Bone mineral density predicts osteoporotic fractures in elderly men: the MINOS study

Osteoporosis in men is becoming a public health problem in developed countries. Fracture incidence increases with age, and the number of fractures increases because of the ageing of the population. We assessed the predictive value of bone mineral density (BMD) for osteoporotic fractures evaluated prospectively in a large cohort of elderly men and assessed the sensitivity of the T-score =–2 to detect men who will sustain a fracture. Fracture incidence was evaluated for 90 months in 759 men from the MINOS cohort aged 50 and over at baseline. In 74 men, 77 incident vertebral and peripheral fractures occurred. BMD was measured at baseline at the lumbar spine, hip, whole body and distal forearm. The incidence of osteoporotic fractures increased with age and with decreasing body weight. In men with low BMD (T-score <–2), fracture incidence varied from 2.26 to 3.07 fractures per 100 person-years and was 2.1 to 3.6 times higher than in men with normal BMD. After adjustment for age, body weight and height, baseline BMD was 3.7 to 7.9% ( P <0.05–0.0001) lower at all the sites of measurement in men who sustained a fracture. After adjustment for age, weight and prevalent fractures, BMD was predictive of osteoporotic fractures at all the sites. Odds ratios varied from 1.28 to 1.89 per 1 SD decrease in BMD ( P <0.05–0.0001). The predictive accuracy of BMD for fractures (area under the curve of the receiving operator characteristics adjusted for age, weight and prevalent fractures) varied from 0.643 to 0.712 according to the skeletal site and was higher for the whole body than for other sites. Thus, BMD itself has a limited value for determining men at an increased risk for fracture. The percentage of incident fractures occurring in men with low BMD (T-score <–2) ranged from 13.7% at the trochanter to 44.6% at the ultradistal radius. Conversely, 27 to 45% of incident fractures occurred in men with mildly decreased BMD (T-score between –1 and –2). In conclusion, BMD predicts osteoporotic fractures in men independently of age, body weight and prevalent fractures. However, the sensitivity of BMD to detect men at high risk of fracture is low. More studies on the predictors of fractures in men, such as bone architecture, morphology, biochemical markers of bone turnover and hormonal levels, are necessary.     

Hormonal and biochemical parameters and osteoporotic fractures in elderly men.

Low testosterone has been associated with hip fracture in men in some studies. However, data on other hormonal parameters and fracture outcome in men is minimal. This study examined the association between free testosterone (free T) estradiol (E2), sex hormone-binding globulin (SHBG), 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), insulin-like growth factor I (IGF-I), and fracture in 437 elderly community-dwelling men. Age, height, weight, quadriceps strength, femoral neck bone mineral density (FN BMD), and fracture data (1989-1997) also were obtained. Fractures were classified as major (hip, pelvis, proximal tibia, multiple rib, vertebral, and proximal humerus) or minor (remaining distal upper and lower limb fractures). Fifty-four subjects had a fracture (24 major and 30 minor). There was no association between minor fractures and any hormonal parameter. Risk of major fracture was increased 2-fold for each SD increase in age, decrease in weight and height, and increase in SHBG, and risk of major fracture was increased 3-fold for each SD decrease in quadriceps strength, FN BMD, and 25(OH)D (univariate logistic regression). Independent predictors of major fracture were FN BMD, 2.7 (1.5-4.7; odds ratio [OR]) and 95% confidence interval [CI]); 25(OH)D, 2.8 (1.5-5.3); and SHBG, 1.7 (1.2-2.4). An abnormal value for three factors resulted in a 30-fold increase in risk but only affected 2% of the population. It is not immediately apparent how 25(OH)D and SHBG, largely independently of BMD, may contribute to fracture risk. They may be markers for biological age or health status not measured by methods that are more traditional and as such may be useful in identifying those at high risk of fracture.     

Bone mineral density in elderly men and women: results from the Framingham osteoporosis study.

Our study investigated bone mineral density of the proximal femur and ultradistal and proximal radius in a population of elderly men and women. The Framingham study started in 1948, following a population-based sample for evaluation of cardiovascular risk factors and events. During the 20th biennial Framingham examination (1988-89) we conducted the Framingham osteoporosis study, measuring bone mineral density in the proximal femur and distal and proximal radius for 1154 study participants. Ages ranged from 68 to 98 years, with a mean age of 76 years. Bone mineral density was measured using Lunar SP2 and DP3 densitometers. This cross-sectional study evaluates mean bone mineral density measurements at each site by 5 year age intervals for men and women, testing for trends in bone density with age. Analyses were repeated adjusting for weight and height. Among the 446 and 708 women, bone mineral density of the femur and bone mineral content of the proximal radius were inversely and significantly related to age in both sexes and were considerably higher in men than women at all sites. The linear decline with age group in our cross-sectional study remained after multivariate adjustment for height and weight. The ultradistal radius showed no significant correlation with age for either sex. There were significant correlations between the bone measurements made at different sites for both men and women (range in r = 0.27-0.89). Cross-sectional curves of bone mineral density with age showed no significant differences in slope between males and females.(ABSTRACT TRUNCATED AT 250 WORDS)     

An evaluation of osteoporosis screening tools for the osteoporotic fractures in men (MrOS) study

SUMMARY: No large-scale evaluations of osteoporosis screening tools have been done in men. OST and MOST were examined among 4658 US Caucasian and 1914 Hong Kong Chinese men. Both tools have high negative predictive values, accurately screening out men with low risk, and saving a third of DXA tests. INTRODUCTION: Prior investigations have studied the performance of osteoporosis screening tools in women, but no large-scale evaluations have been done in men. METHODS: This study examines the performance of the Osteoporosis Self-assessment Tool (OST), the Male Osteoporosis Screening Tool (MOST), quantitative ultrasound index (QUI), and body weight as screening tools. Osteoporosis was defined by a dual-energy X-ray absorptiometry (DXA) measured bone mineral density (BMD) T-score < or =-2.5. Four thousand six hundred and fifty-eight US Caucasian and 1914 Hong Kong Chinese men, aged > or =65 years and community-dwelling, were included in the analysis. Receiver operating characteristic (ROC) analysis was used to compare the area under the ROC curve (AUC) between different screening tools. RESULTS: MOST had a significantly larger AUC (> or =0.8) than OST, QUI, and body weight in detecting osteoporosis. Using the second tertile as cutoff, OST and MOST yielded sensitivities of around 90% and negative predictive values (NPVs) of >97%, accurately screening out Caucasian and Chinese men with low risk of osteoporosis. CONCLUSIONS: OST and MOST can effectively rule out osteoporosis for both Caucasian and Chinese men, and compared to referring men 65 years and older for BMD DXA testing, they save a third of DXA resources.     

Symptomatic fracture incidence in elderly men and women: The Dubbo osteoporosis epidemiology study (DOES)

This longitudinal population-based study documents the incidence of all symptomatic fractures from 1989 to 1992 in an elderly, predominantly Caucasian population of males and females (60 years as at 1 January 1989) living in the geographically isolated region of the city of Dubbo, NSW, Australia. Fractures were ascertained by reviewing reports from all radiology services in the region. There were 306 fractures in 271 patients during the study period representing 11 401 person-years of observation. In the 60–80 year age group only 10% of fractures involved the hip, while in the over-80 age group this proportion rose to 41%. Incidence of distal forearm, hip and total fractures increased exponentially in both sexes with increasing age. Rib fractures were relatively common, with incidence rates for rib fractures similar to those for humeral fractures. Overall fracture incidence was 2685 per 100000 person-years (males 1940 per 100000 and females 3250 per 100000). Residual lifetime fracture risk in a person aged 60 years with average life expectancy was 29% for males and 56% for females. Symptomatic fracture rates with the improved methodology in this study were higher than previously reported in both elderly males and females, with a marked preponderance of non-hip fractures in the 60–80 year age group. These symptomatic fractures have previously been underestimated, if not largely ignored, in public health approaches including cost—benefit analyses of osteoporosis prevention and treatment. Total fracture risk during later life is substantial, with fractures other than hip fractures constituting the majority of morbid fracture events, especially in the 60–80 year age group.     

Association of quantitative heel ultrasound with history of osteoporotic fractures in elderly men: The ESOPO study

In order to evaluate the usefulness of calcaneal quantitative ultrasound (QUS) in the assessment of male osteoporosis, a cross-sectional, population-based study was performed. A cohort of 4,832 men, randomly selected, community-dwelling, aged 60–80 years and representative of the general older male Italian population was recruited. QUS measurements were assessed in 83 centers distributed all over Italy and equipped with an Achilles device (GE-Lunar, Madison, Wisconsin, USA). All participants were administered a questionnaire covering lifestyle variables and medical history. Low-energy fractures that had occurred since age 50 were recorded. Overall, 43 subjects reported a previous hip fracture and 455 subjects reported other non-spinal fractures. Univariate analysis showed that fractured subjects were older, with a lower level of outdoor physical activity and a more frequent history of prolonged bedridden periods in comparison with unfractured subjects. Men reporting non-spinal fractures showed a higher prevalence of smoking, while no difference was found among groups in anthropometric measures and calcium intake. QUS measurements showed that all QUS parameters were significantly lower in both fracture groups ( p <0.001). Multiple logistic regression analysis demonstrated that each SD reduction in QUS measures was associated with an approximate doubling of the risk for hip fracture, independent of age and other clinical variables (broadband ultrasound attenuation [BUA]: odds ratio [OR]=2.24; 95% confidence interval [CI] 1.61–3.08; stiffness index: OR=2.19; CI 1.56–3.11; speed of sound [SOS]: OR=1.71; CI 1.18–3.24) and with an increase of the risk of other non-spinal fractures (BUA: 1.38; CI 1.22–1.59; stiffness index: OR=1.27; CI 1.17–1.38; SOS: OR=1.14; CI 0.96–1.40). It can be concluded that calcaneal QUS measurement is associated with the risk for hip fracture and any non-spinal fractures among a community-dwelling cohort of elderly men. The strength of the association between QUS measurement and fracture is similar to that observed in elderly women.     

Direct clinical and welfare costs of osteoporotic fractures in elderly men and women

Osteoporosis is an increasing health care problem in all aging populations, but overall direct costs associated with the total fracture burden of osteoporosis remain uncertain. We have examined direct costs associated with 151 osteoporotic fractures occurring between 1989 and 1992 in a large cohort of elderly men and women followed prospectively as part of the Dubbo Osteoporosis Epidemiology Study. The median cost of hospital treated fractures was $A10 511 per fracture and for fractures treated on an outpatient basis $A455 in 1992 Australian dollars. Femoral neck fractures were the most expensive fractures ($15984 median cost). There was no significant difference in costs between men and women for either hospital- or outpatient-treated fractures. Rehabilitation hospital costs comprised the largest proportion of costs (49%) for hospital-treated fractures. Community services comprised the major cost (40%) of outpatient-treated fractures. Univariate predictors of costs were quadriceps strength and bone density, although multivariate analysis showed quadriceps strength to be the best overall predictor of costs. The predicted annual treatment costs in Australia for atraumatic fractures occurring in subjects 60 years was $A779 million or approximately $A44 million per million of population per annum. Estimated total osteoporotic fracture-related costs for the Australian population were much higher than previously reported. The majority of direct costs (95%) were incurred by hospitalized patients and related to hospital and rehabilitation costs. Extrapolation of these data suggests that the direct costs for hip fracture alone will increase approximately twofold in most Western countries by 2025. Improving the cost-effectiveness of treating osteoporotic fractures should involve reduced hospitalization and/or greater efficiency in community rehabilitation services. The costs of various approaches to osteoporosis prevention must be placed into the context of these direct costs and prevention should target men as well as women.     

Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study.

In this prospective 12-year study in men and women 60 years of age and older, there was a 4-6% per year reduction in the incidence rate of overall osteoporotic fractures, but the study was unable to exclude any change in the hip fracture incidence rate. Approximately one-half of hip fractures occurred before 80 years in men and two-thirds before 85 years in women. The age distribution of hip fractures underlines the need for earlier intervention in osteoporosis. INTRODUCTION: Although hip fracture is the major osteoporotic fracture in terms of health outcomes, quality of life, and costs, there is a paucity of long-term data on secular changes in men and women within a defined community. This long-term prospective population-based study over 12 years from 1989 to 2000 specifically examined the age distribution and secular changes in the incidence rates of hip and other osteoporotic fractures in men and women 60 years of age and older in a predominantly white population in Dubbo, Australia. MATERIALS AND METHODS: Hip and all other clinical fractures were ascertained by reviewing all radiography reports from the two area radiology services, ensuring complete ascertainment of all clinical osteoporotic fractures. RESULTS AND CONCLUSION: Among the 1055 symptomatic atraumatic fractures (after excluding pathological fractures), there was a significant reduction in the overall fracture incidence rate in women (4% per year; p = 0.0003) and men (6% per year; p = 0.0004) over the 12 years. There were 229 hip fractures (175 in women and 54 in men) within 39,357 person-years of observation. The overall rate +/- SE of hip fracture was 759 +/- 57 per 100,000 person-years in women and 329 +/- 45 per 100,000 person-years in men, with an exponential increase with age. With advancing age, the incidence rate of hip fractures in men approached that in women; the female:male ratio fell from 4.5 (95% CI: 1.3-15.7) to 1.5 (0.9-2.5) and 1.9 (1.2-2.8) in the 60-69, 70-79, and 80+ year age groups, respectively. In women, the absolute number of fractures and incidence rate continuously increased with age; however, in men, the absolute number of hip fractures peaked at 80-84 years of age and then decreased. Most importantly, despite the continuing increase with age, almost one-half (48%) of the hip fractures occurred before the age of 80 years in men, and 66% of hip fractures occurred before the age of 85 years in women. The overall hip fracture incidence is comparable with other white (except Sweden) and Asian groups as well as two other Australian studies. This study could not exclude a change in hip fracture incidence rate, even in those 80 years of age and over among whom the incidence of hip fractures was the highest. The incidence data highlight the fact that a large proportion of hip fractures occurs in those under 80 years of age, particularly in men. This age distribution underlines the need for earlier intervention in osteoporosis in women and particularly in men to achieve the most cost-effective outcomes.     

Bone strength measured by peripheral quantitative computed tomography and the risk of nonvertebral fractures: The osteoporotic fractures in men (MrOS) study

Many fractures occur in individuals without osteoporosis defined by areal bone mineral density (aBMD). Inclusion of other aspects of skeletal strength may be useful in identifying at‐risk subjects. We used surrogate measures of bone strength at the radius and tibia measured by peripheral quantitative computed tomography (pQCT) to evaluate their relationships with nonvertebral fracture risk. Femoral neck (FN) aBMD, measured by dual‐energy X‐ray absorptiometry (DXA), also was included. The study population consisted of 1143 white men aged 69+ years with pQCT measures at the radius and tibia from the Minneapolis and Pittsburgh centers of the Osteoporotic Fractures in Men (MrOS) study. Principal‐components analysis and Cox proportional‐hazards modeling were used to identify 21 of 58 pQCT variables with a major contribution to nonvertebral incident fractures. After a mean 2.9 years of follow‐up, 39 fractures occurred. Men without incident fractures had significantly greater bone mineral content, cross‐sectional area, and indices of bone strength than those with fractures by pQCT. Every SD decrease in the 18 of 21 pQCT parameters was significantly associated with increased fracture risk (hazard ration ranged from 1.4 to 2.2) independent of age, study site, body mass index (BMI), and FN aBMD. Using area under the receiver operation characteristics curve (AUC), the combination of FN aBMD and three radius strength parameters individually increased fracture prediction over FN aBMD alone (AUC increased from 0.73 to 0.80). Peripheral bone strength measures are associated with fracture risk and may improve our ability to identify older men at high risk of fracture. © 2011 American Society for Bone and Mineral Research.     

Bone repair in osteoporotic bone: postmenopausal and cortisone-induced osteoporosis

Although osteoporosis has been the subject of a considerable number of publications in recent years, very few studies have investigated the effects of osteopososis on the process of tissue repair. Most of the studies are based on animal data, using the ovariectomized rat model, and in most cases, fractures were obtained by femoral osteotomy. This model is imperfect in several aspects to fit with postmenopausal osteoporosis which is a complex, multifactorial disorder. Furthermore, a surgically induced fracture is not exactly the same as a fracture which occurs as a result of bone fragility. However, and despite contradictory results in some of the studies, in ovariectomized rats a delay in bone consolidation has been reported in the model, associated locally with a decrease in bone mineral density and mechanical resistance. Very few human data are available, which confirm the existence of a delay in consolidation subsequent to femoral fractures in aged patients compared to young patients.     

BMI and fracture risk in older men: The osteoporotic fractures in men study (MrOS)

Low body mass index (BMI) is a risk factor for fracture, but little is known about the association between high BMI and fracture risk. We evaluated the association between BMI and fracture in the Osteoporotic Fractures in Men Study (MrOS), a cohort of 5995 US men 65 years of age and older. Standardized measures included weight, height, and hip bone mineral density (BMD) by dual‐energy X‐ray absorptiometry (DXA); medical history; lifestyle; and physical performance. Only 6 men (0.1%) were underweight (<18.5 kg/m²); therefore, men in this category were excluded. Also, 27% of men had normal BMI (18.5 to 24.9 kg/m²), 52% were overweight (25 to 29.9 kg/m²), 18% were obese I (30 to 34.9 kg/m²), and 3% were obese II (35 to 39.9 kg/m²). Overall, nonspine fracture incidence was 16.1 per 1000 person‐years, and hip fracture incidence was 3.1 per 1000 person‐years. In age‐, race‐, and BMD‐adjusted models, compared with normal weight, the hazard ratio (HR) for nonspine fracture was 1.04 [95% confidence interval (CI) 0.87–1.25] for overweight, 1.29 (95% CI 1.00–1.67) for obese I, and 1.94 (95% CI 1.25–3.02) for obese II. Associations were weaker and not statistically significant after adjustment for mobility limitations and walking pace (HR = 1.02, 95% CI 0.84–1.23, for overweight; HR = 1.12, 95% CI 0.86–1.46, for obese I, and HR = 1.44, 95% CI 0.90–2.28, for obese II). Obesity is common among older men, and when BMD is held constant, it is associated with an increased risk of fracture. This association is at least partially explained by worse physical function in obese men. © 2011 American Society for Bone and Mineral Research.     

骨质疏松性骨折愈合过程中的骨重建因子

一般性骨折愈合过程分为血肿机化演进期、原始骨痂形成期和骨痂改造塑形期;而骨质疏松性骨折愈合过程分为纤维骨痂期、软骨骨痂期和骨性骨痂期。骨质疏松性骨折愈合的组织学观察表明,纤维骨痂期主要是成纤维细胞合成Ⅲ型胶原;软骨骨痂期主要是成软骨细胞合成、分泌Ⅱ型胶原;骨性骨痂期主要是随着软骨内成骨的出现和发展,Ⅱ型胶原消失,逐渐由抗张力性能较强的Ⅰ型胶原所取代。一般来说,实验性骨质疏松性骨折的愈合方式与一般性骨折愈合方式相似,软骨内成骨和膜内成骨共同参与了骨质疏松性骨折的修复过程,但以软骨内成骨为主。     

骨质疏松及其骨折的局部药物治疗

骨质疏松虽然是一种系统性代谢性骨骼疾病,但其最大的危害却是局部脆性骨折。目前骨质疏松的治疗仍主要依赖于系统用药,但系统用药存在周期长、费用高、治疗依从性差、全身性副作用较大等缺陷。骨质疏松骨折好发部位非常集中,多集中在胸腰段和双髋,随着现代微创介入外科的迅速发展,使得局部治疗骨质疏松成为可能。局部药物治疗可以实现局部促进骨形成或者抑制骨吸收,从而在重点部位起到预防骨折、加速骨折愈合以及增强植入物稳定性的作用,弥补了系统用药的副作用及起效慢等缺点。局部治疗可通过局部注射药物或内植物表面涂层的药物释放以发挥作用,目前有多种呈递系统能够有效搭载并缓释具有生物活性的药物。双膦酸盐、甲状旁腺激素(parathyroid hormone,PTH)、骨形成蛋白(bone morphogenetic protein,BMP)、他汀类药物等都是常见的临床前研究药物。此外,靶向核因子κB受体活化因子(receptor activator of nuclear factor kappa-B,RANK)和Wnt通路等生物靶向药也处在研究之中。总之,骨质疏松的局部治疗或能提供新的辅助治疗策略,联合应用系统用药和局部用药,取长补短,是未来治疗骨质疏松的研究及应用方向。     

广州市多社区1529名中老年人骨质疏松患病率及骨质疏松性骨折发生率分析

目的调查了解广州市社区中老年人骨量减少、骨质疏松症(osteoporosis,OP)的患病率及骨质疏松性骨折发生率,分析近年来骨质疏松患病率的增减趋势。方法采用现场问卷调查了解受试者的基本资料(包括性别、年龄、身高、体重、骨折史等),并用美国双能X线骨密度仪测量1529例40～87岁中老年人群的腰椎正位和左髋部骨密度(bone mineral density,BMD),以性别、年龄分组进行分析。结果随着年龄递增,各组髋部BMD值逐渐下降,而腰椎BMD值并未随着增龄而呈现递减的趋势,60岁以上中老人髋部BMD值显著低于腰椎BMD值(P0.05)。根据腰椎BMD值计算,中老年人OP总患病率为30.7%,其中女性为34.2%,明显高于男性的17.9%(P0.05)。低骨量(osteopenia,OPA)总患病率为41.8%,男女分别为42.4%和41.6%(P0.05)。根据髋部BMD值计算,OP总患病率更高,达到38.2%,女性为39.4%,高于男性的33.9%(P0.05)。OPA总患病率为47.4%,男性为52.7%,女性为46.0%(P0.05)。受调查的中老年男性中有骨折史的为82例,女性为357例,OP患者骨折发生率为37.8%,远高于非OP患者23.1%(P0.01),再骨折发生率OP患者为6.2%,高于非OP患者的2.64%(P0.01)。结论广州市社区中老年人骨质疏松患病率和脆性骨折发生率较高,且其发生率均较以往有明显增高的趋势,建议早筛查、早诊断、早治疗。根据髋部BMD值进行骨质疏松评估的敏感性更高,应该首选髋部作为骨密度测量的部位。     

Treatment of osteoporotic ankle fractures in the elderly: surgical strategies

The goal of displaced ankle fracture treatment is to restore congruity and stability to the ankle mortise. However, adequate fixation in patients with osteoporosis is difficult due to poorly mineralized bone. This article presents alternative fixation strategies that can helpachieve ankle stability in this patient population.     

The epidemiology of osteoporotic fractures in a Mediterranean country

A population study was carried out over a period of 3 years (1987–1989) to determine the incidence of osteoporotic fractures. Fractures diagnosed in the two acute hospitals of the Maltese Islands were collected and classified according to the fracture site, age, sex, and patient's residence. Fractures in the Maltese Islands can only be diagnosed and adequately treated in these two general hospitals. A total of 8780 fractures were examined. Fracture of the neck of the femur was the most common fracture for which patients were admitted to the hospital. There were twice (1.96) as many females as males hospitalized for this fracture, giving an annual incidence of 262/100,000 females to 134/100,000 males over the age of 45. The fracture incidence was 2–3 times less than that found in North European countries, but was similar to the fracture rates obtained in Mediterranean studies. Fracture radius was the most frequent fracture treated on an outpatients basis. In over 45-year-olds, the female predominance persisted, giving a ratio of 3.65:1. This gave an annual incidence of 452/100,000 females to 150/100,000 males. Again, the fracture indicence obtained was significantly lower than that of Northern European countries. Other long bones showed a similar female to male (F:M) ratio in the cohort over 45 years of age. The bones showing this F:M ratio were the humerus (3.9:1), fibula (1.89:1), and tibia (1.6:1). Below 45 years of age males had more fractures than females for any bone studied. The epidimiological graphs obtained were similar to those of other studies suggesting that similar factors influence the development of osteoporosis. Further studies are required to analyze these factors in detail.     

老年性骨质疏松性骨折的发生与预防

骨质疏松性骨折是一项在老年人中极为常见和严重的健康问题。随着人口的老龄化,骨量丢失在变成一个日益严重的临床问题。然而老年人骨量丢失这个情况很少被人们发觉,因而不能得到很好的治疗。除了骨矿物含量密度(骨密度)的下降,导致骨质疏松性骨折的因素常与影响姿势稳定性的神经肌肉失调有关。骨质疏松性骨折的预防围绕充足的矿物营养,包括每日钙和维生素D的供应以及抗骨吸收药物的应用,两者都可以降低骨折发生风险。预防骨折还需要预防跌倒,并减少跌倒产生的冲击力。因此,药物和非药物干预同样重要。本综述也探讨了骨折风险预测工具(FRAX)的使用,它可以通过使用患者的特定数据来预测特定时间内骨折的风险。当前,老年性骨质疏松症仍缺乏诊断和治疗,但年龄并不能成为骨质疏松性骨折干预的障碍。     

Muscle power and physical activity are associated with bone strength in older men: The osteoporotic fractures in men study

The purpose of these analyses was to explore whether physical activity score, leg power or grip strength were associated with tibia and radius estimates of bone strength, cortical density, or total bone area. Peripheral quantitative computed tomography (pQCT) was used to compare tibial and radial bone volumetric density (vBMD, mg/cm³), total (ToA, mm²) and cortical (CoA, mm²) bone area, and estimates of bone compressive strength (bone strength index, BSI) and bending strength (polar strength strain index, SSIp) in a subset (n = 1171) of men (≥ 65 years) who participated in the multi-site Osteoporotic Fractures in Men (MrOS) study. Physical activity was assessed by questionnaire (PASE), leg power by Nottingham Power Rig, and grip strength by a hand-held Dynamometer. Participants were categorized into quartiles of PASE, grip strength or leg power. The model was adjusted for age, race, clinic, weight, and limb length. In the tibia, BSI (+ 7%) and SSIp (+ 4%) were highest in the most active physically quartile compared to the least active (p < 0.05). At the 4% site of the tibia, men with the greatest leg power had both greater ToA (+ 5%, p < 0.001) and BSI (+ 5.3%, p = 0.086) compared to men with the least leg power. At the 66% site of the tibia, the men with the highest leg power, compared to the men with the lowest leg power, had greater ToA (+ 3%, p = 0.045) SSIp (+ 5%, p = 0.008). Similar results were found at both the distal and midshaft of the radius. The findings of this study suggest the importance of maintaining levels of physical activity and muscle strength in older men to prevent bone fragility.