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The largest NIH funded study in Asia. Mr. Os. (Hong Kong). Risk 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 men. Causes of secondary osteoporosis. Hypogonadism

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risk factors for hip fracture in men
Risk 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 men
Risk factors for osteoporosis in men

Causes of secondary osteoporosis

  • Hypogonadism
  • Steroid therapy
  • Immobilization
  • Alcoholism
  • RA
  • Cancer
  • Thyrotoxicosis
risk factors for osteoporosis in men7
Risk factors for osteoporosis in men
  • Aging
  • Thinness
  • Low calcium intake
  • Very low protein intake
  • Inactivity
  • Decreased androgen
  • Decreased estrogen
slide8

Mr OS (Hong Kong)

Mr OS (US)

Mr OS (Sweden)

design of cohort studies
Design 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 cohort studies
Determinants of validity of cohort studies
  • Sampling method
  • Sample size
  • Validity of measurements
  • Completeness of follow up
what is known about determinants of bmd and fractures
What is known about determinants of BMD and fractures?
  • Study of Osteoporotic fractures (SOF)
  • Dubbo study (Australia)
  • Rancho Bernando study
  • NHANES I, II, III
  • STORM
sampling method
Sampling 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 os
Questionnaire for Mr & Ms Os
  • General including falls (Stanford Health Assessment)
  • Cigarette smoking
  • Alcohol consumption
questionnaire for mr ms os16
Questionnaire 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 mr ms os
Physical examination for Mr & Ms Os
  • Height and Weight
  • BMD by DEXA (Hologic QDR 4500W)
  • Ankle / arm BP index
  • Visual function : acuity, depth
  • Neuromuscular : grip strength, walk speed, chair stand
outcome measures
Outcome measures
  • Fractures (History and X-Ray)
  • BMD
  • QCT
determinants of bmd in chinese men age adjusted
Determinants of BMD in Chinese men (Age-adjusted)
  • What are the physical characteristics that are associated with BMD in Chinese men?
determinants of bmd in chinese men age adjusted24
Determinants of BMD in Chinese men (Age-adjusted)

Percent difference

  • Weight (5 kg): +3.6
determinants of bmd in chinese men age adjusted25
Determinants of BMD in Chinese men (Age-adjusted)
  • What medical factors are associated with BMD in Chinese men?
determinants of bmd in chinese men age adjusted26
Determinants of BMD in Chinese men (Age-adjusted)
  • Medical Diseases associated with lower BMD:

Percent difference

    • Chronic obstructive lung disease (-5.8)
    • Gastrointestinal surgery (-4.7)
    • Fracture after age 50 years (-5.7)
determinants of bmd in chinese men age adjusted27
Determinants of BMD in Chinese men (Age-adjusted)
  • Medical Diseases associated with higher BMD:

Percent difference

    • Hypertension (4.0)
    • Diabetes (6.9)
    • Hyperthyroidism (5.1)
determinants of bmd in chinese men age adjusted28
Determinants of BMD in Chinese men (Age-adjusted)
  • Medications associated with lower BMD:

Percent difference

Inhaled corticosteroids (0.9%) (-12.9)

Oral corticosteroids (0.6%) (-4.4)

Medications associated with hiher BMD:

    • Thiazide diuretics (4.7)
determinants of bmd in chinese men age adjusted30
Determinants of BMD in Chinese men (Age-adjusted)
  • Cigarette Smoking:

Percent difference

Current smokers(-4.6)

More than 46 packyrs(-3.1)

determinants of bmd in chinese men age adjusted31
Determinants of BMD in Chinese men (Age-adjusted)
  • Physical Activity:

Percent difference

    • PASE (0.5)
    • Total number of city streets per day for normal routine and exercises:

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

determinants of bmd in chinese men age adjusted32
Determinants of BMD in Chinese men (Age-adjusted)
  • Dietary Factors:

Percent difference

    • Calcium (mg) per day (50mg) (0.2)
    • Protein (g) per day (10g) (0.2)
  • Depression:
    • GDS score (3) (-1.4)
multivariate model of risk factors for total hip bmd mros34
Multivariate model of risk factors for total hip BMD (MrOs)

% Diff (95% CI)

COPD

-2.5 (-4.3, -0.8)

GI surgery

-2.8 (-4.6, -1.0)

Inhaled steroid

-8.3 (-14.3, -2.3)

Diabetes mellitus

4.0 (2.4, 5.6)

Thyroid disease

4.1 (0.2, 7.9)