Estrogens as regulators of bone health in men

Bone metabolism is influenced by sex steroids during growth and adulthood in both men and women. Although this influence is well described in women, the relative importance of androgens and estrogens in the regulation of the male skeleton remains uncertain. Even though estradiol has been considered the 'female hormone', levels of serum estradiol in elderly men are higher than those in postmenopausal women. Estradiol levels are more strongly associated with BMD, bone turnover and bone loss than testosterone levels are in adult men. Case reports of young men with estrogen resistance or aromatase deficiency also suggest a crucial role for estradiol in regulation of skeletal growth in men. Moreover, serum levels of both estrogens and androgens are inversely associated with the risk of fracture in aging men. A large, prospective, population-based study showed that levels of serum estradiol predict the risk of fracture, independently of serum testosterone. Evidence suggests that a threshold level of estradiol exists below which the male skeleton is impaired; rates of bone loss and fracture seem to be increased and bone maturation delayed in men with estradiol levels below this threshold. On the basis of these findings, we propose that not only androgens, but also estrogens, are important regulators of bone health in men.