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(Hong Kong)

(Hong Kong)

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(Hong Kong)

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  1. The largest NIH funded study in Asia Mr Os (Hong Kong)

  2. 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

  3. Risk factors for osteoporosis in men Causes of secondary osteoporosis • Hypogonadism • Steroid therapy • Immobilization • Alcoholism • RA • Cancer • Thyrotoxicosis

  4. Risk factors for osteoporosis in men • Aging • Thinness • Low calcium intake • Very low protein intake • Inactivity • Decreased androgen • Decreased estrogen

  5. Mr OS (Hong Kong) Mr OS (US) Mr OS (Sweden)

  6. Design of cohort studies Outcomes (death / disease / others) Exposure

  7. 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

  8. Determinants of validity of cohort studies • Sampling method • Sample size • Validity of measurements • Completeness of follow up

  9. 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

  10. Correlates of femoral neck BMD (Orwoll)

  11. Sampling Method • Volunteer samples (independent walking) • Stratified by age group 65 - 69 33% 70 - 74 35% ≥ 75 31% • 2000 men and 2000 women

  12. Questionnaire for Mr & Ms Os • General including falls (Stanford Health Assessment) • Cigarette smoking • Alcohol consumption

  13. Questionnaire for Mr & Ms Os • Dietary intake (Block food frequency) • Medication use • Physical activity (PASE) • Mental status by MMSE • Depression by Geriatric Depression Scale

  14. 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

  15. Outcome measures • Fractures (History and X-Ray) • BMD • QCT

  16. Characteristic of MrOs Subjects (MeanSD)

  17. PASE Scoring

  18. Characteristic of MrOs Subjects (MeanSD)

  19. Characteristic of MrOs Subjects

  20. Determinants of BMD in Chinese men (Age-adjusted) • What are the physical characteristics that are associated with BMD in Chinese men?

  21. Determinants of BMD in Chinese men (Age-adjusted) Percent difference • Weight (5 kg): +3.6

  22. Determinants of BMD in Chinese men (Age-adjusted) • What medical factors are associated with BMD in Chinese men?

  23. 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)

  24. 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)

  25. 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)

  26. Determinants of BMD in Chinese men (Age-adjusted) • What about lifestyle factors?

  27. Determinants of BMD in Chinese men (Age-adjusted) • Cigarette Smoking: Percent difference Current smokers(-4.6) More than 46 packyrs(-3.1)

  28. 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)

  29. 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)

  30. Multivariate model of risk factors for total hip BMD (MrOs)

  31. 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)

  32. Multivariate model of risk factors for total hip BMD (MrOs)