12281 - Risk factors for hip fracture in men q Low BMD and...

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Unformatted text preview: Risk factors for hip fracture in men q Low BMD and RF for low BMD fractures q Previous q Low body mass q Taller q Frequent falls and RF for falls Risk factors for osteoporosis in men Causes of secondary osteoporosis q q q q q q q Hypogonadism Steroid therapy Immobilization Alcoholism RA Cancer Thyrotoxicosis Risk factors for osteoporosis in men q q q q q q q Aging Thinness Low calcium intake Very low protein intake Inactivity Decreased androgen Decreased estrogen Design of cohort studies Exposure Outcomes (death / disease / others) Why do we need cohort studies? q Cross-sectional studies can only describe associations q Cohort studies can - Defined temporal relationship - Study multiple outcomes - Can be converted to RCCT Determinants of validity of cohort studies q Sampling q Sample q Validity method size of measurements of follow up q Completeness What is known about determinants of BMD and fractures? q q q q q Study of Osteoporotic fractures (SOF) Dubbo study (Australia) Rancho Bernando study NHANES I, II, III STORM Correlates of femoral neck BMD (Orwoll) Factors Age (5 years) Weights (10 kg) Fracture history Hypertension COAD Gastrectomy Current alcohol Current smoking % diff -2.6 5.4 -7.4 4.2 -6.3 -11.6 4.9 -3.9 Sampling Method q q Volunteer samples (independent walking) Stratified by age group 65 - 69 70 - 74 75 33% 35% 31% q 2000 men and 2000 women Questionnaire for Mr & Ms Os q General including falls (Stanford Health Assessment) q q Cigarette smoking Alcohol consumption Questionnaire for Mr & Ms Os q q q q q 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 q q q q q 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 q Fractures q BMD q QCT (History and X-Ray) Characteristic of MrOs Subjects (Mean SD) Mean (SD) Age Height (cm) Weight (kg) BMI (kg/m2) PASE score 72.4 (5) 163.1 (5.7) 62.4 (9.4) 23.4 (3.1) 97.3 (50.3) PASE Scoring Sitting Job + no exercise Sitting Job + Aerobic Exercise 3-4 times per week Job that requires standing and walking + No exercise Job that requires standing and walking + Aerobic Exercise 3-4 times per week 33 96 184 221 Characteristic of MrOs Subjects (Mean SD) Diet Total calories intake (kcal) Protein intake (g) Calcium intake (mg) Mean (SD) 2161 (747) 90 (41) 649 (344) Characteristic of MrOs Subjects Percentage Current cigarette smoking Alcoholism - drink 4 /day in p12m - ever drink 5/day Had 1 or more fracture Diabetes mellitus Thyroid disease COPD 11.9% 0.4% 8.0% 13.7% 14.7% 2.1% 11.6% Determinants of BMD in Chinese men (Ageadjusted) What are the physical characteristics that are associated with BMD in Chinese men? Determinants of BMD in Chinese men (Ageadjusted) Percent difference Weight (5 kg): +3.6 Determinants of BMD in Chinese men (Ageadjusted) What medical factors are associated with BMD in Chinese men? Determinants of BMD in Chinese men (Ageadjusted) Medical Diseases associated with lower BMD: Chronic obstructive lung disease (5.8) Gastrointestinal surgery Fracture after age 50 years Percent difference (4.7) (5.7) Determinants of BMD in Chinese men (Ageadjusted) Medical Diseases associated with higher BMD: Hypertension Diabetes Hyperthyroidism (5.1) Percent difference (4.0) (6.9) Determinants of BMD in Chinese men (Ageadjusted) Medications associated with lower BMD: Percent difference Inhaled corticosteroids (0.9%) (12.9) Medications associated with hiher BMD: Thiazide diuretics Oral corticosteroids (0.6%) (4.4) (4.7) Determinants of BMD in Chinese men (Ageadjusted) What about lifestyle factors? Determinants of BMD in Chinese men (Ageadjusted) Cigarette Smoking: Percent difference Percent differenc (4.6) (3.1) Current smokers More than 46 packyrs Determinants of BMD in Chinese men (Ageadjusted) Percent difference PASE (0.5) Total number of city streets per day for normal routine and exercises: 20 or above (25% of subjects) Physical Activity: (1.8) Determinants of BMD in Chinese men (Ageadjusted) Dietary Factors: Percent difference Calcium (mg) per day (50mg) Protein (g) per day (10g) (0.2) (0.2) Depression: GDS score (3) (1.4) Multivariate model of risk factors for total hip BMD (MrOs) % Diff (95% CI) Age (per 5 yr) Body weight (per 5 kg) Grip strength (per 5 kg) -0.7 (-1.3, -0.1) 3.6 (3.3, 3.9) 0.8 (0.3, 1.3) Multivariate model of risk factors for total hip BMD (MrOs) % Diff (95% CI) COPD GI surgery Inhaled steroid Diabetes mellitus Thyroid disease -2.5 (-4.3, -0.8) -2.8 (-4.6, -1.0) -8.3 (-14.3, -2.3) 4.0 (2.4, 5.6) 4.1 (0.2, 7.9) Multivariate model of risk factors for total hip BMD (MrOs) % Diff (95% CI) Current smoker Thiazide diuretic Calcium intake (per 50 mg) -1.5 (-3.2, 0.2) 2.7 (-0.3, 5.6) 0.1 (-0.01, 0.2) ...
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This note was uploaded on 02/23/2012 for the course PHARM 290 taught by Professor Staff during the Fall '10 term at Rutgers.

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