Abstract and Introduction
Abstract
Multiple changes occur across various endocrine systems as an individual ages. The understanding of the factors that cause age-related changes and how they should be managed clinically is evolving. This statement reviews the current state of research in the growth hormone, adrenal, ovarian, testicular, and thyroid axes, as well as in osteoporosis, vitamin D deficiency, type 2 diabetes, and water metabolism, with a specific focus on older individuals. Each section describes the natural history and observational data in older individuals, available therapies, clinical trial data on efficacy and safety in older individuals, key points, and scientific gaps. The goal of this statement is to inform future research that refines prevention and treatment strategies in age-associated endocrine conditions, with the goal of improving the health of older individuals.
Introduction
Hormones regulate and coordinate multiple physiologic functions. With increasing age, declines in physical and cognitive function occur. The extent to which age-associated changes in hormonal regulation and increases in prevalence of specific endocrine diseases contribute to declines in physical and cognitive function is incompletely understood. This area will only expand in importance as the number of older individuals increases worldwide. Current projections show an increase in those aged 65 years and older from 703 million (1 in 11 people) to 1.5 billion in 2050 (1 in 6 people).[1]
This Scientific Statement was developed to provide a high-level summary of the current state of research across multiple hormonal axes in aging and to identify areas in need of future research. Each section describes the natural history and observational data in older individuals, available therapies, clinical trial data on efficacy and safety in older individuals, key points, and scientific gaps. The extent to which hormonal changes with age are deemed "normal aging" vs "endocrine disease" can be arbitrary and depends in part on whether treatment is currently indicated. Four hypothalamic-pituitary axes are presented: growth hormone, adrenal, gonadal (divided into ovarian and testicular), and thyroid. These are followed by osteoporosis, vitamin D deficiency, diabetes, and water metabolism topics. Geroscience has emerged as a research approach examining biological mechanisms of aging and their interplay with comorbid disease. In the conclusion, cross-cutting themes of research areas in need of further investigation and the need for geroscience approaches are summarized.
J Clin Endocrinol Metab. 2023;108(8):1835-1874. © 2023 Endocrine Society