Chapter 41: Role of Sex Steroids in the Pathogenesis of Osteoporosis Matthew T. Drake and Sundeep Khosla

Table 1: Spearman Correlation Coefficients Relating Rates of Change in BMD at the Radius and Ulna to Serum Sex Steroid Levels Among a Sample of Rochester, MN, Men Stratified by Age From the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7 th Edition.

Figure 1 Figure 1 Patterns of age-related bone loss in women and men. Dashed lines, trabecular bone; solid lines, cortical bone. The figure is based on multiple cross-sectional and longitudinal studies using DXA. (Reprinted with permission from Elsevier from Khosla S, Riggs BL 2005 Pathophysiology of age-related bone loss and osteoporosis. Endocrinol Metab Clin North Am 34:1015–1030, Copyright 2005.) From the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7 th Edition.

Figure 2 Figure 2 (A) Values for vBMD (mg/cm3) of the total vertebral body in a population sample of Rochester, MN, women and men between the ages of 20 and 97 yr. Thin-dashed line, premenopausal women; thick- dashed line, postmenopausal women; solid line, men. (B) Values for cortical vBMD at the distal radius in the same cohort. Line coding as in A. All changes with age were significant (p < 0.05). (Adapted with permission of the American Society for Bone and Mineral Research from Riggs BL, Melton LJI, Robb RA, Camp JJ, Atkinson EJ, Peterson JM, Rouleau PA, McCollough CH, Bouxsein ML, Khosla S 2004 Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. J Bone Miner Res 19:1945–1954.) © 2008 American Society for Bone and Mineral Research From the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7 th Edition.

Figure 3 Figure 3 Age-specific incidence rates for proximal femur (hip), vertebral (spine), and distal forearm (wrist) fractures in Rochester, MN, women (A) and men (B). (Adapted with permission from Elsevier from Cooper C, Melton LJ 1992 Epidemiology of osteoporosis. Trends Endocrinol Metab 3:224–229, Copyright 1992.) From the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7 th Edition.

Figure 4 Figure 4 Percent changes in (A) bone resorption markers (urinary deoxypyridinoline [Dpd] and N- telopeptide of type I collagen [NTX]) and (B) bone formation markers (serum osteocalcin and N-terminal extension peptide of type I collagen [PINP]) in a group of elderly men (mean age, 68 yr) made acutely hypogonadal and treated with an aromatase inhibitor (group A), estrogen alone (group B), testosterone alone (group C), or both estrogen and testosterone (group D). Significance for change from baseline: *p < 0.05; **p < 0.01; ***p < (Adapted with permission from American Society for Clinical Investigation from Falahati-Nini A, Riggs BL, Atkinson EJ, O'Fallon WM, Eastell R, Khosla S 2000 Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men. J Clin Invest 106:1553–1560.(34)) From the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7 th Edition.