Clinical risk factors for osteoporotic fracture: a population-based prospective cohort study in Korea.
ABSTRACT Clinical risk factors (CRFs), either alone or in combination with bone mineral density, are used to determine the fracture risk for clinical assessment and to determine intervention thresholds. Because fracture risk is strongly affected by ethnicity and population-specific differences, we sought to identify Korean-specific CRFs for fracture, in combination with quantitative ultrasound (qUS) measurements of the radius and tibia. A total of 9351 subjects (4732 men and 4619 women) aged 40 to 69 years were followed for a mean of 46.3 +/- 2.2 months. We obtained CRF information using a standardized questionnaire and measured anthropometric variables. Speed of sound at the radius (SoSR) and tibia (SoST) were measured by qUS. Fracture events were recorded using a questionnaire, and a height-loss threshold was used as an indicator of vertebral fracture. Relative risks were calculated by Cox regression analysis. A total of 195 subjects (61 men and 134 women) suffered low-trauma fractures. Older age, lower body mass index (BMI), and previous fracture history were positively associated with fracture risk in both sexes. Decreased hip circumference, lack of regular exercise, higher alcohol intake, menopause, and osteoarthritis history were further independent CRFs for fracture in women. However, neither SoSR nor SoST was independently associated with fracture risk. In this study, we identified the major Korean-specific CRFs for fracture and found that smaller hip circumference was a novel risk factor. This information will allow optimal risk-assessment targeting Koreans for whom treatment would provide the greatest benefit.
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ABSTRACT: We investigated the prevalence and risk factors of vertebral fractures in Korea. In a community-based prospective epidemiology study, 1,155 men and 1,529 women (mean age 59 years, range 43-74) were recruited from Ansung, a rural Korean community. Prevalent vertebral fractures were identified on the lateral spinal radiographs at T11 to L4 using vertebral morphometry. Bone mineral density (BMD) was measured at the lumbar spine, femur neck and total hip. Of the 2,684 subjects, 137 (11.9%) men and 227 (14.8%) women had vertebral fractures and the standardized prevalence for vertebral fractures using the age distribution of Korean population was 8.8% in men and 12.6% in women. In univariate analysis, older age, low hip circumference, low BMD, low income and education levels in both sexes, previous history of fracture in men, high waist-to-hip circumference ratio, postmenopausal status, longer duration since menopause, and higher number of pregnancies and deliveries in women were associated with an increased risk of vertebral fractures. However, after adjusting for age, only low BMD in both sexes and a previous history of fracture in men were significantly associated with an increased risk of vertebral fractures. Vertebral fractures are prevalent in Korea as in other countries. Older age, low BMD and a previous history of fracture are significant risk factors for vertebral fractures.Journal of Bone and Mineral Metabolism 07/2011; 30(2):183-92. · 2.22 Impact Factor
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ABSTRACT: OBJECTIVE: A site-dependent association between obesity and fracture has been reported in postmenopausal women. In this study we investigated the relationship between body mass index (BMI) and fracture at different skeletal sites in older men (≥65 years). METHODS: We carried out a population-based cohort study using data from the SIDIAP(Q) database. SIDIAP(Q) contains the primary care and hospital admission computerized medical records of >1,300 GPs in Catalonia (North-East Spain), with information on a representative 30% of the population (>2 million people). In 2007, 186,171 men ≥65 were eligible, of whom 139,419 (74.9%) had an available BMI measurement. For this analysis men were categorized as underweight/normal (<25 kg/m(2) , n=26,298), overweight (25 - <30 kg/m(2) , n=70,851), and obese (≥30 kg/m(2) , n=42,270). Incident fractures in the period 2007-2009 were ascertained using ICD codes. RESULTS: A statistically significant reduction in clinical spine and hip fractures was observed in obese (RR 0.65; 95% CI 0.53,0.80 and RR 0.63; 95% CI 0.54,0.74), and overweight men (RR 0.77; 95% CI 0.64,0.92 and RR 0.63; 95% CI 0.55,0.72) when compared with underweight/normal men. Additionally, obese men had significantly fewer wrist/forearm (RR 0.77; 95% CI 0.61,0.97) and pelvic (RR 0.44; 95% CI 0.28,0.70) fractures than underweight/normal men. Conversely, multiple rib fractures were more frequent in overweight (RR 3.42; 95% CI 1.03,11.37) and obese (RR 3.96; 95% CI 1.16,13.52) men. CONCLUSIONS: In this population-based cohort of older men, obesity was associated with a reduced risk of clinical spine, hip, pelvis and wrist/forearm fracture and increased risk of multiple rib fractures when compared to normal or underweight men. Further work is needed to identify the mechanisms underlying these associations. © 2013 American Society for Bone and Mineral Research.Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 01/2013; · 6.04 Impact Factor
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ABSTRACT: OBJECTIVES: This study aimed to evaluate the relationship between radiographic knee osteoarthritis and vertebral fractures (VFs) in an Asian population. METHODS: This cross-sectional study involved data from 1,829 participants of the Fifth Korean National Health and Nutrition Examination Survey. Radiographic knee osteoarthritis was defined as Kellgren-Lawrence (KL) grades ≥2. Prevalent VF was defined as a loss of ≥4 cm of height from the peak height. BMD was measured using dual-energy X-ray absorptiometry, in the lumbar spine and femoral neck. RESULTS: In both sexes, the prevalence of VFs increased with age, and was higher in the knee osteoarthritis group than in the control group (in men 13.2 % in osteoarthritis group and 7.9 % in control group; in women 27.7 % in osteoarthritis group and 14.7 % in control group). Age-adjusted BMD at the lumbar spine and femoral neck was significantly higher in the knee osteoarthritis group. In multivariable analysis, KL grade 4 was significantly associated with vertebral fractures in men. In women, there was a significant trend for a positive association between KL grades and vertebral fractures. CONCLUSIONS: Despite high systemic BMD, knee osteoarthritis was positively associated with VFs. These results suggest that bone quality, and consequently bone strength, may be decreased at the systemic level in knee osteoarthritis.Modern Rheumatology 03/2013; · 1.72 Impact Factor