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The CAG repeat polymorphism in the androgen receptor gene affects bone density and bone metabolism in healthy males
Abstract
OBJECTIVE Bone metabolism and bone density (BD) are influenced by sex hormones. Testosterone (T) action is exerted through the androgen receptor (AR). We investigated the potential impact of the CAG repeat (CAGR) polymorphism within the AR gene on BD and bone metabolism in healthy younger males. PATIENTS AND MEASUREMENTS The number of CAGRs in 110 healthy men aged 20–50 years was determined by sequence analysis. We assessed BD by the radiation‐free method of quantitative ultrasound (QUS) of the phalanges. Serum levels of bone‐specific alkaline phosphatase (BAP) and urine secretion of free deoxypyridinoline (DPD, corrected for creatinine), serum levels of sex hormones, body fat content and lifestyle factors were determined. RESULTS In stepwise multiple regression models controlling for age, body fat content and lifestyle factors, the number of CAGRs was an independent negative predictor of BD (partial r = − 0·286, P = 0·001), whereas it was positively associated with markers of bone turnover (for BAP: partial r = 0·32, P = 0·001; for DPD: partial r = 0·241, P = 0·013). Levels of free T and oestradiol showed an independent and positive association with BD; age contributed significantly to lower BD. Age and free T were negatively associated with markers of bone turnover, whereas oestradiol showed a positive correlation with BAP and DPD. anova in groups according to age and the CAGR length suggested an increased age‐dependent bone loss in subjects with a CAGR length of 22–31 compared with 14–21 CAGRs (overall P < 0·01). CONCLUSIONS A high number of CAG repeats within the androgen receptor gene attenuates testosterone effects on bone density and bone metabolism. This seems to be associated with accelerated age‐dependent bone loss.
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“Results demonstrated findings similar to those observed in men with low T, including depressed mood, anxiety, impaired spermatogenesis, and loss of bone mineral density (BMD), among others.”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [32]
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“A receptor with a short CAG sequence produces greater activity when androgens attach, and men with shorter CAG polymorphisms exhibit androgenic traits, such as preserved bone density (Zitzmann et al 2001) and prostate growth during testosterone treatment (Zitzmann et al 2003).”
Androgen Receptor Gene CAG Repeat Polymorphism in the Development of Ovarian Hyperandrogenism
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“As clinical consequences, the number of CAGr was shown to be inversely associated with the risk of prostate cancer [27, 28, 31, 32, 33], benign prostatic hyperplasia [34, 35], sperm production [36, 37], bone density [38], endothelial function and HDL-cholesterol concentrations [39] as well as depression [40].”
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“Third, AR repeat polymorphisms have been shown to be associated with the incidence of other androgen-related clinical conditions; specifically, a high number of repeats seem to adversely influence fertility and spermatogenesis (60) and bone density (61), and fewer repeats are associated with increased risk of baldness…”
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“Although the CAG repeat polymorphism of AR was shown to be associated with BMD in women or in men in some studies [11, 21, 22, 23, 24], other studies have failed to detect an effect of this polymorphism on BMD or fracture risk [25, 26].”
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“Presence of a high number of CAG repeats within the androgen receptor gene attenuates the effects of testosterone on bone density and bone metabolism ( 23 ), whereas a decreased number of CA repeats in the IGF-I gene is associated with a lower birth weight, lower body height and serum IGF-I concentrations at the lowes…”
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“Shorter AR CAG are associated with prostate cancer (16, 17), benign prostatic hypertrophy (18, 19), prostate growth during testosterone treatment (20), semen parameters of fertility (21–23) and bone mineral density (24).”
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Karasik, D., & Ferrari, S. (2008) · Annals of Human Genetics · doi:10.1111/j.1469-1809.2008.00447.x · Cited by 78
“The few studies of the AR in men are not well-powered (Van Pottelbergh et al., 2001; Zitzmann et al., 2001), thus their results are inconclusive for male-specific associations.”
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“Thus, shorter CAG repeats are associated with higher androgenicity and longer CAG repeats with lower androgenicity”
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“Our study corroborates some of the findings by Zitzmann et al. (2004), especially the positive correlation Figure 3 A negative correlation in Klinefelter syndrome, between mean CAG repeat lengths and haematocrit, spearman’s q = )0.”
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Ferlin, A., Schipilliti, M., Mambro, A. D., Vinanzi, C., & Foresta, C. (2010) · Molecular Human Reproduction · doi:10.1093/molehr/gaq026 · Cited by 71
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Self-citationCAG repeat length in the androgen receptor gene affects the risk of male infertility
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Self-citationIs the androgen receptor CAG repeat length significant for prostate cancer?
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“demonstrated to be associated with reduced bone mass in both women and men [33, 34], however, other studies”
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“…parameters, based on small cross-sectional samples from selected or patient-based populations limiting their ability to detect a true relationship (Zitzmann et al., 2001a,b; Hersberger et al., 2005; Walsh et al., 2005; Stanworth et al., 2008, 2011; Guadalupe-Grau et al., 2010a,b; Nielsen et al.,…”
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“The finding that shorter CAG repeats are associated with higher androgenicity and longer CAG repeats with lower androgenicity has been seen in both hypogonadal and normal men [96-101] .”
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Self-citationAge-related influence of common aromatase gene polymorphisms on bone mass of healthy men
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“In healthy men, AR CAGn is a negative predictor of BMD, and the effect of age on bone loss is greater in subjects with longer repeat length (22–31 repeats) compared to those with shorter repeat lengths (14 –21 repeats; Zitzmann et al. 2001b).”
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“Accordingly, data in the literature show that TRT is particularly effective in those patients with a marked baseline deficit of bone density [20].”
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“Consequently, the finding of the number of CAG repeats as a negative indicator of bone density in men aged 20 to 50 years might imply that the CAG polymorphism determines the development of peak bone mass in men [28].”
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Gaffney, C., Pagano, M. J., Kuker, A. P., Stember, D. S., & Stahl, P. J. (2015) · Sexual Medicine Reviews · doi:10.1002/smrj.63 · Cited by 18
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Metadata
- Authors
- Zitzmann, M., Brune, M., Kornmann, B., Gromoll, J., Junker, R., & Nieschlag, E.
- Affiliations
- University of Münster (DE)
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2001-11
- Volume
- 55
- Issue
- 5
- Pages
- 649-657
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W2017076191
- Cited by
- 107
- References
- 51
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2016: 4 · 2015: 2 · 2014: 3 · 2013: 6 · 2012: 4
- FWCI
- 9.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Sexual Differentiation and Disorders
- Keywords
- androgen receptor gene, CAG repeat polymorphism, bone mineral density, bone metabolism, bone turnover markers, bone-specific alkaline phosphatase, deoxypyridinoline, testosterone, estradiol, age-related bone loss, healthy young men
- MeSH terms
- Adult, Aging, Alkaline Phosphatase, Amino Acids, Analysis of Variance, Body Constitution, Bone and Bones, Estradiol, Humans, Male, Middle Aged, Polymorphism, Genetic, Receptors, Androgen, Sex Hormone-Binding Globulin, Testosterone, Biomarkers, Bone Density, Trinucleotide Repeats
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