title: Bone mineral density enhances use of clinical risk factors in predicting ten-year risk of osteoporotic fractures in Chinese men: the Hong Kong Osteoporosis Study.
abstract: This prospective study aimed to determine the risk factors and the 10-year probability of osteoporotic fracture in Southern Chinese men. The findings show substantial population differences in fracture incidence and risk prediction compared to the FRAX(TM) model, and the addition of BMD information to clinical risk factor assessment improved fracture risk prediction in Chinese men.
  
  
  BACKGROUND
  Clinical risk factors with or without bone mineral density (BMD) measurements are increasingly recognized as reliable predictors of fracture risk. Prospective data on fracture incidence in Asian men remain sparse. This prospective study aimed to determine the risk factors and the 10-year absolute fracture risk in Southern Chinese men.
  
  
  METHODS
  This is a part of the Hong Kong Osteoporosis Study. One thousand eight hundred ten (1,810) community-dwelling, treatment-naive men aged 50 years or above were evaluated. Baseline demographic characteristics, clinical risk factors and BMD were recorded. Ten-year risk of osteoporotic fracture was calculated using Cox proportional hazards models.
  
  
  RESULTS
  The mean age of subjects was 68.0 ± 10.3 years. After a mean follow-up period of 3.5±2.9 years (range 1 to 14 years), 37 incident low-trauma fractures were recorded. The incidence for all osteoporotic fractures and hip fractures was 635/100,000 and 123/100,000 person-years, respectively. The most significant predictors of osteoporotic fracture were history of fall (RR 14.5), femoral neck BMD T-score < -2.5 (RR 13.8) and history of fracture (RR 4.4). Each SD reduction in BMD was associated with a 1.8 to 2.6-fold increase in fracture risk. Subjects with seven clinical risk factors and BMD T-score of -1 had an absolute 10-year risk of osteoporotic fracture of 8.9%, but this increased to 22.7% if they also had a femoral neck BMD T-score of -2.5.
  
  
  CONCLUSIONS
  These findings show substantial population differences in fracture incidence and risk prediction. The addition of BMD information to clinical risk factor assessment improved fracture risk prediction in Chinese men.
authors.affiliation: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
authors.forename: C H
authors.initials: CH
authors.lastname: Bow
authors.forename: S W Y
authors.initials: SW
authors.lastname: Tsang
authors.forename: C H N
authors.initials: CH
authors.lastname: Loong
authors.forename: C S S
authors.initials: CS
authors.lastname: Soong
authors.forename: S C
authors.initials: SC
authors.lastname: Yeung
authors.forename: A W C
authors.initials: AW
authors.lastname: Kung
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D044466:Asian People / Q000208:ethnology; D015519:Bone Density; D005272:Femur Neck / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006615:Hip / Q000000981:diagnostic imaging; D006620:Hip Fractures / Q000453:epidemiology*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000208:ethnology; D011446:Prospective Studies; D012307:Risk Factors