risk factors for hip fracture in men l low bmd and rf for low bmd l previous fractures l low body...

$: Risk factors for hip fracture in men l Low BMD and RF for low BMD l Previous fractures l Low body mass l Taller l Frequent falls and RF for falls$

Risk factors for hip fracture in menRisk factors for hip fracture in men

Low BMD and RF for low BMD

Previous fractures

Low body mass

Taller

Frequent falls and RF for falls

Risk factors for osteoporosis in menRisk factors for osteoporosis in men

Hypogonadism

Steroid therapy

Immobilization

Alcoholism

RA

Cancer

Thyrotoxicosis

Causes of secondary osteoporosisCauses of secondary osteoporosis

Risk factors for osteoporosis in menRisk factors for osteoporosis in men Aging

Thinness

Low calcium intake

Very low protein intake

Inactivity

Decreased androgen

Decreased estrogen

Design of cohort studiesDesign of cohort studies

Outcomes

(death / disease / others)

Exposure

Why do we need cohort studies?Why do we need cohort studies?

Cross-sectional studies can only

describe associations

Cohort studies can

- Defined temporal relationship

- Study multiple outcomes

- Can be converted to RCCT

Determinants of validity of Determinants of validity of cohort studiescohort studies

Sampling method

Sample size

Validity of measurements

Completeness of follow up

What is known about determinants What is known about determinants of BMD and fractures? of BMD and fractures?

Study of Osteoporotic fractures (SOF)

Dubbo study (Australia)

Rancho Bernando study

NHANES I, II, III

STORM

Correlates of femoral neck BMD (OrwCorrelates of femoral neck BMD (Orwoll) oll)

Factors % diffAge (5 years) -2.6Weights (10 kg) 5.4Fracture history -7.4Hypertension 4.2COAD -6.3Gastrectomy -11.6Current alcohol 4.9Current smoking -3.9

Sampling MethodSampling Method

Volunteer samples (independent walking)

Stratified by age group

65 - 69 33%

70 - 74 35%

≥ 75 31%

2000 men and 2000 women

Questionnaire for Mr & Ms OsQuestionnaire for Mr & Ms Os

General including falls

(Stanford Health Assessment)

Cigarette smoking

Alcohol consumption

Questionnaire for Mr & Ms OsQuestionnaire for Mr & Ms Os

Dietary intake (Block food frequency)

Medication use

Physical activity (PASE)

Mental status by MMSE

Depression by Geriatric Depression Scale

Physical examination for Physical examination for Mr & Ms OsMr & Ms Os

Height and Weight

BMD by DEXA (Hologic QDR 4500W)

Ankle / arm BP index

Visual function : acuity, depth

Neuromuscular : grip strength, walk spe

ed, chair stand

Outcome measuresOutcome measures

Fractures (History and X-Ray)

BMD

QCT

Characteristic of MrOs Subjects (MeCharacteristic of MrOs Subjects (MeananSD)SD)

Mean (SD)

Age 72.4 (5)

Height (cm) 163.1 (5.7)

Weight (kg) 62.4 (9.4)

BMI (kg/m2) 23.4 (3.1)

PASE score 97.3 (50.3)

PASE ScoringPASE Scoring

Sitting Job + no exercise 33

Sitting Job +

Aerobic Exercise 3-4 times per week96

Job that requires standing and walking +

No exercise184

Job that requires standing and walking +

Aerobic Exercise 3-4 times per week221

Characteristic of MrOs Subjects (MeCharacteristic of MrOs Subjects (MeananSD)SD)

Diet Mean (SD)

Total calories intake (kcal) 2161 (747)

Protein intake (g) 90 (41)

Calcium intake (mg) 649 (344)

Characteristic of MrOs SubjectsCharacteristic of MrOs Subjects

Percentage

Current cigarette smoking 11.9%

Alcoholism - drink 4 /day in p12m 0.4%

- ever drink 5/day 8.0%

Had 1 or more fracture 13.7%

Diabetes mellitus 14.7%

Thyroid disease 2.1%

COPD 11.6%

Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)


What are the physical What are the physical

characteristics that are associated characteristics that are associated

with BMD in Chinese men?with BMD in Chinese men?

Percent differencePercent difference Weight (5 kg): +3.6 Weight (5 kg): +3.6



What medical factors are What medical factors are

associated with BMD in associated with BMD in

Chinese men?Chinese men?



Medical Diseases associated with lower Medical Diseases associated with lower BMD:BMD:

Percent Percent differencedifference– Chronic obstructive lung diseaseChronic obstructive lung disease (-(-

5.8)5.8)

– Gastrointestinal surgeryGastrointestinal surgery (-4.7)(-4.7)

– Fracture after age 50 yearsFracture after age 50 years (-5.7)(-5.7)



Medical Diseases associated with Medical Diseases associated with

higher BMD: higher BMD: Percent Percent

differencedifference

– HypertensionHypertension (4.0)(4.0)

– DiabetesDiabetes (6.9)(6.9)

– HyperthyroidismHyperthyroidism (5.1)(5.1)



Medications associated with lower BMD:Medications associated with lower BMD: Percent differencePercent difference

Inhaled corticosteroids (0.9%) (-12.9)Inhaled corticosteroids (0.9%) (-12.9)

Oral corticosteroids (0.6%) (-4.4)Oral corticosteroids (0.6%) (-4.4)Medications associated with hiher BMD:Medications associated with hiher BMD:

– Thiazide diureticsThiazide diuretics (4.7)(4.7)



What about lifestyle factors?What about lifestyle factors?



Cigarette Smoking:Cigarette Smoking: Percent differencePercent difference

Current smokersCurrent smokers (-4.6)(-4.6)

More than 46 packyrsMore than 46 packyrs (-3.1)(-3.1)



Physical Activity:Physical Activity:

Percent differencePercent difference

– PASEPASE (0.5)(0.5)

– Total number of city streets per day Total number of city streets per day

for normal routine and exercises: for normal routine and exercises:

20 or above (25% of subjects)20 or above (25% of subjects) (1.8)(1.8)



Dietary Factors:Dietary Factors:

Percent differencePercent difference

– Calcium (mg) per day (50mg)Calcium (mg) per day (50mg) (0.2)(0.2)

– Protein (g) per day (10g)Protein (g) per day (10g) (0.2)(0.2)

Depression:Depression:

– GDS score (3)GDS score (3) (-1.4)(-1.4)



Multivariate model of risk factors Multivariate model of risk factors

for total hip BMD (MrOs)for total hip BMD (MrOs)

% Diff (95% CI)

Age (per 5 yr) -0.7 (-1.3, -0.1)

Body weight (per 5 kg) 3.6 (3.3, 3.9)

Grip strength (per 5 kg) 0.8 (0.3, 1.3)



4.1 (0.2, 7.9)Thyroid disease

4.0 (2.4, 5.6)Diabetes mellitus

-8.3 (-14.3, -2.3)

-2.8 (-4.6, -1.0)

-2.5 (-4.3, -0.8)

% Diff (95% CI)

Inhaled steroid

GI surgery

COPD



% Diff (95% CI)

Current smoker -1.5 (-3.2, 0.2)

Thiazide diuretic 2.7 (-0.3, 5.6)

Calcium intake (per 50 mg) 0.1 (-0.01, 0.2)

risk factors for hip fracture in men l low bmd and rf for low bmd l previous fractures l low body...

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