MrOs and MsOs (Hong Kong)

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Mr
Os
(Hong Kong)
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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

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Risk factors for osteoporosis in men
Causes of secondary osteoporosis

• Hypogonadism
• Steroid therapy
• Immobilization
• Alcoholism
• RA
• Cancer
• Thyrotoxicosis

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Risk factors for osteoporosis in men

• Aging
• Thinness
• Low calcium intake
• Very low protein intake
• Inactivity
• Decreased androgen
• Decreased estrogen

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Mr OS (Hong Kong)
Mr OS (US)
Mr OS (Sweden)
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Design of cohort studies

• Outcomes
• (death / disease / others)

Exposure
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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

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Determinants of validity of cohort studies

• Sampling method
• Sample size
• Validity of measurements
• Completeness of follow up

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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

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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
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Sampling Method

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

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Questionnaire for Mr Ms Os

• General including falls
  (Stanford Health Assessment)
• Cigarette smoking
• Alcohol consumption

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Questionnaire for Mr Ms Os

• Dietary intake (Block food frequency)
• Medication use
• Physical activity (PASE)
• Mental status by MMSE
• Depression by Geriatric Depression Scale

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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

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Outcome measures

• Fractures (History and X-Ray)
• BMD
• QCT

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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)
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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
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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)
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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
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Determinants of BMD in Chinese men (Age-adjusted)

• What are the physical characteristics that are
  associated with BMD in Chinese men?

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Determinants of BMD in Chinese men (Age-adjusted)

• Percent difference
• Weight (5 kg) 3.6

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Determinants of BMD in Chinese men (Age-adjusted)

• What medical factors are associated with BMD in
  Chinese men?

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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)

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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)

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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)

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Determinants of BMD in Chinese men (Age-adjusted)

• What about lifestyle factors?

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Determinants of BMD in Chinese men (Age-adjusted)

• Cigarette Smoking
• Percent
  difference
• Current smokers (-4.6)
• More than 46 packyrs (-3.1)

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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)

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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)

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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)
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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
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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)
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