Relative Skeletal Muscle Index Research Articles

The relation between sarcopenia, associated factors, and disease activity in patients with rheumatoid arthritis

Aim The aim of this study was to detect the incidence of sarcopenia in patients with rheumatoid arthritis (RA) and study associated factors. Patients and methods Dual-energy X-ray absorptiometry was used to assess the body composition of 80 patients with RA and 80 healthy controls. Sarcopenia was defined as a relative skeletal muscle index of less than 5.5 kg/m2 in male and less than 7.26 kg/m2 in female patients. BMI, waist circumference, and disease activity score 28 erythrocyte sedimentation rate were used to assess disease activity. Functional disability was measured using Health Assessment Questionnaire, and 4-m gait speed test was used to determine patient's physical performance. Results The relative skeletal muscle index was significantly lower in the RA group (6.1 ± 1.2 vs. 7.2 ± 0.9 kg/m2, P Conclusion Sarcopenia is a common finding in patients with RA but does not have an association with disease activity, functional disability, or physical performance. Future studies are required for better comprehension of sarcopenia to clear up its relationship with different comorbidities.

Association of the Baltic Sea and Mediterranean diets with indices of sarcopenia in elderly women, OSPTRE-FPS study

To examine whether higher adherence to Baltic Sea diet (BSD) and Mediterranean diet (MED) have beneficial association with sarcopenia indices in elderly women. In total 554 women, aged 65-72years belonging to OSTPRE-FPS study answered a questionnaire on lifestyle factors and 3-day food record at baseline in 2002. Food consumptions and nutrient intakes were calculated. Nine components were selected to calculate BSD score. MED score was calculated using eight components. Body composition was measured by dual-energy X-ray absorptiometry. Physical function measures included walking speed 10m, chair rises, one leg stance, knee extension, handgrip strength and squat at baseline and at year 3. Sarcopenia and short physical performance battery (SPPB) score were defined based on the European working group on sarcopenia criteria. Lower body muscle quality (LBMQ) was calculated as walking speed 10m/leg muscle mass. Women in the higher quartiles of BSD and MED scores lost less relative skeletal muscle index and total body lean mass (LM) over 3-year follow-up (P trend≤0.034). At the baseline, women in the higher BSD score quartiles had greater LM, faster walking speed 10m, greater LBMQ, higher SPPB score (P trend≤0.034), and higher proportion of squat test completion. Similarly, women in the higher quartiles of MED sore had significantly faster walking speed 10m, greater LBMQ (P trend≤0.041) and higher proportion of squat test completion. Better diet quality as measured by higher adherence to BSD and MED might reduce the risk of sarcopenia in elderly women.

Body Composition and Bone Mineral Density in Patients With Heart Failure.

The purpose of this study was to examine associations among bone mineral density, osteopenia/osteoporosis, body mass index (BMI), and body composition in patients with heart failure (HF). A total of 119 patients (age = 61 ± 12 years, 65% male) underwent dual-energy X-ray absorptiometry scans to determine bone mineral density and body composition. In multivariable linear regressions, BMI, relative skeletal muscle index (RSMI), and mineral-free lean mass were positively associated with total body bone mineral density. Mineral-free lean mass was most strongly associated with bone mineral density (β = .398). In multivariable logistic regressions, higher BMI, RSMI, and mineral-free lean mass were associated with lower odds for osteopenia/osteoporosis. Fat mass was not associated with total body bone mineral density or osteopenia/osteoporosis. These results suggest that muscle mass may be the important component of body mass associated with bone mineral density in patients with HF.

Study on skeletal muscle mass of 1 836 check-up adults and its association with age in Qiqihar

To analyze the correlation between skeletal muscle mass and age among check-up adults. The study objects were those who aged 18-87 years old and came to a city hospital of Qiqihar for health examination from December, 2013 to September, 2014, excepted those with coronary heart disease, infectious disease, endocrine system disease, hypertension, anemia, cancer, liver disease, kidney disease and those carrying with heart pacemaker. A total of 1 836 respondents were finally enrolled into analysis. Appendicular Skeletal Muscle (ASM) was measured by a Body Composition Analyzer, and relative skeletal muscle index (RSMI) was calculated. The relationship among ASM, RSMI and age was assessed by linear regression analysis. The difference of height, weight, BMI, waist-hip-ratio (WHR), total muscle mass and percentage of body fat between genders were tested by t-test. The difference of ASM and total skeletal muscle mass between genders and among age groups was tested by multi-factor variance analysis. The difference of the muscle decline between genders was compared by Chi-square test. The total muscle mass in males was (52.22 ± 6.65) kg, which was significantly higher than that in females ((38.05 ± 4.39) kg) (t=28.20, P<0.001). ASM in 18-29, 30-39, 40-49, 50-59, 60-69, 70-87 years was (24.64 ± 3.23), (24.00 ± 3.12), (24.35 ± 3.03), (23.33 ± 2.97), (22.54 ± 2.91) and (21.40 ± 3.36) kg (F=16.12, P<0.001) in males, respectively, and (16.48 ± 3.14), (16.72 ± 1.93), (16.75 ± 1.93), (16.84 ± 2.28), (16.52 ± 2.35) and(14.70 ± 2.37)kg (F=4.38, P=0.001) in females, respectively. ASM in males ((23.72 ± 3.16) kg) was higher than that in females ((16.65 ± 2.25) kg) (t=55.97, P<0.001). There was a negative correlation between age and ASM in males after 50 years old, the regression equation was y=28.31-0.09x (P<0.001). While a negative correlation between age and ASM in females occurred after 60 years old, the regression equation was y=27.69-0.18x (P<0.001). The prevalence of low ASM was 16.85% (124/736) in females, which was significantly higher than that in males (8.73%, 96/1 100) (χ(2)=27.57, P<0.001). A negative correlation was found between age and ASM in males after 50 years old and in females after 60 years old. The prevalence of low RSMI in females was significantly higher than that in males.

Relative appendicular skeletal muscle mass is associated with isokinetic muscle strength and balance in healthy collegiate men

ABSTRACTThere are few studies on the relationship between skeletal muscle mass and balance in the young ages. We investigated the relationship between appendicular skeletal muscle mass, isokinetic muscle strength of lower extremity, and balance among healthy young men using relative skeletal muscle index. Thirty men were grouped according to relative appendicular skeletal muscle mass index: higher skeletal muscle group (n = 15) and lower skeletal muscle group (n = 15). Static and dynamic balance abilities were measured using the following: a test where participants stood on one leg with eyes closed, a modified Clinical Test of Sensory Interaction on Balance (mCTSIB) with eyes open and eyes closed, a stability test, and limits of stability test. The muscle strength of lower extremities was measured with an isokinetic analyser in hip, knee, and ankle joints. Participants with higher appendicular skeletal muscle mass were significantly more stable in maintaining dynamic balance than those with lower appendicular skeletal muscle mass. Moreover, appendicular skeletal muscle mass index was positively correlated with dynamic balance ability. Participants with higher appendicular skeletal muscle mass had stronger strength in the lower extremity, and there were significant differences in the isokinetic torque ratios between groups. From these results, it can be inferred that higher appendicular skeletal muscle mass relates to muscle strength and the alteration in the peak torque ratio of the lower extremity, contributing to the maintenance of balance.

Reduction in Endogenous Insulin Secretion is a Risk Factor of Sarcopenia in Men with Type 2 Diabetes Mellitus.

Sarcopenia has recently attracted widespread attention, because it increases risks of fall and bedridden. Although patients with type 2 diabetes mellitus (T2DM) are known to have lower muscle mass of limbs than healthy people, the mechanism is still unclear. We thus examined the association of muscle mass with parameters of endogenous insulin secretion such as fasting immunoreactive insulin, fasting C-peptide immunoreactivity (CPR), and daily urine CPR in 191 men with T2DM. Muscle mass of arms and legs was evaluated by dual-energy X-ray absorptiometry, and we calculated relative skeletal muscle index (RSMI), which is useful for the diagnosis of sarcopenia. Multiple regression analyses adjusted for age, duration of T2DM, serum creatinine, HbA1c, and insulin-like growth factor-I showed that each parameter of endogenous insulin was significantly and positively correlated with muscle mass of arms and legs as well as RSMI (p < 0.05). Moreover, logistic regression analyses adjusted for confounding factors mentioned above showed that each parameter of endogenous insulin was significantly lower in subjects with sarcopenia than those without it (p < 0.05). In conclusion, reduction in endogenous insulin secretion is an independent risk factor of sarcopenia in men with T2DM.

Impact of First 10 Years of Post Menopause on Muscle Function, Muscle Mass and Bone Mineral Density in Adult Women

Background: Previous studies suggested that the early identification of risk factors for the development of osteoporosis should reduce medical complications, which are associated with increased morbidity and mortality in older women. Purpose: The present study had the objective to identify the relationship between Bone Mineral Density (BMD), anthropometric characteristics, years of post-menopause, strength, muscle mass and the performance on functional tests in up 10 years postmenopausal women. Methods: Participated of the study fifty-eight post menopause women who were assessed by dual-energy X-ray absorptiometry (DXA) of femoral neck and whole-body to determine BMD and relative skeletal muscle index (RSMI). Also, the muscle strength was assessed by handgrip strength test (HGS) and two functional tests were performed: Timed Up-and-Go (TUG) and Five-Times-Sit-To-Stand (FTSTS). Results: The results shown a positive correlation between BMD and weight (r = 0.54, p < 0.05), BMD and BMI (r = 0.56, p < 0.05), BMD and RSMI (r = 0.38, p < 0.05). Conclusions: The findings of the present study demonstrated a correlation between muscle mass and BMD and also shown that anthropometric characteristics, such as higher weight and BMI were correlated with higher BMD and muscle mass in up 10 years postmenopausal women.

Resting energy expenditure and systolic blood pressure relationships in women across 4.5 years.

Recent studies have reported a strong association between blood pressure (BP) and resting energy expenditure (REE). However, it is not known whether this relationship persists over time. Therefore, the authors examined the temporal relationship between REE and systolic BP. In addition, the impact of sympathetic tone and anthropometric variables on this relationship was examined. All testing was performed on healthy, overweight African American and European American women aged 25 to 45 years over 4.5 years in the University of Alabama at Birmingham General Clinical Research Center. Repeated-measures mixed-models revealed REE as a significant determinant of systolic BP (β=0.0155, P<.0001), independent of catecholamines, leg fat, visceral fat, fat-free mass, fat mass, height, relative skeletal muscle index, and resting heart rate. Observations that REE is predictive of systolic BP across 4.5 years support previous findings that REE may potentially mediate resting BP, independent of anthropometric variables and a marker for sympathetic tone.

Simplified method of clinical phenotyping for older men and women using established field-based measures

The purpose of this investigation was to determine body composition classification using field-based testing measurements in healthy elderly men and women. The use of isoperformance curves is presented as a method for this determination. Baseline values from 107 healthy Caucasian men and women, over the age of 65years old, who participated in a separate longitudinal study, were used for this investigation. Field-based measurements of age, height, weight, body mass index (BMI), and handgrip strength were recorded on an individual basis. Relative skeletal muscle index (RSMI) and body fat percentage (FAT%) were determined by dual-energy X-ray absorptiometry (DXA) for each participant. Sarcopenia cut-off values for RSMI of 7.26kg·m−2 for men and 5.45kg·m−2 for women and elderly obesity cut-off values for FAT% of 27% for men and 38% for women were used. Individuals above the RSMI cut-off and below the FAT% cut-off were classified in the normal phenotype category, while individuals below the RSMI cut-off and above the FAT% cut-off were classified in the sarcopenic-obese phenotype category. Prediction equations for RSMI and FAT% from sex, BMI, and handgrip strength values were developed using multiple regression analysis. The prediction equations were validated using double cross-validation. The final regression equation developed to predict FAT% from sex, BMI, and handgrip strength resulted in a strong relationship (adjusted R2=0.741) to DXA values with a low standard error of the estimate (SEE=3.994%). The final regression equation developed to predict RSMI from the field-based testing measures also resulted in a strong relationship (adjusted R2=0.841) to DXA values with a low standard error of the estimate (SEE=0.544kg·m−2). Isoperformance curves were developed from the relationship between BMI and handgrip strength for men and women with the aforementioned clinical phenotype classification criteria. These visual representations were used to aid in the classification and evaluation of sarcopenia, obesity, and sarcopenic-obesity in elderly individuals. Future research should replicate the current findings with an increased sample size and the development of tailored interventions for each body composition category.

OP0264 Effect of vitamin D supplementation and physical activity in preventing sarcopenia in older adults with osteoporosis: A randomized controlled trial

BackgroundAgeing is associated with changes in body composition and due to the ageing of the populations and the lessened physical activity (PA), sarcopenia and osteopenia/osteoporosis are emerging as major health...

SAT0379 Prevalence of sarcopenia and osteopenia/osteoporosis in older adults with parkinson’s disease: A cross-sectional analysis

BackgroundParkinson’s disease (PD), a movement disorder characterized by tremor, slowness of movement and postural imbalance,is a recognised cause of disability in older adults. Sarcopenia, osteopenia/osteoporosis and muscle weakness (directly and...

SAT0378 The effect of osteopenia/osteoporosis and sarcopaenia on frailty in older adults: A cross-sectional analysis

BackgroundAgeing is associated with changes in body composition most notably, loss of muscle mass and strength (sarcopenia) and bone mass (osteopenia/osteoporosis) which if associated with physical inactivity may progress to...

Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia

PurposeThe aim of the study was to determine the relationship between the components of clinical sarcopenia and osteoporosis in postmenopausal women. MethodsA population-based cohort of 590 Finnish postmenopausal women (mean age 67.9; range 65–72) was selected from the Osteoporosis Fracture Prevention (OSTPRE-FPS) study in 2002. Bone mineral density (BMD) and lean tissue mass were assessed by dual X-ray absorptiometry (DXA). The study sample was divided into three categories according to the WHO BMD classification: normal, osteopenia and osteoporosis. The study sample was divided into non-sarcopenic, presarcopenic, sarcopenic and non-classified groups according to quartiles of RSMI i.e. relative skeletal muscle index (appendicular muscle mass (kg)/square of height (m)), hand grip strength (kPa) and walking speed. ResultsIn logistic regression analysis sarcopenic women had 12.9 times higher odds of having osteoporosis (p≤0.001, OR=12.9; 95% CI=3.1–53.5) in comparison to non-sarcopenic women. In comparison to women in the highest grip strength quartile, women within the lowest quartile had 11.7 times higher odds of having osteoporosis (p=0.001, OR=11.7; 2.6–53.4). Sarcopenic women had 2.7 times higher odds of having fractures than their non-sarcopenic counterparts (p=0.005, OR=2.732; 1.4–5.5). Sarcopenic women had also 2.1 times higher risk of falls during the preceding 12 months compared to non-sarcopenic women (p=0.021, OR=2.1; 1.1–3.9). Adjustment for age, body mass index (BMI), physical activity and hormone therapy (HT) did not significantly alter these results. ConclusionsThe components of clinical sarcopenia are strongly associated with osteoporosis. Grip strength is the most significant measurement to reveal the association between sarcopenia and osteoporosis, falls and fractures.

Prevalence of sarcopenia in Japanese women with osteopenia and osteoporosis

Sarcopenia and osteoporosis are both significant health burdens among postmenopausal women. This study examined associations between sarcopenia and osteopenia/osteoporosis in Japanese women and evaluated the prevalence of sarcopenia in women with osteopenia and osteoporosis. A total of 2400 Japanese women aged 40-88years underwent dual-energy x-ray absorptiometry (DXA) scans of the whole body, lumbar spine, and total hip. Osteopenia and osteoporosis were defined according to World Health Organization criteria using bone mineral density (BMD) of the lumbar spine or hip. Sarcopenia was defined as a relative skeletal muscle index (RSMI) more than 2 standard deviations below the mean for a young adult reference population, calculated as the appendicular skeletal muscle mass (ASM) obtained from whole-body DXA divided by height in meters squared (RSMI=ASM/height(2)). Significant and marginal/moderate positive correlations were observed between RSMI and lumbar spine/total hip BMDs (r=0.197 and r=0.274, respectively; p<0.0001 each). The BMDs of the lumbar spine and total hip showed significant moderate negative correlations with age (r=-0.270 and r=-0.375, respectively; p<0.0001 each), but RSMI showed no association with age in this population (r=0.056). When osteopenia/osteoporosis was defined using lumbar spine BMD, prevalences of sarcopenia in subjects with normal BMD, osteopenia and osteoporosis were 10.4, 16.8, and 20.4%, respectively. When osteopenia/osteoporosis was defined using total hip BMD, the prevalences of sarcopenia in these subjects were 9.0, 17.8, and 29.7%, respectively. A Chi-square test for independence showed a significant association between sarcopenia and osteopenia/osteoporosis (p<0.0001). These results indicate that sarcopenia is significantly associated with osteopenia and osteoporosis in Japanese women.

Association of 29C&gt;T polymorphism in the transforming growth factor‐β1 gene with lean body mass in community‐dwelling Japanese population

Sarcopenia is the significant degenerative loss of skeletal muscle mass and strength associated with aging, and it is one of the components of frailty. We previously reported an association between the 29C>T polymorphism in the transforming growth factor-β1 gene (rs1800470) and the prevalence of vertebral fractures in subjects with postmenopausal osteoporosis. The association was not attributable to bone mineral density, which suggests that polymorphism influences some aspects of bone quality that affects strength and/or frailty rather than bone strength itself. Thus, we examined the relationship between genetic polymorphism and lean body mass in a Japanese population. A total of 479 adults comprising 143 men and 336 women, age 23 to 85 years, participated in the present study. Fat-free mass was measured by dual energy X-ray absorptiometry, and the relative skeletal muscle index was calculated as the ratio of appendicular (sum of arms and legs) fat-free mass to the square of height. Total, leg, and appendicular fat-free mass as well as the relative skeletal muscle index were significantly lower in male subjects with CT/TT genotypes compared to those with CC genotype. Female subjects did not show any genotype-dependent differences when analyzed as a group, but when those without menstruation (postmenopausal women) were analyzed, arm fat-free mass was significantly lower in the CT/TT genotypes than in the CC genotype. T allele of the 29C>T polymorphism in the transforming growth factor-β1 gene might be a risk factor of sarcopenia in a Japanese population.

Relative Skeletal Muscle Index Correlates with Bone Density and Strength in Young Women

Relative Skeletal Muscle Index Correlates with Bone Density and Strength in Young Women

Increased prevalence of sarcopenia in men taking androgen suppression treatment for prostate cancer

Introduction: Ageing is characterized by a gradual decrease in muscle mass (termed sarcopenia) and muscle strength which contributes to the decline in physical function, increased disability and loss of independence. Ageing is also associated with an increase in the incidence of prostate cancer (PCa), the most frequent cancer in men. Due to the earlier detection of PCa through improved screening, patients are being prescribed androgen deprivation therapy (ADT) in the earlier stages of the disease and for longer periods of time. As a result, this form of treatment for PCa may accelerate the onset of sarcopenia, predisposing the patient to an array of adverse consequences. The aim of this study was to investigate the prevalence of sarcopenia in men taking ADT for PCa.Methods: Two hundred and forty six men, ADT = 125 with a mean age of 72.4 years and non-PCa = 121 with a mean age of 71.0 years, underwent whole body scanning by dual X-ray absorptiometry (Hologic) and the relative skeletal muscle index (RSMI), defined as appendicular skeletal muscle/ht2, calculated. The mean time for ADT usage was 11.5 months with a range of 2n144 months. A RSMI of l7.26 kg/m2 was classed as sarcopenia using reference values from the Rosetta population aged 18n39 years. In addition, we used data from the 1999n2004 NHANES for normal weight non-Hispanic White men aged 20n39 years to classify severe sarcopenia (g2 standard deviations below young values: RSMI l 6.38 kg/m2) and moderate sarcopenia (1n2 standard deviations below young values: RSMI 6.38n7.05 kg/m2).Results: There was no difference between ADT and non-PCa men for age, height, or weight, however, ADT-treated men had lower (p l 0.01) whole body lean mass (55.2 p 6.7 kg vs. 58.0 p 7.3 kg) and appendicular skeletal muscle mass (23.0 p 3.1 kg vs. 24.7 p 4.0 kg), and greater (p l 0.01) % soft tissue fat (29.1 p 4.8% vs. 27.1 p 5.6%) than non-PCa. The prevalence of sarcopenia (Rosetta reference base) was 27.0% in ADT-treated men and 14.2% in non-PCa men. Using the severe and moderate sarcopenia cut-off values, the prevalence was 9.6% and 8.8%, respectively for ADT men, and only 2.5% and 7.4% for non-PCa men.Conclusions: The prevalence of sarcopenia in men with prostate cancer taking ADT is approximately two-fold that of non-prostate cancer men. The acceleration in the development of sarcopenia may predispose these individuals to an earlier onset and longer duration of disability.

Sarcopenia in premenopausal and postmenopausal women with osteopenia, osteoporosis and normal bone mineral density

Sarcopenia, the decline of muscle mass with age, causes impaired gait, disability and falls. It may therefore increase the risk of fracture for osteoporotic women. The aims of this study were to determine the prevalence of sarcopenia in osteopenic and osteoporotic women, and to determine if hormone replacement therapy (HRT), diet, or physical activity (PA) has a role in the prevention of sarcopenia. One hundred and thirty-one premenopausal and 82 postmenopausal (54 taking HRT) healthy women (17-77 years) volunteered for the study. Body composition was measured by dual X-ray absorptiometry (DXA). Sarcopenia was defined as a relative skeletal muscle index (RSMI) (appendicular skeletal muscle mass divided by height) below 5.45 kg/m2. Osteopenia was defined by a densitometric t-score for bone mineral density (BMD) (g/cm2) below -1.0 and osteoporosis by a t-score below -2.5. Nutrient intake was assessed using 3-day food records and physical activity (PA) was measured using the Baecke Physical Activity Questionnaire. Pearson chi-squared, independent t-tests, simple correlation and multiple regression were used to analyze the data. In premenopausal osteopenic women the prevalence of sarcopenia was 12.5%. In postmenopausal women it was 25% for those with osteopenia, and 50% for those with osteoporosis. PA was independently related to RSMI (beta=0.222, p=0.0001), but diet and HRT were not. After adjusting for PA, RSMI was not significantly related to BMD. These data suggest that the relationship between RSMI, BMD and risk of osteoporosis may largely be mediated through participation in PA. Sarcopenia screening simultaneous to BMD examinations by DXA, may be of value in identifying osteoporotic women with sarcopenia, a group that may be most in need of exercise interventions to increase muscle and BMD.

Increased risk of falls and increased bone resorption in elderly men with partial androgen deficiency: the MINOS study.

The goal of this study was to identify the clinical and biological patterns of hypogonadism in a cohort of 1040 elderly men. Residual androgenic activity was estimated by total testosterone as well as the apparent free testosterone concentration (AFTC) and free testosterone index (FTI) calculated on the basis of concentrations of SHBG and total testosterone using appropriate formulae. The lower limit of the normal range defined by 2 SD below the mean in 150 healthy, nonobese, and nonsmoking men, aged 19-40 yr, was calculated for total testosterone (9.26 nmol/liter), AFTC (146 pmol/liter), and FTI (0.14 nmol/nmol). The prevalence of hypogonadism increased with ageing. Hypogonadal men were older and heavier (due to a higher fat body mass) and had lower concentrations of 17 beta-estradiol and androstenedione than men with normal androgenic activity. Men with decreased AFTC had a slightly lower bone mineral density (BMD) at certain sites. Men with decreased FTI had lower appendicular skeletal muscle mass and relative skeletal muscle index. For all three measures of androgenic activity, hypogonadal men had increased levels of the markers of bone resorption. In the multiple regression models including both 17 beta-estradiol and testosterone (total, AFTC, or FTI), 17 beta-estradiol was the only significant determinant of BMD. In the multiple regression models including 17 beta-estradiol and AFTC or FTI, only testosterone was a significant determinant of the variability in bone formation markers, whereas both 17 beta-estradiol and testosterone were significant determinants of the variability of the markers of bone resorption. Hypogonadism was associated with an increase in the risk of falls, an impairment of static and dynamic balance, as well as the inability to stand up from a chair and to perform the tandem walk. Decreased AFTC (<146 pmol/liter) discriminated best men with functional disabilities (odds ratio, 1.54-7.95; P < 0.05-0.0001). Hypogonadal elderly men had increased bone resorption that was not adequately matched by an increase in bone formation, lower muscle strength, impaired static and dynamic balance, a higher risk of falls, and, in men with low AFTC, a slightly lower BMD. Low AFTC seems to have the best discriminative power for densitometric, biochemical, and functional parameters, followed by FTI, whereas total testosterone was the least discriminative. In multiple regression models, 17 beta-estradiol was the strongest determinant of BMD, and AFTC and FTI were significant determinants of the variability in bone formation markers, whereas both 17 beta-estradiol and testosterone determined the variability in bone resorption markers.