Using the unique population-based medical records linkage system in Rochester, we will identify selected patients with various conditions (vertebral and distal forearm fractures, stroke, and primary hyperparathyroidism) back to 1950 and follow them efficiently through comprehensive outpatient and inpatient medical records to the present for fracture outcomes (retrospective, or historical, cohort studies) in order to quantify the risk of proximal femur (hip) fractures and other age-related fractures in comparison with matched control cohorts or with standardized morbidity ratios (SMRs). The direct measurement of fracture incidence possible in these cohort studies complements the data available from smaller, short-term prospective studies which utilize bone mineral density as the endpoint and should make an important contribution to identification of the important causes of age=related fractures in the community. Specifically, we will assess the relationship of vertebral and distal forearm fractures (presumed to be manifestations of Type I, or postmenopausal, osteoporosis) to hip fractures (the principal manifestation of Type II, or age-related, osteoporosis) to test the hypothesis that Type I and Type II osteoporosis are distinct pathophysiologic entities and to validate our delineation of the fracture syndromes associated with each form of involutional osteoporosis. We will also continue our series of studies on secondary osteoporosis, which is additive to postmenopausal and age-related bone loss, by assessing fracture, risk in Rochester residents with stroke and with primary hyperparathyroidism and, if the risk is increased, identifying the specific subgroups of patients most affected and establishing the temporal relationships between the onset of each condition and subsequent fractures. These data may help us generate hypotheses concerning the pathophysiologic abnormalities at which control efforts might be directed. Finally, because these patient cohorts are population-based, we will use them to estimate age- and sex- specific incidence rates for distal forearm fractures and symptomatic vertebral fractures, in addition to updating the Rochester hip fracture cohort (1928-82) through 1992 to test the hypothesis that age-adjusted incidence rates are increasing. This information is important for predicting the future fracture burden in the population and for assessing the potential benefits of osteoporosis prevention programs.
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