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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
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
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)
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
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
What medical factors are What medical factors are
associated with BMD in associated with BMD in
Chinese men?Chinese men?
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
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)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
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)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
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)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
What about lifestyle factors?What about lifestyle factors?
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
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)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
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)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
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)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
Determinants of BMD in Determinants of BMD in Chinese men (Age-adjusted)Chinese men (Age-adjusted)
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)
Multivariate model of risk factors Multivariate model of risk factors
for total hip BMD (MrOs)for total hip BMD (MrOs)
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
Multivariate model of risk factors Multivariate model of risk factors
for total hip BMD (MrOs)for total hip BMD (MrOs)
% 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)