The Relationship between Sex Hormones and Bone Turnover Markers in Adult Men

BACKGROUND: Bone mass changes in men is related to age, BMI, sex hormones and other factors. In prior studies, bone markers were negatively correlated with bone mineral density, free testosterone, and estrogen and was positively correlated with SHBG. In a study of sex hormones and bone markers in Korean men estradiol was negatively correlated with deoxypyridinoline. In this study, the relationship of testosterone, estradiol, calculated free testosterone, FEI and SHBG to bone turnover markers in adult men were investigated. METHODS: This was a cross-sectional study of 184 men who had undertaken a health screening program in one general hospital in Bundang from November, 2001 to February, 2003. We surveyed information concerning the past medical history, current medication, alcohol consumption amount per week and smoking amount by means of self questionnaire records. Serum total testosterone, estradiol, SHBG and osteocalcin, alkaline phosphatase were measured at a fasting state. Urine was tested for deoxypyridinoline. Free testosterone was calculated using albumin, SHBG, and total testosterone level. RESULTS: Deoxypyridinoline adjusted by age, BMI was negatively correlated with FEI (r=-0.17, P=0.020) and was positively correlated with smoking amount (r=0.20 P= 0.007). Osteocalcin was negatively correlated with calculated free testosterone and ethanol consumption amount (r=-0.186, P=.0.12, r=-0.186, P=0.012). Multiple regression analysis showed that the most powerful factor influencing deoxypyridinoline was smoking amount (R2= 0.046), followed by FEI, BMI, and the one influencing osteocalcin was BMI (R2=0.050), ethanol amount and calculated free testosterone. After adjusting for age, BMI, drinking amount and smoking amount FEI shown to be a predictor of deoxypyridinoline (beta=-0.08, p<0.01, R2=0.101). After adjusting for age, BMI, and drinking amount calculated free testosterone was shown to be a predictor of osteocalcin (beta=-0.570, P<0.01, R2=0.130) in multiple regression model. CONCLUSIONS: In adult men, FEI shown to be a predictor of deoxypyridinoline and calculated free testosterone to be a predictor of osteocalcin as an independent variable.

The Relationship between Testosterone and Bone Mineral Density in Middle Aged Men

BACKGROUND: With the population aging, osteoporosis is becoming a major health issue. Although not as common as women, osteoporosis and its clinical end point of fracture are significant health care concern in men. Despite the considerable public health burden, our understanding of their pathogenesis is incomplete, and several factors known to affect bone metabolism in men are still controversial. So this study was made to investigate relationship between testosterone and bone mineral density in men. METHODS: This was a cross-sectional study of 432 men undertaken health screening program in Pundang CHA General Hospital from January 2000 to December 2000. We surveyed information concerning exercise and consumption of alcohol and smoking by means of self questionnaire records. Serum total testosterone, SHBG, and osteocalcin were measured at a fasting state. Second morning urine was tested for deoxypyridinoline. BMD was assessed using pQCT. RESULTS: FTI (free testosterone index) was positively correlated with BMD (r=0.265, P<0.01). Age, osteocalcin, SHBG, and urine deoxypridinoline were negatively correlated with BMD (r= 0.397, P<0.01, r= 0.121, P<0.05, r= 0.214, P<0.01, and r= 0.126, P<0.01). BMI and total testosterone had no significant correlation with BMD, and there were no apparent association among the level of alcohol and tobacco use, regular exercise and BMD. FTI was not independently correlated with BMD after age, BMI and urine deoxypyridinoline were adjusted, but showed a trend to significantly predict BMD (beta =0.10, P=0.052). CONCLUSION: These data suggest that FTI may play a role in determination of BMD in men, allowing the potential for clinical intervention. But further investigation of the role of testosterone in bone metabolism in men is necessary.

The Relationship among Testosterone, IGF- 1 and Fat Mass

BACGROUND: The age-related increase in fat mass seems related to decrease in hormone level. Few studies have been done in Korea concerning the association between testosterone, GH (growth hormone) and fat mass. This study was undertaken to evaluate the relationship among testosterone, IGF-1 and fat mass. METHODS: The study was performed from February to October 2001 in the Health Screening Center of Pundang CHA Hospital with 243 men as subjects. Fat intake was measured through interview with diet therapist and other data were obtained by self-questionnaire. Fat mass was measured using Inbody 3.0 and the level of total testosterone, SHBG and IGF-1 in serum were measured. RESULTS: Smoking was negatively correlated with fat mass and WHR (waist to hip ratio) (P <0.05) and fat intake was positively correlated with fat mass (P <0.05). Fat mass was negatively correlated with total testosterone, calculated free testosterone, and SHBG (gamma = 0.26; P <0.01, gamma = 0.15; P <0.05, gamma = 0.31; P <0.01). WHR was positively correlated with age (gamma =0.26; P <0.01) and negatively correlated with total testosterone, calculated free testosterone, and IGF-1 (gamma = 0.24; P <0.01, gamma = 0.20; P <0.01, gamma = 0.16; P <0.05). After adjustment for age, body mass index, smoking, and fat intake, the calculated free testosterone and IGF-1 were independently negatively correlated with fat mass (beta = 0.072; P <0.01, beta = 0.0035; P <0.05) and WHR (beta = 6.9E-04; P <0.05, beta = 4.0E-05; P <0.05) but, total testosterone and SHBG were not independently correlated with fat mass and WHR. CONCLUSION: The results indicate that the calculated free testosterone and IGF-1 can be independent determinants of fat mass and WHR in middle-aged men.

Risk factors of delirium in elderly inpatients

BACKGROUND: This study was done to investigate the clinical risk factors of delirium in general hospital's elderly inpatients. METHODS: A case-control study design was used. Forty cases and age -sex matched 120 contols were identified using hospital discharge data from June 1995 to May 2001. The controls were selected during the same period. The clinical records of each subject were reviewed using discharged disease code to select cases. Subsequent7, the data were recorded from clinical records. RESULTS: The subjects admitted with delirium tended to have increased age (P=0.007), hypoxia(P=0.018), low hemoglobin(P =0.011),sleep disturbance (P=0.001), more ADL total dependence ( P=0.018), diagnoses with infections (P=0.006), diabetes (P=0.046), and hypertension (P=0.041). Above risk factors seemed to be clinically associated with delirium. CONSLUSION: These findings indicate that rapid infection control, maintenance of good sleep hygiene, well-controlled diabetes and hypertension, and correction of hypoxia may help to prevent delirium in general hospital's elderly inpatients.

Relationship between total testosterone and serum lipid in middle aged men

BACKGROUND: The prevalance of coronary heart disease is significantly higher in men than in premenopausal women of the same age. Impact that endogenous androgens have on serum lipid has many arguments and few researches were made in Korea. So this study was made to investigate correlation between total testosterone and serum lipid known as effect on cardiovascular disease. METHODS: This was a cross sectional study on 560 middle aged men undertaken health screening program in Pundang General Hospital, Korea from June 1999 to June 2000. We surveyed informations concerning exercise, consumption of alcohol and smoking by means of self questionnaire records and total testosterone and serum lipid were measured at fasting state. RESULTS: Body mass index was positively correlated with total cholesterol and triglycerides(r=2.023;P<0.01, r=0.229;P<0.01) but negatively correlated with HDL cholesterol(r= 0.284;P<0.001). Total testosterone concentrations were negatively correlated with total cholesterol and triglyceride(r= 0.096; P<0.05, r= 0.145; P<0.01) but positively correlated with HDL cholesterol(r=0.155; P<0.001). Total testosterone concentrations were independently correlated with HDL cholesterol after age and body mass index were adjusted(beta=0.734; P<0.05). And after statistical adjustment for age, body mass index, exercise, smoking and alcohol, total testosterone concentrations were significantly correlated with triglyceride(beta= 10.467; P<0.05). CONCLUSION: The result indicate that total testosterone can be a independent determinant of HDL cholesterol and we expect that appropriate maintenance of total tetosterone concentrations will have a protective effect for cardiovascular disease.

The relationship between grip strength and radial BMD in middle aged men

BACKGROUND: Although it has become obvious that male osteoporosis represent a public health issue, few studies has been done in Korea concerning the association between grip strength and bone mineral density(BMD) in men. This study was undertaken to enforce the necessity of muscle strengthening exercise program to improve BMD in middle-aged men by evaluate the association between grip strength and BMD. METHODS: The study was performed from January to December 1998 in the health screening center of CHA hospital with 174 men who measured both BMD and grip strength . BMD was measured at the proximal and distal radius of the dominant hand using Osteoplan p-DXA and grip strength was measured from the dominant hand using dynamometer. Daily calcium intake was measured through the interview with the diet therapist. Other datas were obtained from the questionnaire. RESULTS: We found a significant positive correlation between grip strength and BMD of distal and proximal radius(r=0.208; P<0.01, r=0.255;P<0.01)and a significant negative correlation between age and BMD of distal and proximal radius(r= -0.313; P<0.01, r= -0.190; P<0.05). There was no correlation between calcium intake and BMD. BMI was correlated significantly only with BMD of distal radius(r=0.194; P<0.05). There was no significant difference in BMD either by smoking or exercise. The multiple regression analysis showed that grip strength was independently correlated with BMD of the proximal radius significantly(beta =1.731, P<0.05), but not with BMD of the distal radius after adjusting the confounding variables. CONCLUSION: In conclusion, there is a significant correlation between grip strength and BMD in middle aged men. Therefore it can be safely concluded that it is helpful to carry out muscle strengthening program to improve muscle strength and increase BMD for preventing male osteoporosis.

The relationship between the Alzheimer's Disease Assessment Scale and other measures of dementia

BACKGROUND: The cognitive subscale of the Alzheimer's Disease Assessment Scale(ADAS-Cog) has been extensively valiated in assessing cognitive function in patients with Alzheimer's Disease(AD) and used as an efficacy measure in clinical trials of AD. There is a need for additional data on the relationship between cognitive performance and other measures of dementia to fully assess the value of the ADAS-Cog as a measure of treatment efficacy. METHODS: We used data from 53 AD participants in 8 multicenter clinical drug trials to examine the distribution of baseline ADAS-Cog scores in relation to Mini-Mental State Examination(MMSE), Global Deterioration Scale(GDES), Katz Index of Activity of Daily Living(ADL), Lawton Instrumental Activity of Daily Living(IADL), Geriatric Depression Scale(GDS) and Mini-Nutritional Assessment(MNA). RESULTS: The ADAS-Cog score was statistically significantly correlated with MMSE (R=-0.755, P<0.001), GDES(R=0.403, P<0.003), ADL(R=-0.532, P<0.001), IADL(R=-0.626, P<0.001) and MNA(R=-0.427, P=0.004) scores. But GDS scores were not associated with ADAS-Cog scores.(R= -0.123, P=0.396) CONCLUSIONS: This study characterizes the relationship between ADAS-Cog scores and other commonly used measures of dementia in AD patients. As expected, baseline scores on ADAS-Cog and MMSE demonstrated significantly high correlation. The relatively weaker correlation between ADAS-Cog and GDES scores may be related to the fact that GDES does not evaluate cognitive function only. There are also significant correlations between ADAS-Cog and ADL, IADL, and MNA which indicate the severity and progression of dementia in AD patients. Further studies with larger samples including cognitive function of broader spectrum need to confirm the findings in this study.

The frequency of common hidden disease in the elderly

BACKGROUND: With the rapid increase in the number of the aged population, curable or controlled disease were treated as aging process because of the difficulty of early detection and treatment of disease and the specificity of elderly patients. We help manage elderly patients by studying their frequency of common known disease and hidden disease that would enable the curable diseases to be detected early, and noncurable disease to be controlled. METHODS: The subjects included 128 patients over 60 years old who had completed structured questionnaires and we reviewed chart records among 208 patients registered from January 1997 to July at the Health Screening Center of a general hospital in Kyonggi-do. Known diseases were based on charts recorded through structured questionnaires and hidden diseases were based on health screening results and overall geriatric assessment data. RESULTS: The number of patients was 128 in which male was 47 and female was 81. The ratio between male and female was 1: 1.72 and the average age was 66.0 years. In the order of frequency the most common known diseases were hypertension, arthritis, G-I disturbance, diabetes mellitus, chronic obstructive pulmonary disease, heart disease, depression and the hidden diseases they were arthritis, G-1 disease, depressive mood, malnutrition, hypertension, osteoporosis, hearing loss, hypercholesterolemia, hypomagnesemia, incontinence, anemia, decreased cognitive function. CONCLUSION: We assessed the characteristics of multiple pathology in geriatric patients and realized that it was important t manage aggressively those with a hidden disease that can be treatable after early detection through overall geriatric assessement.

Prevalence of Depressive Mood and its Associated Factors in the Elderly

BACKGROUND: It was known that physical illness and depression due to cognitive function defects increase in the elderly, This study was designed to evaluate the prevalence of depressive mood, associated factors and to help understanding recent trends of the depressive elderly. METHODS: We selected 108 subjects over 65-year-old who visited Health Promotion Center, Pundang CHA General Hospital for geriatric health evaluation from Mar. 1996 to Feb. 1997. We analyzed Geriatric Evaluation Record to Know the effect of sociodemographic factors, life styles and geriatric medical factors by Geriatric Depression Scale(GDS). RESULTS: The result showed that depressive mood appeared 20(37.0%) in male, 35(64.8%) in female and 55(50.9%) in total among 108 subjects. Factors associated with depressive mood of the elderly were occupation(p<0.05), regular exercise(p<0.001), nutritional status(p<0.05), functional status and alcohol drinking. CONCLUSIONS: The prevalence of depressive mood of the elderly was 50.9%, and the depressive mood have been affected more for the elderly who was out of work, not doing regular exercises and got high nutritional risk. Further study is required to know other factors influencing on depressive mood of the elderly.