The association between sex hormones and bone mineral density in US females.

Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE

Original Publication: London : Nature Publishing Group, copyright 2011-

Bone Density* ; Estradiol*/blood ; Testosterone*/blood; Humans ; Female ; Middle Aged ; Aged ; Cross-Sectional Studies ; United States/epidemiology ; Nutrition Surveys ; Gonadal Steroid Hormones/blood ; Gonadal Steroid Hormones/metabolism ; Osteoporosis ; Osteoporotic Fractures/etiology ; Osteoporotic Fractures/epidemiology ; Osteoporotic Fractures/blood ; Biomarkers/blood ; Fractures, Bone/etiology ; Fractures, Bone/epidemiology ; Fractures, Bone/metabolism ; Fractures, Bone/blood

Osteoporosis and osteoporosis-related fractures exhibits a higher prevalence among females, particularly those aged 50 and above, implying a potential association between sex hormones and bone mineral density (BMD). However, the precise role of sex hormones in BMD remains elusive. Meanwhile, estradiol-to-testosterone ratio (E 2 /T ratio) or testosterone-to-estradiol ratio (T/E 2 ratio) is a new biomarker of sex hormone milieu. We investigated whether sex hormones, E 2 /T ratio and T/E 2 ratio were associated with BMD or fractures risk in US females. This study is a cross-sectional study, and the data sourced from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 cycle. This study primarily focuses on females aged 50 and above, employing weighted multivariate linear regression, restricted cubic spline (RCS) model to examine the association between sex hormones and BMD or FRAX scores. We included 1,012 females. Testosterone was not associated with BMD or fracture risk. Increasing estradiol and E 2 /T ratio were positively correlated with BMD and negatively correlated with osteoporosis-related fractures risk, while increasing T/E 2 ratio was negatively correlated with BMD and increased risk of osteoporosis-related fractures. The T/E 2 ratio showed better specificity for predicting low BMD compared to estradiol alone. These findings suggest that hormonal ratios can serve as predictive biomarkers for osteoporosis and fractures. This study highlights the potential of E 2 /T and T/E 2 ratios as biomarkers for assessing osteoporosis risk in postmenopausal women. Incorporating these ratios into clinical practice could improve early diagnosis and risk stratification for osteoporosis-related fractures. Future longitudinal studies are needed to confirm these findings and further explore the causal relationships between sex hormones and bone health.
Competing Interests: Competing interests: The authors declare no competing interests.
(© 2025. The Author(s).)

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2024-BS-186, 2024 Natural Science Foundation of Liaoning Province

Keywords: Bone mineral density; Estradiol; Hormones; Osteoporosis; Testosterone

4TI98Z838E (Estradiol)
3XMK78S47O (Testosterone)
0 (Gonadal Steroid Hormones)
0 (Biomarkers)

Date Created: 20250214 Date Completed: 20250214 Latest Revision: 20250218

20250218

PMC11829004

10.1038/s41598-025-89985-z

39953073