The incidence of fractures due to osteoporosis and falls are highest among the elderly, and represent major health problems. Falls are an important risk factor for some types of fractures, and a principal cause of injuries, death, and disability among the elderly. The injuries and fear of falling that often develop after a fall can increase the level of frailty and dependence of the elderly. We have already shown that the incidence of nonspine fractures among Japanese men and women and only half that of Caucasians, even though bone density is similar after adjusting for body size. The incidence of falls is also half that of Caucasians. Preventing falls, fractures, and their consequences will require understanding the underlying causes, which may vary by gender and ethnicity. The Hawaii Osteoporosis Study (HOS) began in 1981 with a population-based sample of 1379 men (ages 60 to 81) and 1098 of their wives; all are of Japanese ancestry. Measurements of bone mineral density (BMD) and radiographs for identifying vertebral fractures were obtained in 1981, and again at subsequent examinations through 1995 for both men and women. Risk factor for falls were measured for the women and a subset of men in 1992 and again in 1995. We propose here to extend the existing longitudinal study of osteoporosis and falls among the HOS men to older ages, and expand it to include risk factors which were not measured previously. BMD and risk factors for factors for fractures and falls will be measured at the beginning and end of the study. Identical, standardized examinations of the wives (funded separately) will overlap with the examinations of men, resulting in reduced costs overall. The proposed examinations will provide prospective data regarding changes in BMD over a 21 year period (1981-2002), and risk factors for falls over 10 years (1992-2002). The new exams will also allow us to extend our study of the natural history of osteoporosis and falls to older ages, where more than half of all hop fractures occur, and provide greater statistical power for analyses. The proposed study will address many of the priority areas mentioned in the Program Announcement. It will investigate the incidence and prevalence of fractures and falls, distributions of risk factors, and changes in risk factors over time among elderly men, for whom little data are currently available. It will also evaluate the extent to which measured risk factors explain the observed difference in rates of fractures and falls between men and women, which may lead to better interventions.
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