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Shiraki M.,Research Institute and Practice for Involutional Diseases | Kuroda T.,Public Health Research Foundation | Tanaka S.,Kyoto University
Internal Medicine | Year: 2011

Objective Osteoporosis has been reported to increase the risk of mortality. However, these reports did not evaluate the effects of co-mobidities and the severity of osteoporosis on mortality. The aim of our study was to determine whether or not major osteoporotic fractures contribute to the increased mortality risk in Japanese women. Method We conducted a prospective observational study. Risk factors contributing to mortality were assessed by Cox's proportional hazard model. Subjects A total of 1,429 ambulatory postmenopausal female volunteers aged over 50 years old were enrolled in the study. Information was obtained from the subjects on baseline biochemical indices, bone mineral density (BMD), prevalent fractures, and co-morbidities. Mortality was assessed and confirmed by the certificates or hospital records. The subjects were classified into three categories in accordance with or without osteoporosis. The osteoporotic group was further categorized by the basis of the presence or absence of major osteoporotic fractures. Results Mean age and SD of the participants were 66.5±9.3 (50-90) years old. The participants were followed for a total of 4.5±3.5 years (mean ± SD) and a total of 141 participants (9.9%) died during the observation. In addition to the traditional risks for mortality, such as age (Hazard ratio, 2.817, 95% CI, 2.237- 3.560, p<0.0001), BMI (HR 0.504, 0.304-0.824, p=0.0061), prevalent malignancies (HR 2.885, 1.929-4.214, p<0.0001), dementia (HR 1.602, 1.027-2.450, p=0.038) and cardio-vascular disease (HR 1.878, 1.228-2.787, p=0.0043), the serum level of creatinine (HR 2.451, 1.107-5.284, p=0.027) and severity of osteoporosis (HR 1.390, 1.129-1.719, P=0.0018) were found to be significant independent risk factors for all-cause mortality. Conclusion These results emphasize the importance of osteoporotic fracture in terms of survival. © 2011 The Japanese Society of Internal Medicine. Source


Hirano F.,Asahikawa Medical College | Kuroda T.,Public Health Research Foundation | Shiraki M.,Research Institute and Practice for Involutional Diseases
Geriatrics and Gerontology International | Year: 2012

Aim: Arterial calcification and osteoporosis commonly accompany one another in postmenopausal women. Hypertension is a known contributing factor to arterial calcification. Thus, we aimed to investigate any associations between hypertension, arterial calcification and vertebral fractures in a cross-sectional study in Japanese postmenopausal women. Methods: The medical histories of 421 postmenopausal Japanese women diagnosed with hypertension, diabetes mellitus or hyperlipidemia were investigated. Bodyweight, body height and ultradistal bone mineral density (BMD) were measured. The prevalent vertebral fractures were diagnosed by a semiquantitative method, and the number of breast arterial calcifications (BAC) was investigated by mammography screening. Results: Patients with vertebral fractures were of a significantly higher age, lower height, lower ultradistal BMD and had a higher number of BAC compared with those without vertebral fractures. Furthermore, a significantly higher prevalence of hypertension was observed in the patients with vertebral fractures as compared with those without. A multivariate stepwise regression analysis using these variables for vertebral fractures showed that the significant odds ratios (OR) of age (OR 1.76, 95% CI 1.11-2.77, P=0.016), the prevalence of BAC (OR 2.52, 95% CI 1.62-3.93, P<0.001) and the presence of hypertension (OR 1.76, 95% CI 1.11-2.80, P=0.017) were found as significant independent risk factors for vertebral fractures. Conclusion: This is the first report of the relevance of BAC or hypertension to vertebral fractures in Japanese women. The results suggest that hypertension, BAC and osteoporotic fractures share a common metabolic pathway in their pathogenesis. © 2011 Japan Geriatrics Society. Source


Tanaka S.,Kyoto University | Yoshimura N.,Tokyo Medical University | Kuroda T.,Public Health Research Foundation | Hosoi T.,National Center for Geriatrics and Gerontology | And 2 more authors.
Bone | Year: 2010

Introduction: We aimed to (i) explore risk factors for major osteoporotic fracture or immobilization; (ii) develop a prediction model that can be used to assess the risk of fracture and immobilization; and (iii) assess external validity of the final model. Methods: A total of 1787 postmenopausal Japanese women were followed in a hospital-based cohort study. Endpoints included the annual incidence of major osteoporotic fracture and immobilization. For each endpoint, multivariate Poisson regression models were fitted separately and risk factors were screened through backward variable selection. The predictive accuracy of the final model (FRISC) was evaluated in two independent community-based cohorts. Results: Over a median follow-up of 5.3. years, a total of 383 major osteoporotic fractures (279 clinical vertebral, 44 hip, 60 distal forearm) and 83 immobilizations occurred in the developmental dataset. Backward variable selection confirmed that the following are risk factors for major osteoporotic fracture: age, weight, prior fracture, back pain, and lumbar bone mineral density (BMD). Age, prior fracture and dementia were significant risk factors for immobilization. Hosmer-Lemeshow tests did not indicate any significant deviation between the observed fracture frequency and prediction from the FRISC in the independent validation dataset. The C statistic for the FRISC was 0.727 (95% confidence interval: 0.660 to 0.794) and was higher than that for BMD alone significantly (p= 0.03). Conclusions: We developed a novel prediction model for fracture and immobilization, FRISC, and the clinical risk factors in the FRISC allows better identification of populations at high risk of fracture than BMD alone. A web application is available at http://www.biostatistics.jp/prediction/frisc. © 2010 Elsevier Inc. Source


Kuroda T.,Public Health Research Foundation | Onoe Y.,Tokyo Womens Medical University | Yoshikata R.,Tokyo Womens Medical University | Ohta H.,International University of Health and Welfare
Asia Pacific Journal of Clinical Nutrition | Year: 2013

Back ground and aims: It is well known that insufficient nutrient intake leads to poor bone status. To find a simple evaluation method for prevention of nutrition intake disorder, a cross-sectional study with 275 healthy Japanese female students aged 19-25 was conducted. Methods: Anthropometric parameters, bone mineral density (BMD) at lumbar and total hip, bone metabolic markers and physical activity were measured in study participants and the frequency of skipping meals (breakfast, lunch, supper), and absolute values for nutrient intakes were assessed using a Diet History Questionnaire. Results: The frequency of skipping breakfast significantly correlate to total energy intake (ρ= -0.276, p<0.001). BMI, total intake of energy, intake of protein, intake of phosphate, and energy expenditure positively correlated significantly to BMD at lumbar and total hip (p<0.05) using simple linear regression. BMI (regression coefficient (b))=0.088, p<0.001), bone alkaline phosphatase (b= -0.050, p=0.012), total energy expenditure (b=0.019, p<0.001), and frequency of skipping breakfast (b= -0.018, p=0.048) were independent risk factors for lower total hip BMD by multiple regression analysis. The total hip BMD in participants who skipped breakfast three or more times was significantly lower than in those who did not skip breakfast (p=0.007). Conclusions: In conclusion, managing the frequency of skipping breakfast and reducing it to <3 times per week may be beneficial for the maintenance of bone health in younger women. Source


Tanaka S.,Kyoto University | Kuroda T.,Public Health Research Foundation | Saito M.,Jikei University School of Medicine | Shiraki M.,Research Institute and Practice for Involutional Diseases
Journal of Bone and Mineral Research | Year: 2011

We investigated whether measurement of pentosidine, in addition to the conventional risk assessment tool, the Fracture and Immobilization Score (FRISC), improves early identification of fracture cases. A total of 765 postmenopausal Japanese women with baseline measurement of urinary pentosidine were followed in a hospital-based cohort study. Endpoints were incidence of vertebral fracture, incidence of long bone fracture, and incidence of long bone and vertebral fracture. To assess the effect of pentosidine on fracture risk, we fitted multivariate Cox regression models adjusted for age, body weight, diabetes mellitus, lumbar BMD, prior fracture, and presence of back pain. To explore potential nonlinear relationships, we fitted a multivariate generalized additive model. To assess the discriminatory power of pentosidine, we performed receiver operating characteristic analysis. The hazard ratios for a 1 SD increase in pentosidine were 1.18 (95% CI 1.05-1.33, p < 0.01) for vertebral fracture and 1.20 (95% CI 1.07-1.33, p < 0.01) for long bone and vertebral fractures. The relationship was approximately linear, and there was no indication of the presence of a threshold. The C statistics were 0.732 (95% CI 0.686-0.778) for the model with both pentosidine and the 10-year risk and 0.702 (95% CI 0.654-0.750) for the 10-year risk alone. Eighty-three subjects (11%) in the whole cohort were in the highest quartile of pentosidine, although their 10-year risks were less than 15% and included 17 incident vertebral fracture cases. Urinary pentosidine improves risk classification using conventional risk assessment tools. Optimal clinical strategies of diagnosis and treatment remain uncertain and in need of additional investigation. © 2011 American Society for Bone and Mineral Research. Source

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