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MrOs and MsOs (Hong Kong)

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Risk factors for osteoporosis in men. Hypogonadism. Steroid therapy. Immobilization. Alcoholism ... secondary osteoporosis. Risk factors for osteoporosis in ... – PowerPoint PPT presentation

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Title: MrOs and MsOs (Hong Kong)


1
Mr
Os
(Hong Kong)
2
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3
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4
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5
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

6
Risk factors for osteoporosis in men
Causes of secondary osteoporosis
  • Hypogonadism
  • Steroid therapy
  • Immobilization
  • Alcoholism
  • RA
  • Cancer
  • Thyrotoxicosis

7
Risk factors for osteoporosis in men
  • Aging
  • Thinness
  • Low calcium intake
  • Very low protein intake
  • Inactivity
  • Decreased androgen
  • Decreased estrogen

8
Mr OS (Hong Kong)
Mr OS (US)
Mr OS (Sweden)
9
Design of cohort studies
  • Outcomes
  • (death / disease / others)

Exposure
10
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

11
Determinants of validity of cohort studies
  • Sampling method
  • Sample size
  • Validity of measurements
  • Completeness of follow up

12
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

13
Correlates of femoral neck BMD (Orwoll)
Factors diff
Age (5 years) -2.6
Weights (10 kg) 5.4
Fracture history -7.4
Hypertension 4.2
COAD -6.3
Gastrectomy -11.6
Current alcohol 4.9
Current smoking -3.9
14
Sampling Method
  • Volunteer samples (independent walking)
  • Stratified by age group
  • 65 - 69 33
  • 70 - 74 35
  • 75 31
  • 2000 men and 2000 women

15
Questionnaire for Mr Ms Os
  • General including falls
    (Stanford Health Assessment)
  • Cigarette smoking
  • Alcohol consumption

16
Questionnaire for Mr Ms Os
  • Dietary intake (Block food frequency)
  • Medication use
  • Physical activity (PASE)
  • Mental status by MMSE
  • Depression by Geriatric Depression Scale

17
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

18
Outcome measures
  • Fractures (History and X-Ray)
  • BMD
  • QCT

19
Characteristic of MrOs Subjects (Mean?SD)
Mean (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)
20
PASE Scoring
Sitting Job no exercise 33
Sitting Job Aerobic Exercise 3-4 times per week 96
Job that requires standing and walking No exercise 184
Job that requires standing and walking Aerobic Exercise 3-4 times per week 221
21
Characteristic of MrOs Subjects (Mean?SD)
Diet Mean (SD) Mean (SD)
Total calories intake (kcal) 2161 (747)
Protein intake (g) 90 (41)
Calcium intake (mg) 649 (344)
22
Characteristic of MrOs Subjects
Percentage 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
23
Determinants of BMD in Chinese men (Age-adjusted)
  • What are the physical characteristics that are
    associated with BMD in Chinese men?

24
Determinants of BMD in Chinese men (Age-adjusted)
  • Percent difference
  • Weight (5 kg) 3.6

25
Determinants of BMD in Chinese men (Age-adjusted)
  • What medical factors are associated with BMD in
    Chinese men?

26
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)

27
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)

28
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)

29
Determinants of BMD in Chinese men (Age-adjusted)
  • What about lifestyle factors?

30
Determinants of BMD in Chinese men (Age-adjusted)
  • Cigarette Smoking
  • Percent
    difference
  • Current smokers (-4.6)
  • More than 46 packyrs (-3.1)

31
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)

32
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)

33
Multivariate model of risk factors for total hip
BMD (MrOs)
Diff (95 CI) 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)
34
Multivariate model of risk factors for total hip
BMD (MrOs)
Diff (95 CI)
-2.5 (-4.3, -0.8)
COPD
-2.8 (-4.6, -1.0)
GI surgery
Inhaled steroid
-8.3 (-14.3, -2.3)
4.0 (2.4, 5.6)
Diabetes mellitus
4.1 (0.2, 7.9)
Thyroid disease
35
Multivariate model of risk factors for total hip
BMD (MrOs)
Diff (95 CI) 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)
36
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