Publications (14)61.03 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: The association between sex hormones and sex hormone binding globin (SHBG) with vertebral fractures in men is not well studied. In these analyses, we determined whether sex hormones and SHBG were associated with greater likelihood of vertebral fractures in a prospective cohort study of community dwelling older men. We included data from participants in MrOS who had been randomly selected for hormone measurement (N = 1463 including 1054 with follow-up data 4.6 years later.). Major outcomes included prevalent vertebral fracture (semi-quantitative grade ≥ 2, N = 140, 9.6%); and new or worsening vertebral fracture (change in SQ grade ≥ 1, N = 55, 5.2%). Odds ratios per SD decrease in sex hormones and per SD increase in SHBG were estimated with logistic regression adjusted for potentially confounding factors including age, bone mineral density, and other sex hormones. Higher SHBG was associated with a greater likelihood of prevalent vertebral fractures (OR: 1.38 per SD increase, 95% CI: 1.11, 1.72). Total estradiol analyzed as a continuous variable was not associated with prevalent vertebral fractures (OR per SD decrease: 0.86, 95% CI: 0.68 to 1.10). Men with total estradiol values ≤ 17 pg/ml had a borderline higher likelihood of prevalent fracture than men with higher values (OR: 1.46, 95% CI: 0.99, 2.16). There was no association between total testosterone and prevalent fracture. In longitudinal analyses, SHBG (OR: 1.42 per SD increase, 95% CI: 1.03, 1.95) was associated with new or worsening vertebral fracture, but there was no association with total estradiol or total testosterone. In conclusion, higher SHBG (but not testosterone or estradiol) is an independent risk factor for vertebral fractures in older men.
- [Show abstract] [Hide abstract] ABSTRACT: Background: pain may reduce stability and increase falls and subsequent fractures in older men. Objectives: to examine the association between joint pain and any pain with falls, hip and non-spine fractures in older community-dwelling men. Design: a cohort study. Setting and participants: analyses included 5,993 community-dwelling men aged ≥65 years from the MrOS cohort. Measurements: pain at hip, knee and elsewhere (any) was assessed by self-report. Men reported falls via questionnaires mailed 3× per year during the year following the baseline visit. Fractures were verified centrally. Mean follow-up time for fractures was 9.7 (SD 3.1) years. Logistic regression models estimated likelihood of falls and proportional hazards models estimated risk of fractures. Models were adjusted for age, BMI, race, smoking, alcohol use, medications use, co-morbidities and arthritis; fracture models additionally adjusted for bone mineral density. Results: one quarter (25%, n = 1,519) reported ≥1 fall; 710 reported ≥2 falls in the year after baseline. In multivariate models, baseline pain at hip, knee or any pain increased likelihood of ≥1 fall and ≥2 falls over the following year. For example, knee pain increased likelihood of ≥1 fall (odds ratio, OR 1.44; 95% confidence interval, CI 1.25-1.65) and ≥2 falls (OR 1.75; 95% CI 1.46-2.10). During follow-up, 936 (15.6%) men suffered a non-spine fracture (n = 217, 3.6% hip). In multivariate models, baseline pain was not associated with incident hip or non-spine fractures. Conclusions: any pain, knee pain and hip pain were each strong independent risk factors for falls in older men. Increased risk of falls did not translate into an increased risk of fractures.
- [Show abstract] [Hide abstract] ABSTRACT: Sleep and melatonin have been associated with healthy aging. In this study, we examine the association between melatonin levels and sleep among older men. Cross-sectional study of a community-dwelling cohort of 2,821 men aged 65 years or older recruited from six U.S. centers. First morning void urine samples were collected to measure melatonin's major urinary metabolite, 6-sulfatoxymelatonin (aMT6s). We also assessed objective and subjective sleep parameters. We used logistic regression models to calculate multivariate (MV) odds ratios (ORs), and 95% confidence intervals (CIs) adjusted for important demographic variables and comorbidities. In the overall sample, the only significant finding in fully adjusted models was that aMT6s levels were inversely associated with subjectively measured daytime sleepiness (sleepiness mean score of 5.79 in the top aMT6s quartile, and 6.26 in the bottom aMT6s quartile, MV OR, 1.32; 95% CI, 0.95-1.84; p trend ≤ .02). When restricting to men without β-blocker use (a known melatonin suppressant), aMT6s levels were significantly associated with shorter sleep time, that is, less than 5 hours (MV OR, = 1.90; 95% CI, 1.21-2.99; p trend = .01), and worse sleep efficiency, that is, less than 70% (MV OR, 1.58; 95% CI, 1.28-2.65; p trend < .001). aMT6s were not associated with subjective sleep quality or respiratory disturbance in any of our analyses. Lower nocturnal melatonin levels were associated with worsened daytime sleepiness, sleep efficiency, and shorter sleep time in older men. The role of circadian interventions, and whether melatonin levels are a modifiable risk factor for poor sleep in older men, warrants further study. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
- [Show abstract] [Hide abstract] ABSTRACT: Maintaining adequate serum levels of vitamin D may be important for sleep duration and quality; however, these associations are not well understood. We examined whether levels of serum 25(OH)D are associated with objective measures of sleep in older men. Cross-sectional study within a large cohort of community-dwelling older men, the MrOS study. Among 3,048 men age 68 years or older, we measured total serum vitamin D. Objective estimates of nightly total sleep time, sleep efficiency, and wake time after sleep onset (WASO) were obtained using wrist actigraphy worn for an average of 5 consecutive 24-h periods. 16.4% of this study population had low levels of vitamin D (< 20.3 ng/mL 25(OH)D). Lower serum vitamin D levels were associated with a higher odds of short (< 5 h) sleep duration, (odds ratio [OR] for the highest (≥ 40.06 ng/mL) versus lowest (< 20.3 ng/mL) quartile of 25(OH)D, 2.15; 95 % confidence interval (CI), 1.21-3.79; Ptrend = 0.004) as well as increased odds of actigraphy-measured sleep efficiency of less than 70% (OR, 1.45; 95% CI, 0.97-2.18; Ptrend = 0.004), after controlling for age, clinic, season, comorbidities, body mass index, and physical and cognitive function. Lower vitamin D levels were also associated with increased WASO in age-adjusted, but not multivariable adjusted models. Among older men, low levels of total serum 25(OH)D are associated with poorer sleep including short sleep duration and lower sleep efficiency. These findings, if confirmed by others, suggest a potential role for vitamin D in maintaining healthy sleep. © 2014 Associated Professional Sleep Societies, LLC.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Age-related hyperkyphosis has been associated with poor physical function and is a well-established predictor of adverse health outcomes in older women, but its impact on health in older men is less well understood. Methods: We conducted a cross-sectional study to evaluate the association of hyperkyphosis and physical function in 2,363 men, aged 71-98 (M = 79) from the Osteoporotic Fractures in Men Study. Kyphosis was measured using the Rancho Bernardo Study block method. Measurements of grip strength and lower extremity function, including gait speed over 6 m, narrow walk (measure of dynamic balance), repeated chair stands ability and time, and lower extremity power (Nottingham Power Rig) were included separately as primary outcomes. We investigated associations of kyphosis and each outcome in age-adjusted and multivariable linear or logistic regression models, controlling for age, clinic, education, race, bone mineral density, height, weight, diabetes, and physical activity. Results: In multivariate linear regression, we observed a dose-related response of worse scores on each lower extremity physical function test as number of blocks increased, p for trend ≤.001. Using a cutoff of ≥4 blocks, 20% (N = 469) of men were characterized with hyperkyphosis. In multivariate logistic regression, men with hyperkyphosis had increased odds (range 1.5-1.8) of being in the worst quartile of performing lower extremity physical function tasks (p < .001 for each outcome). Kyphosis was not associated with grip strength in any multivariate analysis. Conclusions: Hyperkyphosis is associated with impaired lower extremity physical function in older men. Further studies are needed to determine the direction of causality.
- [Show abstract] [Hide abstract] ABSTRACT: To determine the association between objectively measured physical activity (PA), fractures, and falls. Longitudinal cohort study. Six U.S. clinical sites. Two thousand seven hundred thirty-one men with a mean age of 79. Total and active energy expenditure (EE) and minutes per day spent in sedentary and moderate intensity activities were measured for at least 5 days. Energy expended at a metabolic equivalent of greater than three was termed active EE. Incident nonspine fractures and falls were identified every 4 months. Seven hundred fifty-nine (28.2%) men fell at least once over 12 months of follow-up; 186 (6.8%) experienced one or more fractures over an average follow-up of 3.5 ± 0.9 years. The association between PA and falling varied according to age (P interaction = .02). Men younger than 80 with the lowest active EE had a lower risk of falling than men with the highest active EE (relative risk (RR) = 0.75; P trend = .08), whereas men aged 80 and older with the lowest active EE had a higher risk of falling than men with the highest active EE (RR = 1.43, P trend = .09). In multivariate models including health status, men in the lowest quintile of active EE had a significantly higher risk of fracture (hazard ratio (HR) = 1.82, 95% confidence interval (CI) = 1.10-3.00, P trend = .04) than men in highest quintile. Men with <33 min/d of moderate activity had a 70% greater risk of fracture (HR = 1.70, 95% CI = 1.03-2.80). Age modifies the association between PA and falling. Interventions aimed at obtaining more than 30 minutes of moderate PA per day may reduce fractures, extending PA guidelines to the oldest old, the fastest-growing proportion of those aged 65 and older.
- [Show abstract] [Hide abstract] ABSTRACT: Background: The relationship between objectively assessed activity, energy expenditure, and the development of functional limitations is unknown. Methods: Energy expenditure and activity levels were measured objectively using the multisensor SenseWear Pro Armband worn for greater than or equal to 5 days in 1,983 MrOS men (aged ≥ 78.3 years) free of functional limitations. Validated algorithms calculated energy expenditure; standard cut points defined moderate or greater activity (≥ 3.0 METS); and sedentary behavior (time awake ≤ 1.5 METS). Self-reported functional limitation was determined at the activity assessment and 2.0 years later as inability to perform instrumental activities of daily living (managing money, managing medications, shopping, housework, and meal preparation) and activities of daily living (climb stairs, walk two to three blocks, transfer, or bathe). Results: Each standard deviation decrease in total energy expenditure (420.6 kcal/day) increased the likelihood of inability to perform an instrumental activity of daily living (multivariate odds ratio [mOR]: 1.61, 95% CI: 1.30-2.00) or activity of daily living (mOR: 1.35, 95% CI: 1.12-1.63). Each standard deviation decrease in moderate or greater activity (61.1 minutes/day) increased the likelihood of inability to perform an instrumental activity of daily living (mOR: 1.47, 95% CI: 1.22-1.78) or activity of daily living (mOR: 1.36, 95% CI: 1.14-1.61). Each standard deviation increase in minutes of sedentary behavior (105.2 minutes/day) increased the likelihood of inability to perform an instrumental activity of daily living (mOR: 1.20, 95% CI: 1.03-1.40) or activity of daily living (mOR: 1.17, 95% CI: 1.01-1.35). Conclusion: Older men with lower total energy expenditure, lower moderate activity, or greater sedentary time were more likely to develop a functional limitation.
- [Show abstract] [Hide abstract] ABSTRACT: Assess the association between REM predominant obstructive sleep apnea (OSA), sleepiness, and quality of life in a community-based cohort of men ≥ 65 years-old. A cross-sectional analysis of 2,765 subjects from the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study was performed to identify subjects with an apnea hypopnea index (AHI) < 15 (n = 2,044). Subjects were divided into groups based on the AHI in REM sleep (< 5 [referent group], 5 to < 15, 15 to < 30, and ≥ 30). Daytime somnolence, sleep-related quality of life, sleep disturbance, general quality of life, depressive symptoms, and health status were quantified using Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Pittsburgh Sleep Quality Index (PSQI), Short Form-12 (SF-12), Geriatric Depression Scale-15 (GDS), and self-perceived health status, respectively. Prevalence of REM-predominant OSA (AHI-REM ≥ 5) was 42.8% if OSA was defined as AHI ≥ 15 and 14.4% if OSA was defined as AHI ≥ 5. Higher AHI-REM was associated with polysomnographic indices of poorer sleep architecture (reduced total sleep time, sleep efficiency, REM sleep duration and proportion). Adjusting for age, BMI, and study site, higher AHI-REM was not associated with subjective sleep measures (ESS, FOSQ, PSQI), lower quality of life (SF-12), or greater depressive symptoms (GDS). In a community-based sample of older adult men ≥ 65 years-old, REM-predominant OSA was highly prevalent and was associated with objective indices of poorer sleep quality on polysomnography but not with subjective measures of daytime sleepiness or quality of life. Khan A; Harrison SL; Kezirian EJ; Ancoli-Israel S; O'Hearn D; Orwoll E; Redline S; Ensrud K; Stone KL. Obstructive sleep apnea during rapid eye movement sleep, daytime sleepiness, and quality of life in older men in osteoporotic fractures in men (MrOS) sleep study. J Clin Sleep Med 2013;9(3):191-198.
- [Show abstract] [Hide abstract] ABSTRACT: This study examined the association between race/ethnicity and objectively measured sleep characteristics in a large sample of older men. Black men had significantly shorter total sleep time (6.1 hr vs. 6.4 hr), longer sleep latency (28.7 min vs. 21.9 min), lower sleep efficiency (80.6% vs. 83.4%), and less slow-wave sleep (4.9% vs. 8.8%) than White men, even after controlling for social status, comorbidities, body mass index, and sleep-disordered breathing. Hispanic men slept longer (6.7 hr) at night than Black (6.1 hr) and Asian American men (6.1 hr). This study supports significant variations in sleep characteristics in older men by race/ethnicity.
- [Show abstract] [Hide abstract] ABSTRACT: We used data from the Osteoporotic Fractures in Men (MrOS) study to test the hypothesis that men with higher levels of bone turnover would have accelerated bone loss and an elevated risk of fracture. MrOS enrolled 5995 subjects >65 yr; hip BMD was measured at baseline and after a mean follow-up of 4.6 yr. Nonspine fractures were documented during a mean follow-up of 5.0 yr. Using fasting serum collected at baseline and stored at -190 degrees C, bone turnover measurements (type I collagen N-propeptide [PINP]; beta C-terminal cross-linked telopeptide of type I collagen [betaCTX]; and TRACP5b) were obtained on 384 men with nonspine fracture (including 72 hip fractures) and 947 men selected at random. Among randomly selected men, total hip bone loss was 0.5%/yr among those in the highest quartile of PINP (>44.3 ng/ml) and 0.3%/yr among those in the lower three quartiles (p = 0.01). Fracture risk was elevated among men in the highest quartile of PINP (hip fracture relative hazard = 2.13; 95% CI: 1.23, 3.68; nonspine relative hazard = 1.57, 95% CI: 1.21, 2.05) or betaCTX (hip fracture relative hazard = 1.76, 95 CI: 1.04, 2.98; nonspine relative hazard = 1.29, 95% CI: 0.99, 1.69) but not TRACP5b. Further adjustment for baseline hip BMD eliminated all associations between bone turnover and fracture. We conclude that higher levels of bone turnover are associated with greater hip bone loss in older men, but increased turnover is not independently associated with the risk of hip or nonspine fracture.
- [Show abstract] [Hide abstract] ABSTRACT: To examine the association between sleep-disordered breathing (SDB) and subjective measures of daytime sleepiness, sleep quality, and sleep-related quality of life in a large cohort of community-dwelling older men and to determine whether any association remained after adjustment for sleep duration. Cross-sectional. The functional outcome measures of interest were daytime sleepiness (Epworth Sleepiness Scale, ESS), sleep-related symptoms (Pittsburgh Sleep Quality Index, PSQI), and sleep-related quality of life (Functional Outcomes of Sleep Questionnaire, FOSQ). Analysis of variance and adjusted regression analyses examined the association between these outcome measures and SDB severity and actigraphy-determined total sleep time (TST). We then explored whether associations with SDB were confounded by sleep duration by adjusting models for TST. Community-based sample in home and research clinic settings. Two-thousand eight-hundred forty-nine older men from the multicenter Osteoporotic Fractures in Men Study that began in 2000. All participants underwent in-home polysomnography for 1 night and wrist actigraphy for a minimum of 5 consecutive nights. N/A. Measurements and Results: Participants were aged 76.4 + 5.5 years and had an apnea-hypopnea index (AHI) of 17.0 + 15.0. AHI and TST were weakly correlated. ESS scores individually were modestly associated with AHI and TST, but the association with AHI was attenuated by adjustment for TST. PSQI and FOSQ scores were largely not associated with measures of SDB severity but were modestly associated with TST. Daytime sleepiness, nighttime sleep disturbances, and sleep-related quality of life were modestly associated with TST. After adjustment for TST, there was no independent association with SDB severity. These results underscore the potential differences in SDB functional outcomes in older versus young and middle-aged adults.
- [Show abstract] [Hide abstract] ABSTRACT: To examine the fracture pattern in older women whose bone mineral density (BMD) T-score criteria for osteoporosis at hip and spine disagree, hip and spine BMD were measured in Study of Osteoporotic Fractures participants using dual energy X-ray absorptiometry (DXA). Hip osteoporosis was defined as T-score <or=-2.5 at femoral neck or total hip, and spine osteoporosis as T-score <or=-2.5 at lumbar spine. Incident clinical fractures were self-reported and centrally adjudicated. Incident radiographic spine fractures were defined morphometrically. Compared to women with osteoporosis at neither hip nor spine, those osteoporotic only at hip had a 3.0-fold age- and weight-adjusted increased risk for hip fracture (95% confidence interval [CI]: 2.4-3.6), and smaller increases in risk of nonhip nonspine (hazard ratios [HR]=1.6), clinical spine (odds ratio [OR]=2.2), and radiographic spine fractures (OR=1.5). Women osteoporotic only at spine had a 2.8-fold increased odds of radiographic spine fracture (95% CI: 2.1-3.8), and smaller increases in risk of clinical spine (OR=1.4), nonhip nonspine (HR=1.6), and hip fractures (HR=1.2). Discordant BMD results predict different fracture patterns. DXA fracture risk estimation in these patients should be site specific. Women osteoporotic only at spine would not have been identified from hip BMD measurement alone, and may have a sufficiently high fracture risk to warrant preventive treatment.
- [Show abstract] [Hide abstract] ABSTRACT: To examine the association between SDB and subjective measures of daytime sleepiness, sleep quality, and sleep related quality of life in a large cohort of primarily community-dwelling older women, specifically considering the relative importance of sleep duration in mediating these associations. Cross-sectional. The functional outcome measures of interest were daytime sleepiness (using the Epworth Sleepiness Scale, ESS), sleep-related symptoms (Pittsburgh Sleep Quality Index, PSQI), and sleep related quality of life (Functional Outcomes of Sleep Questionnaire, FOSQ). ANOVA and regression analyses examined the association between SDB severity (measured by indices of breathing disturbances and overnight oxygen saturation) and sleep time (by actigraphy) and these outcome measures. Regression models were adjusted for age, body mass index (BMI), and a medical comorbidity index. We specifically explored whether associations with indices of SDB were mediated by sleep deprivation by adjusting models for actigraphy-determined average total sleep time (TST) during the night. Community-based sample examined in home and outpatient settings. 461 surviving older women from the multicenter Study of Osteoporotic Fractures were examined during Visit 8 from 2002-03. All participants underwent in-home overnight polysomnography for one night and wrist actigraphy for a minimum of 3 24-h periods and completed the above functional outcomes questionnaires. N/A. Participants were aged 82.9 +/- 3.5 (mean +/- SD) years, had BMI of 27.9 +/- 5.1 kg/m2, and had an apnea-hypopnea index (AHI) of 15.7 +/- 15.1. AHI and TST demonstrated a weak correlation (r = -0.15). ESS score individually demonstrated a modest association with AHI, oxygen desaturation, and TST. The association of ESS score and AHI--but not oxygen desaturation-was attenuated to some extent by adjustment for TST. PSQI and FOSQ scores were not associated with measures of SDB severity or TST. After adjustment for TST, SDB severity in community-dwelling older women was not independently associated with self-reported daytime sleepiness, although there may be a modest association that is mediated through reduced TST. In older women, SDB severity was not associated with indices of sleep related symptoms or sleep related quality of life.
- [Show abstract] [Hide abstract] ABSTRACT: To examine the association between alcohol intake and problem drinking history and bone mineral density (BMD), falls and fracture risk. Cross-sectional and prospective cohort study. Six U.S. clinical centers. Five thousand nine hundred seventy-four men aged 65 and older. Alcohol intake and problem drinking histories were ascertained at baseline. Follow-up time was 1 year for falls and a mean of 3.65 years for fractures. Two thousand one hundred twenty-one participants (35.5%) reported limited alcohol intake (<12 drinks/y); 3,156 (52.8%) reported light intake (<14 drinks/wk), and 697 (11.7%) reported moderate to heavy intake (> or =14 drinks/wk) in the year before baseline. One thousand one men (16.8%) had ever had problem drinking. In multivariate models, as alcohol intake increased, so did hip and spine BMD (P for trend < .001). Greater alcohol intake was not associated with greater risk for nonspine or hip fractures. Men with light intake, but not moderate to heavy intake, had a lower risk of two or more incident falls (light intake: relative risk (RR) = 0.77, 95% confidence interval (CI) = 0.65-0.92; moderate to heavy intake: RR = 0.83, 95% CI = 0.63-1.10) than abstainers. Men with problem drinking had higher femoral neck (+1.3%) and spine BMD (+1.4%), and a higher risk of two or more falls (RR = 1.59; 95% CI = 1.30-1.94) than those without a history of problem drinking and similar total hip BMD and risk of fracture. In older men, recent alcohol intake is associated with higher BMD. Alcohol intake and fracture risk is unclear. Light alcohol intake may decrease the risk of falling, but a history of problem drinking increased fall risk.
California Pacific Medical Center Research Institute
San Francisco, California, United States
- Research Institute