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(Hong Kong)

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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(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)

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