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Observational Study
. 2021 Mar 8;106(3):e1156-e1169.
doi: 10.1210/clinem/dgaa922.

Serum FSH Is Associated With BMD, Bone Marrow Adiposity, and Body Composition in the AGES-Reykjavik Study of Older Adults

Annegreet G Veldhuis-Vlug  1   2 , Gina N Woods  3   4 , Sigurdur Sigurdsson  5 , Susan K Ewing  6 , Phuong T Le  1 , Trisha F Hue  6 , Eric Vittinghoff  6 , Kaipin Xu  7 , Vilmundur Gudnason  5   8 , Gunnar Sigurdsson  5 , Deborah M Kado  3   9 , Gudny Eiriksdottir  5 , Tamara Harris  10 , Anne L Schafer  6   11   12 , Xiaojuan Li  7 , Mone Zaidi  13 , Clifford J Rosen  1 , Ann V Schwartz  6
Affiliations
Observational Study

Serum FSH Is Associated With BMD, Bone Marrow Adiposity, and Body Composition in the AGES-Reykjavik Study of Older Adults

Annegreet G Veldhuis-Vlug et al. J Clin Endocrinol Metab. .

Abstract

Context: Follicle-stimulating hormone (FSH) concentrations increase during the perimenopausal transition and remain high after menopause. Loss of bone mineral density (BMD) and gain of bone marrow adiposity (BMA) and body fat mass also occur during this time. In mice, blocking the action of FSH increases bone mass and decreases fat mass.

Objective: To investigate the associations between endogenous FSH levels and BMD, BMA, and body composition in older adults, independent of estradiol and testosterone levels.

Design, setting, and participants: Older adults from the AGES-Reykjavik Study, an observational cohort study.

Main outcome measures: Areal BMD, total body fat, and lean mass were measured with dual-energy x-ray absorptiometry. Lumbar vertebral BMA was measured by 1H-magnetic resonance spectroscopy. Volumetric BMD and visceral and subcutaneous adipose tissue (VAT, SAT) areas were measured with quantitative computed tomography. The least squares means procedure was used to determine sex hormone-adjusted associations between quartiles of serum FSH and BMD, BMA, and body composition.

Results: In women (N = 238, mean age 81 years), those in the highest FSH quartile, compared with the lowest quartile, had lower adjusted mean spine integral BMD (-8.6%), lower spine compressive strength index (-34.8%), higher BMA (+8.4%), lower weight (-8.4%), lower VAT (-17.6%), lower lean mass (-6.1%), and lower fat mass (-11.9%) (all P < 0.05). In men, FSH level was not associated with any outcome.

Conclusions: Older postmenopausal women with higher FSH levels have higher BMA, but lower BMD and lower fat and lean mass, independent of estradiol and testosterone levels. Longitudinal studies are needed to better understand the underlying mechanisms.

Keywords: adiposity; aging; body composition; bone; bone marrow adiposity; follicle-stimulating hormone (FSH).

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Figures

Figure 1.
Figure 1.
Estimated mean QCT bone density and strength and 95% CIs by quartiles of FSH in women (a) and men (b). Values are adjusted for age, subgroup (A or B), estradiol, and testosterone. Significantly different from quartile 4: *P < 0.05.
Figure 2.
Figure 2.
Estimated mean DXA bone density and BMA and 95% CIs by quartiles of FSH in women (a) and men (b). Values are adjusted for age, subgroup (A or B), estradiol, and testosterone. Significantly different from quartile 4: *P < 0.05.
Figure 3.
Figure 3.
Estimated means and 95% CIs for body composition parameters by quartiles of FSH in women (a) and men (b). Values are adjusted for age, subgroup (A or B), estradiol, and testosterone. Significantly different from quartile 4: *P < 0.05, **P < 0.001.
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