bioavailable testosterone and estradiol levels and physical performance measures were determined from baseline, and incident falls were determined every 4 months during 4 years of follow-up. The investigators used generalized estimating equations to estimate risk ratios for the relationship of sex steroids to falls.

Many men fell frequently, and 56% reported at least 1 fall. Lower bioavailable testosterone levels predicted increased fall risk; men with testosterone levels in the lowest quartile had a 40% higher fall risk than did those in the highest quartile. This effect was most apparent in younger men aged 65 to 69 years (relative risk, 1.8; 95% confidence interval, 1.2 - 2.7). In men aged 80 years or older, testosterone level was not associated with falls. Although lower testosterone concentrations were associated with reduced physical performance, the association between low testosterone levels and fall risk persisted despite adjustment for performance.

"Falls were common among older men," the authors write. "Fall risk was higher in men with lower bioavailable testosterone levels. The effect of testosterone level was independent of poorer physical performance, suggesting that the effect of testosterone on fall risk may be mediated by other androgen actions."

Study limitations include study sample predominantly white and healthier than the general population of older men, potential difficulties in using radioimmunoassay methods to measure sex steroid levels, and undetected confounding factors.

"These findings strengthen the link between testosterone and the health of older men, suggesting that the effects of testosterone on fall risk may be via novel mechanisms and provide insight into how testosterone measurements might be useful for identifying men at higher risk for adverse events," the authors conclude. "Moreover, these results provide additional justification for trials of testosterone supplementation in older men and should aid in the design of those studies."

Arch Intern Med. 2006;166:2124-2131.

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