Osteoporosis in the elderly: links between hypertension, obesity and osteoporotic fracture

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Copyright: Yang, Shuman
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Abstract
Hypertension, obesity and osteoporosis are major public health problems in the world. Several lines of in vitro evidence suggest that the conditions are linked, but vivo evidence is lacking or controversial. The present thesis seeks to define the contributions of beta-blockers, hypertension and obesity to fracture risk. In order to realise the aim, I analysed data collected from the Dubbo Osteoporosis Epidemiology Study (DOES). DOES is a population-based, prospective cohort study, in which 3673 participants (1581 men and 2095 women) aged 60 years and above (as at 1989) had been followed up for up to 22 years. The primary outcome of this study was fragility fracture as assessed by X-ray report. The secondary outcome was bone mineral density (BMD) measured by dual energy X-ray absorptiometry (DXA). Risk factors considered in the thesis included, among others, beta-blockers (BBs), hypertension and obesity. BBs, particularly selective BBs, were associated with increased BMD and reduced fracture risk. The data on the association between BBs and bone health has been available for some time. When the data were considered together with previous studies in a Bayesian meta-analysis, BB use is associated with 17% [95% confidence interval (CI): 0.71 to 0.93] reduction in fracture risk. Women with hypertension had lower BMD and higher fracture risk (hazard ratio: 1.23; 95% CI: 1.01-1.50) than those without having the disease, but the association between hypertension and fracture was likely to be mediated through BMD. Greater body mass index (BMI) or body weight was associated with reduced bone loss in men and women. When body fat mass and lean mass were analysed separately, higher body fat mass was associated with reduced bone loss in women. Hypertension was associated with increased fracture risk in women, but the association was likely mediated through BMD. These data suggest that BB use, hypertension, and obesity are associated with osteoporosis and osteoporotic fractures. These modifiable risk factors should be considered carefully in terms of prognosis, treatment and prevention of osteoporotic fracture in the general population.
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Author(s)
Yang, Shuman
Supervisor(s)
Nguyen, Tuan
Eisman, John
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Publication Year
2012
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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