Traditionally, the stronger male skeleton was considered to result from higher androgen levels in men compared to women. However, the regulation of male bone growth by sex steroids appears more complex than originally anticipated. Based on clinical observations and studies in animal models, not only androgens and androgen receptor (AR), but also estrogens and estrogen receptor-alpha (not ERbeta) are required for optimal bone mineral acquisition during male growth. In addition, both sex steroids are involved in the maintenance of male skeletal health. In fact, bone loss and fracture risk have been associated with estrogen exposure in elderly men. Overall, a compelling body of evidence suggests that both androgens and estrogens are crucial for male skeletal growth and maintenance.
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