Associations of Sex Hormone-binding Globulin with Bone Mineral Density Among US Adults, NHANES 2013-2016

Background: Bone metabolism can be influenced by sex steroid hormones. However, the relationship between sex steroid hormones and bone mineral density (BMD) remains inconsistent. Our study explored existing evidence of the association between sex hormones, blood glucose and BMD. Methods: We conducted a cross-sectional study of 6434 participants aged 18-80 years in the National Health and Nutrition Examination Survey (NHANES) 2013-2016 to assess the association between SHBG and BMD. The multivariable linear regression models were performed to evaluate the associations between testosterone, estrogen, sex hormone binding globulin (SHBG) and BMD. Results: On adjustment for traditional risk factors (age, BMI, ALB, ALK, ASP, calcium, cholesterol, potassium, sodium, total protein, uric acid), SHBG could be regarded as an independent predictor for BMD, while fasting blood glucose did not. SHBG levels were significant associated with BMD in the multivariate model; however, it will be a different effect between the genders. On comparative analysis, high level SHBG was predictive of lumbar BMD irrespective of other two sex steroid hormones. Conclusion: This study indicated that SHBG may improve the predictive value for bone loss in adults.