Osteoporosis: Woo J

Chan SP, Chen JF, Chu LW, Van DP, Hosking D, Ip TP, Koh L, Kung A, Lai NS, Lau E, Lee JK, Leewattana R, Min YK, Nghia ND, Boonsong O, Park HM, Ringe J, Setyohadi B, Shin CS, Soontrapa S, Taechakraichana N, Tanjung F, Tobing D, Tsai KS, Woo J, Yang RS. · c/o Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China. · Public Health Nutr. · Pubmed #18647434 No free full text.

Abstract: BACKGROUND: Vitamin D is essential for Ca absorption, prevention of falls and fracture, and maintenance of muscle strength and balance. Lack of awareness of the importance of vitamin D in bone health is common in Asia. OBJECTIVE: To define key statements, objectives and actions for improving osteoporosis management and vitamin D inadequacy in Asia. RESULTS AND CONCLUSION: This declaration was jointly produced by specialists at the Asia Metaforum on the Role of Vitamin D and the Management of Osteoporosis, held in September 2006 in Hong Kong, to define actions to prevent vitamin D insufficiency in Asia. Although developed specifically for Asia, some or all of these statements may be applicable to other regions of the world.

Ho SC, Woo J, Lam S, Chen Y, Sham A, Lau J. · Department of Community and Family Medicine, School of Public Health, Prince of Wales Hospital, The Chinese University of Hong Kong, 4th Floor, NT, Hong Kong. · Osteoporos Int. · Pubmed #12920508 No free full text.

Abstract: Recent interest has been shown in the potential beneficial effects of phytoestrogens on bone health. As the early years of menopause are a period of rapid bone loss, and the risk for osteoporosis increases substantially, the habitual intake of soy protein and isoflavones may play a role in the retardation of bone loss. This paper reports the results of the baseline cross-sectional analysis of the association between dietary soy protein intake and bone mineral density/content in a population-based study of Chinese women. The sample comprised 454 healthy Chinese women (mean age 55.1 +/- 3.57) within the first 12 years of postmenopause. We estimated the dietary intake of soy protein and isoflavones, and other key nutrients, including dietary protein and calcium, using the quantitative food frequency method. Bone mineral density (BMD) and content (BMC) at the spine, hip and total body were measured with a dual energy X-ray densitometer (Hologic 4500A). Soy protein consumption was categorized as quartiles of intake, and related to BMD values at the spine and hip, and BMC of total body. Stratified analyses were carried out among women within or at least 4 years postmenopausal. We observed few differences in BMD/BMC values among the intake quartiles in women within the first 4 years of menopause. However, among the later postmenopausal women, we noted a dose-response relationship with increasing higher BMD values at the trochanter, intertrochanter as well as the total hip and total body with increasing soy protein intake quartiles (P<0.05 from tests for trend). The BMD values differed by about 4-8% between the first and fourth soy protein intake quartiles. Though women from the fourth intake quartile had a 2.9% higher BMD value compared with those from the first intake quartile, the difference was not statistically significant. Stepwise multiple linear regression analyses showed the association between soy intake quartiles and hip BMD as well as total body BMC values remained after adjusting for body weight, which was retained in the final model. Analyses based on soy isoflavones content yielded similar results. This study demonstrated that, among women after the initial few years postmenopausal, soy protein/isoflavones intake had a modest but significant association with hip BMD as well as total body BMC. The effects of soy protein and soy isoflavones on bone health should be further explored in populations with habitual dietary soy intake.

Woo J. · Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, SAR. · Eur J Clin Nutr. · Pubmed #11041086 No free full text.

Abstract: Diet and physical activity are two major lifestyle factors that play a role in the prevention or management of debilitating conditions affecting older people. Both under- and overnutrition predispose to diseases. Low sodium and high potassium intakes, as well as the consumption of fruits and vegetables are associated with a reduction of hypertension and diseases arising from hypertension such as stroke and dementia. Dietary patterns (consumption of quantity and types of fats, cholesterol, vegetable oils, fish) are important in the prevention of coronary heart disease. Calcium and vitamin D intakes are important factors in the development of osteoporosis, while various dietary factors have been linked to the development of cancer. Physical activity is important in the prevention of functional decline and increased survival, reduced incidence of falls and fractures, and has various cardiovascular health benefits. Apart from prevention of diseases, exercise also has an important role in improving function in some chronic diseases such as heart failure or chronic obstructive pulmonary disease. Both diet and exercise interact, so that public health recommendations often take the form of lifestyle modification advice in the prevention of disease and disability.

Chan K, Qin L, Lau M, Woo J, Au S, Choy W, Lee K, Lee S. · Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong. · Arch Phys Med Rehabil. · Pubmed #15129394 No free full text.

Abstract: OBJECTIVE: To evaluate the potential benefits of programmed Tai Chi Chun (TCC) exercise on the weight-bearing bones of early postmenopausal women. DESIGN: Age-matched and randomized prospective intervention. SETTING: University medical school. PARTICIPANTS: One hundred thirty-two healthy postmenopausal women (mean age, 54.0+/-3.5y) within 10 years of menopause onset were recruited and randomized into the TCC exercise group (n=67) or the sedentary control group (n=65). INTERVENTION: Supervised TCC exercise was performed by the TCC group for 45 minutes a day, 5 days a week, for 12 months; control subjects retained a sedentary life style.Main outcome measures Bone mineral density (BMD) was measured in the lumbar spine and proximal femur by using dual-energy x-ray absorptiometry and in the distal tibia by using multislice peripheral quantitative computed tomography (pQCT). All BMD measurements were repeated after 12 months in both groups. Fracture rate was also documented. RESULTS: Baseline measurements showed homogeneity in age, anthropometric variables, and menstruation status between the TCC and control groups. Exactly 81.6% of the subjects in the TCC group and 83.1% of subjects in the control group completed the 12-month follow-up study. BMD measurements revealed a general bone loss in both TCC and sedentary control subjects at all measured skeletal sites, but with a reportedly slower rate in the TCC group. A significant 2.6- to 3.6-fold retardation of bone loss (P<.01) was found in both trabecular and cortical compartments of the distal tibia in the TCC group as compared with the controls, as measured by pQCT. A total of 4 fracture cases were documented during follow-up, including 3 subjects in the control group and 1 in the TCC group. CONCLUSIONS: This is the first prospective and randomized study to show that a programmed TCC exercise intervention is beneficial for retarding bone loss in weight-bearing bones in early postmenopausal women. Long-term follow-up is needed to substantiate the role of TCC exercise in the prevention of osteoporosis and its related fracture.

Woo J, Lau E, Ho SC, Cheng F, Chan C, Chan AS, Haines CJ, Chan TY, Li M, Sham A. · Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong. · Menopause. · Pubmed #12851519 No free full text.

Abstract: OBJECTIVE: Pueraria lobata (PL) is used as a traditional Chinese herbal remedy for menopausal symptoms, as well as an ingredient in preparations for conditions affecting menopausal women, such as osteoporosis, coronary heart disease, and some hormone-dependent cancers. The scientific basis for its action may be its action as a phytoestrogen. DESIGN: To examine the effects of PL in comparison with hormone replacement therapy (HRT) on lipid profile, sex hormone levels, bone turnover markers, and indices of cognitive function. For the study, 127 community-living, postmenopausal women aged 50 to 65 years were randomized to receive HRT (n = 43), PL (equivalent to 100 mg isoflavone; n = 45), or no treatment (n = 39) for 3 months. The following measurements were carried out at baseline and after 3 months for all participants: menopausal symptoms questionnaire; neuropsychological tests covering memory, attention, motor speed, and word-finding ability; quality of life (SF36); lipid profile; urinary deoxypyridinoline; dietary phytoestrogen intake and urinary phytoestrogen; estradiol; follicle-stimulating hormone; and luteinizing hormone. RESULTS: Only participants in the HRT group showed a mean reduction in cholesterol and low-density lipoprotein cholesterol that was significantly different from that of the control group. No significant changes in lipid profile or follicle-stimulating hormone and luteinizing hormone were observed in the PL group compared with the controls. However, both the HRT and PL groups showed an improvement in Mini-Mental State Examination score and attention span compared with the case of participants receiving no treatment. HRT and PL had different effects on cognitive function; HRT improved delayed recall, whereas flexible thinking seemed improved in the PL group. CONCLUSIONS: This study was unable to demonstrate a scientific basis for the use of PL for improving the health of postmenopausal women in general. However, the effect of PL on cognitive function deserves further study.

Lau EM, Woo J, Chan YH, Li M. · Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong. · Bone. · Pubmed #11728919 No free full text.

Abstract: One hundred women on inhaled steroid therapy (dose range from 800 to <1600 microg per day) were randomized to receive 10 mg of oral alendronate or placebo (with 500 mg of calcium in the form of daily calcium carbonate). Bone mineral density (BMD) was measured at baseline, 6 months, and 12 months. The percentage changes in BMD were -0.80% in the placebo group and 2.99% in the alendronate group at the spine (p < 0.001 by analysis of covariance [ANCOVA]), and were -0.51% in the placebo group and 0.97% in the alendronate group at the femoral neck (p < 0.05 by ANCOVA). Five patients in the alendronate-treated group, and a similar number of patients in the placebo group, complained of mild gastric discomfort. We conclude that women on inhaled steroid therapy were at risk of accelerated bone loss, which could be prevented by a daily dose of 10 mg of alendronate.

Lau EM, Woo J, Lam V, Hong A. · Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong. · J Bone Miner Res. · Pubmed #11547841 No free full text.

Abstract: The Chinese diet is low in calcium (less than 500 mg/day on average), and previous observational studies have suggested an association between a low calcium intake and risk of hip and vertebral fracture. In this study, we randomly assigned 200 postmenopausal Chinese women (age range, 55-59 years) to receive 50 g of milk powder containing 800 mg of calcium per day or to a control group. The following are the mean percentage changes (and SEs) in height and bone mineral density (BMD) over 24 months: for height, -0.1 +/- 0.2 cm in the milk supplementation group and -0.2 +/- 0.1 cm in the control group; for BMD at the total hip, -0.06 +/- 0.22% in the milk supplementation group and -0.88 +/- 0.26% in the control group; for BMD at the spine (L1-L4), -0.56 +/- 0.29% in the milk supplementation group and -1.5 +/- 0.29% in the control group; for total body BMD, -0.32 +/- 0.16% in the milk supplementation group and -1.2 +/- 0.19% in the control group (p < 0.05 by analysis of covariance [ANCOVA] for repeated measures for height and BMD at all sites). The milk supplementation group had less loss in terms of both height and BMD than the control group (p < 0.05 by ANCOVA for repeated measures). Serum parathyroid hormone (PTH) concentration was lower and serum 25-hyroxyvitamin D [25(OH)D] level was higher in the milk supplementation group than the control group at 12 months (p < 0.05 by paired t-test). We conclude that supplementing the diet of postmenopausal Chinese women with high calcium milk powder retards bone loss.

Lau EM, Woo J, Chan YH, Griffith J. · Department of Community and Family Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, People's Republic of China. · Bone. · Pubmed #11062355 No free full text.

Abstract: The objectives of the Hong Kong study are to investigate the efficacy of 10 mg alendronate in preventing bone loss at the hip and spine in osteoporotic Chinese women. One hundred osteoporotic Chinese women, aged 60-79 years, were randomized to receive 10 mg of alendronate or placebo, with 500 mg elemental calcium. Bone mineral density (BMD) at the spine and hip were measured at baseline, 6 months, and 12 months. Seventy-eight subjects completed the study. The alendronate-treated group gained more bone at both the spine (p < 0.01) and femoral neck (p < 0.001), with a mean difference (+/-SE) of 2.4% (+/-0.86%) at the spine and 3.98% (+/-0.95%) at the femoral neck. Of the 100 patients, 6 subjects in the alendronate group and 5 subjects in the placebo group had mild gastrointestinal symptoms. We conclude that alendronate (10 mg) was effective in preventing bone loss in postmenopausal osteoporotic Chinese women.

Woo J, Kwok T, Leung J, Tang N. · Department of Medicine and Therapeutics, The Chinese University of Hong Kong, NT, Hong Kong. · J Hum Hypertens. · Pubmed #19092844 No free full text.

Abstract: Both hypertension and osteoporosis have common underlying nutritional aetiology, with regards to dietary cations intake. We tested the hypothesis that sodium intake reflected in urinary Na/Cr and blood pressure would be negatively associated with bone mineral density (BMD), whereas other cations may have opposite associations. Subjects were part of a study of bone health in 4000 men and women aged 65 years and over. A total of 1098 subjects who were not on antihypertensive drugs or calcium supplements and who provided urine samples were available for analysis. Logistic regression was used to examine associations between total hip and lumbar spine BMD, age, gender, body mass index (BMI), urinary Na/Cr, K/Cr, calcium and magnesium intake, systolic blood pressure and diastolic blood pressure. Total hip BMD was inversely associated with age, being female and urinary Na/Cr, and positively associated with BMI, urine K/Cr and dietary calcium intake. Lumbar spine BMD was inversely associated with being female and urinary Na/Cr, and positively associated with BMI, dietary calcium intake and SBP. We conclude that sodium intake, reflected by urinary Na/Cr, is the major factor linking blood pressure and osteoporosis as shown by the inverse relationship with BMD. The findings lend further emphasis to the health benefits of salt reduction in our population both in terms of hypertension and osteoporosis.

Auyeung TW, Kwok T, Lee J, Leung PC, Leung J, Woo J. · Jockey Club Center for Osteoporosis Care and Control, Hong Kong, SAR, China. · Neuroepidemiology. · Pubmed #18784415 No free full text.

Abstract: BACKGROUND: Physical function decline is associated with dementia, which might either be mediated by the coexisting sarcopenia or directly related to the impaired cognition. Our objectives are to examine the relationship between cognitive function and performance-based physical function and to test the hypothesis that cognitive function is related to poor physical function independent of muscle mass. METHODS: We measured muscle strength, performance-based physical function and muscle mass using dual-energy X-ray absorptiometry and cognitive function using the cognitive part of the Community Screening Instrument of Dementia (CSI-D) in 4,000 community-dwelling Chinese elderly aged >65 years. A CSI-D cognitive score of >28.40 was considered as cognitively impaired. The effect of cognitive impairment on muscle strength and physical function was analyzed by multivariate analysis with adjustment for age, appendicular skeletal mass (ASM), the Physical Activity Scale for the Elderly (PASE) and other comorbidities. RESULTS: In both genders, the cognitively impaired (CSI-D cognitive score >28.40) group had a weaker grip strength (-5.10 kg, p < 0.001 in men; -1.08 kg in women, p < 0.001) and performed worse in the two physical function tests (in men, 6-meter walk speed, -0.13 m/s, p < 0.001, chair stand test, 1.42 s, p < 0.001; in women, 6-meter walk speed, -0.08 m/s, p < 0.001, chair stand test, 1.48 s, p < 0.001). After adjustment for age, ASM, PASE and other comorbidities, significant differences in grip strength (-2.60 kg, p < 0.001 in men; -0.49 kg, p = 0.011 in women) and the two physical function tests persisted between the cognitively impaired and nonimpaired group (in men, 6-meter walk speed, -0.072 m/s, p < 0.001, chair stand test, 0.80 s, p = 0.045; in women, 6-meter walk speed, -0.049 m/s, p < 0.001, chair stand test, 0.98 s, p < 0.001). CONCLUSIONS: Poor physical function and muscle strength coexisted with cognitive impairment. This relationship was independent of muscle mass. It is likely therefore that the functional decline in dementia might be related directly to factors resulting in cognitive impairment independently of the coexisting sarcopenia.

Lynn HS, Woo J, Leung PC, Barrett-Connor EL, Nevitt MC, Cauley JA, Adler RA, Orwoll ES, Anonymous00013. · Department of Biostatistics, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China. · Osteoporos Int. · Pubmed #18239959 No free full text.

Abstract: SUMMARY: No large-scale evaluations of osteoporosis screening tools have been done in men. OST and MOST were examined among 4658 US Caucasian and 1914 Hong Kong Chinese men. Both tools have high negative predictive values, accurately screening out men with low risk, and saving a third of DXA tests. INTRODUCTION: Prior investigations have studied the performance of osteoporosis screening tools in women, but no large-scale evaluations have been done in men. METHODS: This study examines the performance of the Osteoporosis Self-assessment Tool (OST), the Male Osteoporosis Screening Tool (MOST), quantitative ultrasound index (QUI), and body weight as screening tools. Osteoporosis was defined by a dual-energy X-ray absorptiometry (DXA) measured bone mineral density (BMD) T-score < or =-2.5. Four thousand six hundred and fifty-eight US Caucasian and 1914 Hong Kong Chinese men, aged > or =65 years and community-dwelling, were included in the analysis. Receiver operating characteristic (ROC) analysis was used to compare the area under the ROC curve (AUC) between different screening tools. RESULTS: MOST had a significantly larger AUC (> or =0.8) than OST, QUI, and body weight in detecting osteoporosis. Using the second tertile as cutoff, OST and MOST yielded sensitivities of around 90% and negative predictive values (NPVs) of >97%, accurately screening out Caucasian and Chinese men with low risk of osteoporosis. CONCLUSIONS: OST and MOST can effectively rule out osteoporosis for both Caucasian and Chinese men, and compared to referring men 65 years and older for BMD DXA testing, they save a third of DXA resources.

Chan RS, Woo J, Chan DC, Cheung CS, Lo DH. · Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China. · Eur J Clin Nutr. · Pubmed #18231119 No free full text.

Abstract: BACKGROUND/OBJECTIVES: To examine the daily intake of bone health-related nutrients and to explore the association between diet composition and estimated net endogenous acid production (estimated NEAP) in Hong Kong Chinese adolescents. SUBJECT/METHODS: In total, 171 boys and 180 girls aged 10-12 years of Chinese origin from nine primary schools from the Hong Kong Adolescent Bone Health Cohort Study. The study design used food frequency questionnaire. Mean daily intakes of foods and selected nutrients were estimated. Mean percentage of nutrient intake contributed by different food groups was presented. Frassetto's method was used to calculate the estimated NEAP from the diet's protein to potassium ratio. RESULTS: There was no significant difference in the energy-adjusted intakes of most nutrients between boys and girls, except for intakes of vitamins C and D. Mean protein, sodium and potassium intakes were higher than the Chinese dietary reference intake (DRI), whereas mean intakes of magnesium, calcium and vitamin D were lower than the DRI. Boys had significantly higher estimated NEAP than girls (P=0.0051). Estimated NEAP was significantly positively correlated with meat intake and negatively associated with the consumption of fruits, vegetables, legumes, beverages and dairy products. CONCLUSIONS: The results highlight the importance of considering whole diet quality when interpreting the effects of single nutrient or diet's net acid load on bone. The effect on high protein intake and low fruit and vegetable intake on the long-term bone health of Hong Kong Chinese adolescents warrants attention.

Woo J, Leung J, Kwok T. · Department of Medicine and Therapeutics, Jockey Club Osteoporosis Centre, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. Hong Kong. · Obesity (Silver Spring). · Pubmed #17636108 No free full text.

Abstract: OBJECTIVE: Recent studies have emphasized the importance of muscle and fat mass in relation to age-related decline in physical function. Our objective was to determine whether BMI, as a surrogate measurement of fat mass, may be used as a measure of risk factor for physical functioning in older adults and whether body composition measurements confer any advantage over BMI. RESEARCH METHODS AND PROCEDURES: Four thousand men and women>or=65 years of age living in the community, stratified by age and sex, underwent the following measurements: body composition by DXA; grip strength; and timed 6-m walk. Subjects were grouped into five categories of BMI using Asian criteria for health-related risks, and between-group differences in physical performance measures and body composition were analyzed using analysis of covariance adjusting for age, physical activity level, and presence of chronic disease. RESULTS: Subjects in the two obese categories had a significantly greater number of instrumental activities of daily living (IADL) impairments compared with the underweight and normal-weight groups. Those with BMI>or=30 kg/m2 had the worst walking performance, and the groups with BMI in the normal and overweight range had optimal performance. Fat mass, but not appendicular muscle mass, was associated with walking speed after adjusting for BMI. DISCUSSION: Fat mass seems to be a more important factor than appendicular muscle mass in determining walking speed in community-living older adults, even after adjusting for BMI.

Griffith JF, Yeung DK, Antonio GE, Wong SY, Kwok TC, Woo J, Leung PC. · Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, Hong Kong SAR, China. · Radiology. · Pubmed #17053202 links to  free full text

Abstract: PURPOSE: To prospectively study the relationship among vertebral marrow fat content, marrow diffusion indexes, and marrow and erector spinae muscle perfusion indexes in female subjects with varying bone mineral density. MATERIALS AND METHODS: Institutional study approval and informed consent were obtained. Dual x-ray absorptiometry, proton magnetic resonance (MR) spectroscopy, diffusion-weighted MR imaging, and dynamic contrast material-enhanced MR imaging of the lumbar spine and erector spinae muscle were performed in 110 women (mean age, 73 years; range, 67-84 years). Marrow fat content, marrow apparent diffusion coefficient (ADC), and perfusion indexes (maximum enhancement and enhancement slope) of marrow and erector spinae muscle were compared among three bone density groups (normal, osteopenic, and osteoporotic). The t test comparisons and Pearson correlations were applied. RESULTS: Seven subjects were excluded, which yielded a final cohort of 103 subjects: 18 with normal bone density, 30 with osteopenia, and 55 with osteoporosis. Vertebral marrow fat content was significantly increased in the osteoporotic group (67.8% +/- 8.5 [standard deviation]) when compared with that of the normal bone density group (59.2% +/- 10.0, P = .002). Vertebral marrow perfusion indexes were significantly decreased in the osteoporotic group (enhancement slope, 1.10%/sec +/- 0.51) compared with those of the osteopenic group (1.45%/sec +/- 0.51, P = .01) and normal bone density group (1.70%/sec +/- 0.52, P < .001). Erector spinae muscle perfusion indexes did not decrease as bone density decreased. The ADC of vertebral marrow did not change with bone density. CONCLUSION: The subjects experienced a decrease in vertebral marrow maximum enhancement and enhancement slope and an increase in marrow fat content as bone density decreased. The reduction in perfusion indexes occurred only within the vertebral body and not in the paravertebral tissues supplied by the same artery.

Lynn H, Kwok T, Wong SY, Woo J, Leung PC. · School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, People's Republic of China. · Bone. · Pubmed #16257280 No free full text.

Abstract: Hypertension and osteoporosis are two major chronic diseases affecting the elderly. A cross-sectional study of 3887 Chinese men (n = 1958) and women (n = 1929) was used to explore the association between angiotensin converting enzyme inhibitor (ACEI) use and bone mineral density (BMD). The participants were aged 65 years and above, and were recruited using a combination of private solicitation and public advertising from community centers, housing estates, and the general community in Hong Kong. Demographic, medical, and lifestyle information was obtained from face to face interviews using standardized questionnaire, and physical examination measurements included anthropometry, tibial, and brachial systolic blood pressures, femoral neck, total hip, and lumbar spine BMD. In multiple regression analyses, after adjusting for age, weight, height, thiazide, beta-blocker, calcium channel blocker, statin, corticosteroid, and calcium supplement use, history of diabetes, heart disease, peripheral vascular disease, cigarette smoking, alcohol intake, and physical activity level, ACEI use was associated with higher femoral neck BMD (+0.015 g/cm2, P = 0.035) in women, and higher femoral neck (+0.015 g/cm2, P = 0.017), total hip (+0.016 g/cm2, P = 0.021), and lumbar spine (+0.043 g/cm2, P < 0.001) BMD in men. Thiazide use was associated with higher BMD at all three sites in general, although associations with BMD increase at the total hip (P = 0.07) and femoral neck (P = 0.09) were weak in men. Calcium channel blocker use was only significantly associated with BMD increase at the lumbar spine (P = 0.03) in women, and beta-blocker use did not have significant associations with BMD at any site. This study suggests that in addition to thiazide diuretics ACEI may have possible benefits in treating not only hypertension but also osteoporosis among older Chinese.

Lau EM, Leung PC, Kwok T, Woo J, Lynn H, Orwoll E, Cummings S, Cauley J. · Hong Kong Orthopaedic and Osteoporosis Center for Treatment and Research, Unit 1301, Hing Wai Building, 36 Queen's Road Central, Hong Kong, China. · Osteoporos Int. · Pubmed #16175311 No free full text.

Abstract: Mr. Os (Hong Kong) is the first study to address the risk factors for osteoporosis in Asian men. A standardized, structured interview and dual X-ray densitometry (DEXA) were performed on 2,000 Chinese men aged 65-92. By multiple regression, the following factors were found to be positively associated with BMD at both the total hip and the spine: body weight, grip strength and a history of diabetes mellitus. The following factors were found to be negatively associated with BMD at both the total hip and spine: cigarette smoking, a history of gastrectomy or bowel resection, current use of inhaled steroid and a history of fracture after 50 years. Moreover, a history of chronic obstructive pulmonary disease (COPD) was negatively associated with BMD at the total hip, and age, the use of an alpha-blocker, thiazide diuretic and nitrate were associated with a higher BMD at the spine. A total of 21.8% of the variance in total hip and 31.5% of the variance in total spine BMD was accounted for in the multivariate analysis.

Kim J, Um SJ, Woo J, Kim JY, Kim HA, Jang KH, Kang SA, Lim BO, Kang I, Choue RW, Cho Y. · Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Hoeki-dong 1, Dongdaemoon-gu, Seoul 130-701, Republic of Korea. · Life Sci. · Pubmed #16109431 No free full text.

Abstract: The seeds of Rhynchosia volubilis (SRV) (Leguminosae) and soybean have been used in oriental folk medicine to prevent postmenopausal osteoporosis. Their beneficial effects are caused by a high content of isoflavone, which function as partial agonists or antagonists of estrogen. To compare the estrogenic effects of SRV and soybean on the MG-63 osteoblastic cell proliferation, 70% methanol extracts of SRV or soybean were treated on MG-63 cells. Although biphasic over a concentration range of 0.001 mg/ml-0.1 mg/ml, both SRV and soybean extracts increased MG-63 cell proliferation. However SRV was more effective at increasing the cell proliferation that paralleled with the greater estrogenic effects as determined by estrogen receptor alpha (ERalpha) expression, an estrogenic response element (ERE)-luciferase activity and the selective expression of insulin-like growth factor-I (IGF-I). SRV-induced IGF-I expression resulted from increases in the mRNA levels. Despite the increased expression of ERbeta, ERE activity and IGF-I expression by soybean were lower than those by SRV. Furthermore, the comparable estrogenic effects between SRV and the combined treatment of genistein and daidzein standards at 0.5 x 10(-8) M, which is a concentration of these two isoflavones similar to that of SRV at 0.001 mg/ml, demonstrate that the greater estrogenicity of SRV for MG-63 cell proliferation is mediated by the synergism of low levels of isoflavones for the selective expression of IGF-I.

Wong SY, Kwok T, Woo J, Lynn H, Griffith JF, Leung J, Tang YY, Leung PC. · Department of Community and Family Medicine, Chinese University of Hong Kong, Shatin NT, Hong Kong. · Osteoporos Int. · Pubmed #16079958 No free full text.

Abstract: Previous population studies have demonstrated an association between peripheral vascular disease and bone mineral density in women, but not in men. In a large prospective cohort of 3,998 Chinese men and women aged 65 to 92 years of age in Hong Kong, the association between peripheral vascular disease and bone mineral density was explored. Demographic and lifestyle information was obtained from face to face interviews using a standardized questionnaire. This included demographic information, medical history and lifestyle factors. Physical examination measurements included anthropometry and tibial and brachial systolic blood pressures. The ratio of the posterior tibial and brachial systolic blood pressures, the ankle/arm index, was used as a measure of peripheral arteriosclerosis in the lower extremities. Bone mineral density (BMD) at the total hip and spine (L1-L4) was measured by Hologic QDR-4500 W densitometers (Hologic, Inc., Waltham, Mass.). In this cross-sectional analysis, the ankle brachial index (ABI) was positively correlated with hip BMD (correlation coefficient=0.27; P<0.001). However, after adjustment for confounders, the correlation became much weaker (correlation coefficient=0.03; P<0.05). This showed that much of the relationship between ABI and BMD could be explained by other confounders. In multiple regression analysis, an increase in ABI of 1 SD of ABI was associated with an increase of 0.5% (95% CI: 0.02%, 0.9%) in hip BMD after adjusting for age, sex, body weight, smoking status, history of diabetes, cardiovascular diseases, use of thiazide diuretics, grip strength and physical activity. Although our study shows that peripheral vascular disease in the lower extremities may be associated with decreased bone mineral density, the association is weak especially after adjustment was made for confounders. This indicates that other factors may be contributing to the association between peripheral vascular disease and osteoporosis.

Yeung DK, Griffith JF, Antonio GE, Lee FK, Woo J, Leung PC. · Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR, China. · J Magn Reson Imaging. · Pubmed #16028245 No free full text.

Abstract: PURPOSE: To use proton magnetic resonance spectroscopy ((1)H-MRS) to evaluate vertebral marrow fat, and to determine whether bone density correlates with fat content and fat unsaturation levels in postmenopausal women. MATERIALS AND METHODS: Fifty-three women (mean age = 70 years) underwent dual energy x-ray absorptiometry and (1)H-MRS, and 12 young female controls (mean age = 28 years) underwent (1)H-MRS of the lumber spine. Water and lipid peak amplitudes were measured to calculate fat content and fat unsaturation index. Spearman's correlation tests and a t-test comparison of means were applied. RESULTS: (1)H-MRS was successful in 15 normal, 15 osteopenic, and 20 osteoporotic subjects, and in all controls. Marrow fat content was significantly elevated in osteoporotic (65.5% +/- 10%) and osteopenic (63.5% +/- 9.3%) subjects compared to normal subjects (56.3% +/- 11.2%) and young controls (29% +/- 9.6%). The fat unsaturation index was significantly decreased in osteoporotic (0.091 +/- 0.013) and osteopenic (0.097 +/- 0.014) subjects compared to normal subjects (0.114 +/- 0.016) and young controls (0.127 +/- 0.031). A good inverse correlation was observed between the fat content and the unsaturation index (r(s) = -0.53, P < 0.0001). CONCLUSION: Osteoporosis is associated with increased marrow fat. As marrow fat increases, saturated lipids appear to increase preferentially to unsaturated lipids.

Chan WM, Woo J, Hui E, Lau WW, Lai JC, Lee D. · Jockey Club Center for Osteoporosis Care and Control, School of Public Health, The Chinese University of Hong Kong, China. · Appl Nurs Res. · Pubmed #15991104 No free full text.

Abstract: A primary care group diabetes care program using telemedicine was developed and its feasibility and acceptability were tested in 22 subjects with Type 2 diabetes mellitus using a one-group, pretest-posttest quasi-experimental design. Compliance with the program was 100%. Significant reductions in total calorie intake as well as body mass index were achieved, with an increase in the percentage of subjects achieving better diabetes control as measured by the 2-hr hemastix. Improvements in diabetes knowledge and disease-specific and generic measures of quality of life were also observed. Most subjects evaluated this mode of service delivery favorably in the questionnaire and focus group discussions. There is potential for the integration of this mode of service delivery into current health services.

Wong SY, Lau EM, Li M, Chung T, Sham A, Woo J. · Department of Community and Family Medicine, School of Public Health, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong. · J Bone Miner Metab. · Pubmed #15838630 No free full text.

Abstract: Apolipoprotein E (Apo E) polymorphism has been implicated in many chronic diseases, including Alzheimer disease and osteoporosis. Significant association of the Apo E4 allele to low bone mineral density (BMD) has been repeatedly reported. We here examined the Apo E genotype frequencies in the Chinese population (n = 692) and its relationship to BMD. A significantly lower frequency (a prevalence of 7%) of the E4 alleles was found in our Chinese subjects compared to that reported in Caucasians (14.7%) or in Japanese (11.7%). However, no significant association between the Apo E4 allele and BMD Z score was observed in our test subjects; this may be due to the rarity of the Apo E4 allele frequency in Chinese, which requires a larger sample size for detection of significant association. Significant associations detected between Apo E2 allele and BMD at the femoral neck in elderly women (P = 0.02) and at the spine in elderly men (P = 0.03) were in the opposite direction and thus regarded as false-positive results. It is concluded that the Apo E4 allele is rare in Chinese, and a larger population size is needed to see if Apo E4 is associated with BMD in Chinese.

Wong SY, Lau EM, Lynn H, Leung PC, Woo J, Cummings SR, Orwoll E. · 4/F, Department of Community and Family Medicine, School of Public Health, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. · Osteoporos Int. · Pubmed #15448988 No free full text.

Abstract: Previous epidemiological study has suggested that depression might be associated with low bone mass in Caucasian women. This has not been studied in Asian men. Mr. Os (Hong Kong) is the first, large, cohort study on osteoporosis in Asian men, and the current analysis deals with the association between depression and bone mass in this group. Data from the baseline examination of Mr. Os (Hong Kong) were used. Two thousand Hong Kong men aged 65 to 92 years were recruited from the community. Depression was diagnosed by face-to-face interview, using a validated Chinese version of the Geriatric Depression Scale (GDS), with depression being defined as a cut-off score of 8 or more. Bone mineral density (BMD) of the lumbar spine, total hip and total body was measured by dual X-ray densitometry (DEXA) using the Hologic QDR-4500 W densitometer. Multiple regression was used to compare BMD in depressed and non-depressed subjects, controlling for confounding variables. In the study sample 8.5% of men were found to be depressed, and the BMD at the total hip in these subjects was 2.1% lower than in non-depressed subjects (95% CI -0.13 to -4.1), after adjustment for age, body weight, medical history, alcohol consumption, cigarette smoking, calcium intake, physical activity and antidepressant use. Depression was associated with a 1.4-fold (95% CI 1.00 to 2.08) relative risk (RR) of being diagnosed with a T-score equal to or less than -1.0 (low bone mass). We conclude that depression is associated with lower BMD; however, to determine whether depression causes lower BMD or vice versa, we will need to await findings from future prospective studies.

Lau EM, Choy DT, Li M, Woo J, Chung T, Sham A. · Department of Family and Community Medicine, Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Shatin, Hong Kong. · Calcif Tissue Int. · Pubmed #15085313 No free full text.

Abstract: Polymerase chain reaction was used to amplify across variable restriction sites of the COLI A1 and COLI A2 genes that encode the alpha 1 and 2 subunits of type I collagen. The relationship between these polymorphisms and bone mineral density (BMD) was studied in 683 Chinese men and women. In 100 men and women, COLI A1 Sp1 polymorphism was not found, which was consistent with other previous studies in Asian populations. However a statistically significant relationship was observed between COLI A2 Eco R1 and Puv II genotypes among the Chinese men studied. The mean BMD was consistently lower in men of the EE and PP genotype (P < 0.05 by analysis of variance [ANOVA]) than in men of the ee and pp genotypes. However, no association between BMD and the Eco R1 or Puv II genotypes was observed in Chinese women (P > 0.05 by ANOVA). We conclude that the COLI Al Sp1 binding site is absent in Hong Kong Chinese, whereas the COLI A2 Eco R1 and Puv II genetic polymorphisms may be associated with the BMD of elderly Chinese men.

Lau EM, Wong SY, Li M, Ma CH, Lim PL, Woo J. · Department of Family and Community Medicine, Chinese University of Hong Kong, Hong Kong. · J Bone Miner Metab. · Pubmed #14999526 No free full text.

Abstract: Transforming growth factor-beta-1 (TGF-Beta(1)) has been implicated in bone mineral density (BMD) determination. We investigated the relationship between the TGF polymorphism, BMD, and vertebral fractures in 588 Chinese men and women. No association between TGF polymorphism and BMD was observed in postmenopausal women (aged 55-59 years), elderly men (aged 70-79 years), or elderly women (aged 70-79 years) at the hip, spine, or total body ( P >> 0.05 by two-way ANOVA). In all study groups, there was no effect of an interaction between TGF polymorphism and calcium intake on BMD ( P >> 0.05 for the interaction effects by two-way ANOVA). No statistical significant association was observed between TGF polymorphism and vertebral fracture in elderly men or women ( P >> 0.05 by the chi-square test), even though men of the TT and TC genotypes seem to have more vertebral fractures. Contrary to previous studies that found an association between BMD and TGF polymorphism in the Japanese, we found no association between TGF polymorphism and BMD of elderly Chinese men or women. This finding could result from different sampling methods between the previous and current studies and environmental factors and ethnic differences between the two populations.

Qin L, Au SK, Leung PC, Lau MC, Woo J, Choy WY, Hung WY, Dambacher MA, Leung KS. · Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong. · Osteoporos Int. · Pubmed #12459939 No free full text.

Abstract: The current study was designed to investigate the rate of bone loss in distal radius and its association with baseline volumetric bone mineral density (BMD) and years since menopause (YSM) in peri- and postmenopausal women using precise and multislice peripheral quantitative computed tomography (pQCT; Densiscan 2000). Two hundred and five healthy Hong Kong Chinese perimenopausal ( n = 26) and postmenopausal ( n = 179) women within 10 years of the onset of menopause were recruited. Anthropometric parameters and menstrual status were also measured. The linear regression model derived from the baseline volumetric BMD revealed a significant and slightly better correlation with YSM than age, with a YSM-related annual decline of 2.56%, 1.82% and 0.65% in trabecular BMD (tBMD), integral BMD (iBMD) and cortical BMD (cBMD), respectively. Follow-up measurements after a time interval of 12 months showed that the rate of bone loss was higher than the annual decline in BMD calculated from the baseline BMD, with decreases of 2.89%, 2.16% 0.91% in tBMD, iBMD and cBMD, respectively. Baseline BMD was associated with age or YSM ( r ranges from -0.283 to -0.502; p<0.001 in all cases), but no relationship was found between annual rate of bone loss and age or YSM. The rate of bone loss did not correlate with baseline volumetric BMD values or YSM after dividing the subjects into fast bone losers (with annual tBMD loss > or =3%), normal bone losers (with annual tBMD loss > or = 1% but <3%) or slow bone losers (with annual tBMD loss <1%). The rate of bone loss was greater in both trabecular and cortical bone of postmenopausal women within the first 3 menopausal years but was only significant in the iBMD as compared with perimenopausal and postmenopausal women over 7 years after onset of menopause. The percentage distribution of slow and fast bone losers was not found to be associated with YSM. As a total of only 4 fracture cases were documented, the study could not provide conclusive information on whether perimenopausal and early postmenopausal baseline volumetric BMD or rate of bone loss determines the development of osteoporosis or fracture occurrence.