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      Race/ethnic differences in bone mineral densities in older men

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          Abstract

          Summary

          BMD was compared across race/ethnic groups. There were substantial race/ethnic differences in BMD even within African or Asian origin. Additional adjustment for body size greatly attenuated or reversed the differences between US Caucasian men vs Asian men. It illustrates the role of body size on the difference between these groups.

          Introduction

          There is insufficient epidemiologic information about men’s bone mineral density (BMD) levels across race/ethnic groups and geographic locations.

          Methods

          In a cross-sectional design, we compared BMD in older men across seven race/ethnic groups in four countries. Femoral neck, total hip, and lumbar spine BMD were measured in men (age 65 to 78 years) from the Osteoporotic Fractures in Men (MrOS) Study (4,074 Caucasian, 208 African-American, 157 Asian, and 116 Hispanic men in USA), Tobago Bone Health Study (422 Afro-Caribbean men), MrOS Hong Kong Study (1,747 Hong Kong Chinese men), and the Namwon Study (1,079 South Korean men). BMD was corrected according to the cross-site calibration results for all scanners.

          Results

          When compared with US Caucasian men, Afro-Caribbean and African-American men had, respectively, 8–20% and 6–11% higher age-adjusted mean BMD at all three bone sites. Hip BMD was similar in US Caucasian and Hispanic men, US Asian, Hong Kong Chinese, and Korean men had 3–14% lower BMD at all bone sites except femoral neck in Korean men. Additional adjustment for weight and height greatly attenuated or reversed the differences between US Caucasian men vs Asian men including US Asian, Hong Kong Chinese, and South Korean men. Among Asian groups, Korean men had higher femoral neck BMD and lower total hip BMD.

          Conclusion

          These findings show substantial race/ethnic differences in BMD even within African or Asian origin and illustrate the important role of body size on the difference between Asian men and others.

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          Most cited references34

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          The Physical Activity Scale for the Elderly (PASE): development and evaluation.

          A Physical Activity Scale for the Elderly (PASE) was evaluated in a sample of community-dwelling, older adults. Respondents were randomly assigned to complete the PASE by mail or telephone before or after a home visit assessment. Item weights for the PASE were derived by regressing a physical activity principal component score on responses to the PASE. The component score was based on 3-day motion sensor counts, a 3-day physical activity dairy and a global activity self-assessment. Test-retest reliability, assessed over a 3-7 week interval, was 0.75 (95% CI = 0.69-0.80). Reliability for mail administration (r = 0.84) was higher than for telephone administration (r = 0.68). Construct validity was established by correlating PASE scores with health status and physiologic measures. As hypothesized, PASE scores were positively associated with grip strength (r = 0.37), static balance (r = +0.33), leg strength (r = 0.25) and negatively correlated with resting heart rate (r = -0.13), age (r = -0.34) and perceived health status (r = -0.34); and overall Sickness Impact Profile score (r = -0.42). The PASE is a brief, easily scored, reliable and valid instrument for the assessment of physical activity in epidemiologic studies of older people.
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            Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study--a large observational study of the determinants of fracture in older men.

            Very little information is available to direct the prevention or management of osteoporosis in men. The Osteoporotic Fractures in Men (MrOS) Study is a prospective cohort study designed to examine the extent to which fracture risk is related to bone mass, bone geometry, lifestyle, anthropometric and neuromuscular measures, and fall propensity, as well as to determine how fractures affect quality of life in men. The study is also designed to understand how osteoporosis is related to prostate disease. At baseline, participants completed questionnaires regarding medical history, medications, physical activity, diet, alcohol intake, and cigarette smoking. Objective measures of anthropometric, neuromuscular, vision, strength, and cognitive variables were obtained. Skeletal assessments included DEXA, calcaneal ultrasound, and vertebral radiographs. Vertebral and proximal femoral QCT was performed on a subset (65%). Serum, urine, and DNA specimens were collected. After the baseline assessments, a questionnaire is mailed to participants every 4 months to ascertain incident falls, fractures, prostate cancer, and deaths. After an average of 4.5 years, participants are scheduled to return for a second comprehensive visit. Men were eligible if > or =65 years. 5995 men enrolled with a mean (+/-SD) age of 73.7 (+/-5.9) years, 11% of which were minorities. Most rated their health as good/excellent. Few were current smokers, although 59% had smoked previously, and 35% reported no alcohol intake, while 47% consumed at least 2 drinks per week. The mean (range) body mass index was 26.9 kg/m2 (17-56). A non-traumatic fracture after age 50 was reported by 17% of the cohort. The MrOS cohort should provide valuable information concerning the determinants of fracture in men and should help set the stage for the development of effective methods to identify those at risk.
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              Overview of recruitment for the osteoporotic fractures in men study (MrOS).

              Large, long term research studies present recruitment challenges that can be met with collaborative approaches to identify and enroll participants. The Osteoporotic Fractures in Men Study (MrOS), a multi-center observational study designed to determine risk factors for osteoporosis, fractures and prostate cancer in older men, recruited 5995 participants over a 25-month period. Enrolling a cohort that represented the race and age distribution of each community, and developing interest in an older male cohort about a condition commonly thought of as a "women's disease," were major recruitment challenges. During the start-up phase, recruitment challenges and strategies were analyzed and collective approaches were developed to address ways to motivate the target population. Key methods included mailings using community and provider contact lists; regional and senior newspaper advertisements; and presentations targeted to seniors. Sites used a centrally developed recruitment brochure. Response to mass mailings at some sites surpassed 10-15% and appointment show rates averaged above 85%. The final number enrolled in MrOS was 5% more than the original recruitment goal of 5700. Minority recruitment was enhanced through the use of the Health Care Financing Administration and other databases that allowed for targeted recruitment. Overall, minority enrollment was approximately 10.56% of the cohort (244 African American, 191 Asian). Men age>80 were enthusiastic and represent about 18% of enrollees. Through a coordinated approach of developing and refining recruitment strategies and materials, sites were able to adapt their original strategies and complete recruitment ahead of schedule.
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                Author and article information

                Contributors
                +1-412-6240218 , jcauley@edc.pitt.edu
                Journal
                Osteoporos Int
                Osteoporosis International
                Springer-Verlag (London )
                0937-941X
                1433-2965
                4 March 2010
                4 March 2010
                December 2010
                : 21
                : 12
                : 2115-2123
                Affiliations
                [1 ]Department of Preventive Medicine, Research Institute for Medical Sciences, Chungnam National University College of Medicine, Daejeon, South Korea
                [2 ]Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261 USA
                [3 ]Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
                [4 ]Jockey Club Centre for Osteoporosis Care and Control, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
                [5 ]Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA USA
                [6 ]Bone and Mineral Unit, Oregon Health and Sciences University, Portland, OR USA
                Article
                1188
                10.1007/s00198-010-1188-3
                2974925
                20204598
                16897e73-269a-458a-ad9f-25705501c5c3
                © The Author(s) 2010
                History
                : 1 December 2009
                : 15 January 2010
                Categories
                Original Article
                Custom metadata
                © International Osteoporosis Foundation and National Osteoporosis Foundation 2010

                Orthopedics
                men,bone mineral density,body size,epidemiology,bone densitometry,race/ethnicity
                Orthopedics
                men, bone mineral density, body size, epidemiology, bone densitometry, race/ethnicity

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