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Associations between Low Levels of Serum Estradiol, Bone Density, and Fractures among Elderly Women: The Study of Osteoporotic Fractures¹

Division of Research, Kaiser Permanente Medical Care Program (B.E.), Oakland, California 94611; the Division of General Internal Medicine (D.C.B., S.R.C.) and the Department of Epidemiology and Biostatistics (S.R.C.), University of California, San Francisco, California 94105; the Department of Epidemiology and Biostatistics, Graduate School of Public Health, University of Pittsburgh (J.A.C.), Pittsburgh, Pennsylvania 15213

Address all correspondence and requests for reprints to: Bruce Ettinger, M.D., Division of Research, Kaiser Permanente Medical Care Program, 3505 Broadway, Oakland, California 94611-5714.

To evaluate the skeletal effects of endogenous serum estradiol, we measured bone mineral density (BMD) at the calcaneus and radius (single photon absorptiometry) and at the hip and spine (dual x-ray absorptiometry) in 274 women aged 65 yr or more who participated in the Study of Osteoporotic Fractures. Lateral radiographs of the thoracic and lumbar spine were also taken, and serum was assayed for estradiol. Those who had estradiol levels from 10–25 pg/mL had 4.9%, 9.6%, 7.3%, and 6.8% greater BMD at total hip, calcaneus, proximal radius, and spine than those with levels below 5 pg/mL. After multiple adjustments, BMD differences remained statistically significant and corresponded to about 0.4 SD. Vertebral deformities were less prevalent among women whose estradiol level exceeded 5 pg/mL; the multiple adjusted odds ratio was 0.4 (95% confidence interval, 0.2–0.8). We conclude that physiologically low estradiol has a salutary effect on the skeleton in elderly women, possibly by reducing skeletal remodeling.

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