Assessment of determinants for osteoporosis in elderly men

Summary  The aim of this cross-sectional study was to determine and quantify some determinants associated to low bone mineral density (BMD) in elderly men. This study showed that ageing, a lower body mass index (BMI), a higher blood level of C-terminal cross-linking telopeptides of type I collagen (CTX-1), family history of osteoporosis, and/or fracture and prior fracture were associated with bone mineral density. Introduction  Our aims were to identify some determinants associated to low bone mineral density in men and to develop a simple algorithm to predict osteoporosis. Methods  A sample of 1,004 men aged 60 years and older was recruited. Biometrical, serological, clinical, and lifestyle determinants were collected. Univariate, multivariate, and logistic regression analyses were performed. Receiver operating characteristic analysis was used to assess the discriminant performance of the algorithm. Results  In the multiple regression analysis, only age, BMI, CTX-1, and family history of osteoporosis and/or fracture were able to predict the femoral neck T-score. When running the procedure with the total hip T-score, prior fracture also appeared to be significant. With the lumbar spine T-score, only age, BMI, and CTX-1 were retained. The best algorithm was based on age, BMI, family history, and CTX-1. A cut-off point of 0.25 yielded a sensibility of 78%, a specificity of 59% with an area under the curve of 0.73 in the development and validation cohorts. Conclusion  Ageing, a lower BMI, higher CTX-1, family history, and prior fracture were associated with T-score. Our algorithm is a simple approach to identify men at risk for osteoporosis.     

Treatment of osteoporosis in men

Osteoporosis in men is recognised worldwide as an important and increasing public health problem. The causes are more heterogeneous than those in women. About 50% are diagnosed as secondary cases. In some secondary forms of osteoporosis the specific diagnosis results in additional therapeutic options (e.g. androgen therapy in proven hypogonadism). The basic therapy for osteoporosis in men is no different to that in postmenopausal women, namely recommendations for counteracting modifiable risk factors, especially with regard to diet, physical exercise, and calcium and vitamin D supplementation. Concerning specific drug medications, however, even today there is still a therapeutic dilemma in male osteoporosis. While older substances (e.g. calcitonin, fluoride, alfacalcidol) are approved for both sexes, all newer medications have primarily been approved for the treatment of postmenopausal osteoporosis. Health authorities request studies in purely male populations. For new drugs, fracture data are necessary while for new substances within a class (e.g. bisphosphonates), at the very least consistent effects on bone mineral density (BMD) and bone turnover markers are requested. Due to these regulatory rules, ibandronate, teriparatide and strontium ranelate are not approved in the European Union. Some years ago, alendronate was the first bisphosphonate that was approved for the treatment of men with osteoporosis, based on consistent results from two independent male studies using a daily 10 mg dosage. Very recently risedronate was approved by the FDA and EMEA. A randomised, placebo-controlled multicentre trial of 285 male patients showed, after 2 years, a 5.8% increase in lumbar spine BMD in the risedronate 35 mg once weekly group vs 1.2% in the placebo group. In a prospective controlled study on 316 men with primary or secondary osteoporosis we found, after 12 months, a lumbar spine BMD of +4.7% vs +1.0% in controls. The number of patients with one or more new vertebral fractures was 8 in the risedronate group and 20 in the placebo group (a fracture reduction of 60%). Furthermore, we found a significantly smaller decrease in height and a steeper decrease in back pain in the risedronate group. Risedronate is the first oral bisphosphonate available for men with the more comfortable once weekly dosage.     

The near absence of osteoporosis treatment in older men with fractures

The burden of osteoporotic fractures in older men is significant. The objectives of our study were to: (1) characterize older men with fractures associated with osteoporosis, (2) determine if medication treatment rates for osteoporosis are improving and (3) identify patient, healthcare benefit and utilization, and clinician characteristics that are significantly associated with treatment. This retrospective cohort study assessed 1,171 men aged 65 or older with any new fracture associated with osteoporosis between 1 January 1998 and 30 June 2001 in a non-profit health maintenance organization in the United States. Multiple logistic regression was used to evaluate pre-fracture factors for their association with osteoporosis treatment in the 6-month post-fracture period. The main outcome measure was pharmacologic treatment for osteoporosis in the 6 months after the index fracture. Subjects average age was 76.7 years; 3.3% had a diagnosis of osteoporosis and 15.2% a diagnosis or medication associated with secondary osteoporosis. Only 7.1% of the study population and 16.0% of those with a hip or vertebral fracture received a medication for osteoporosis following the index fracture, and treatment rates did not improve over time. In the multivariate model, factors significantly associated with drug treatment were a higher value on the Charlson Comorbidity Index (odds ratio 1.26, 95% confidence interval 1.05–1.51), having an osteoporosis diagnosis (odds ratio 8.11, 95% confidence interval 3.08–21.3), chronic glucocorticoid use (odds ratio 5.37, 95% confidence interval 2.37–12.2) and a vertebral fracture (odds ratio 16.6, 95% confidence interval 7.8–31.4). Bone mineral density measurement was rare ( n =13, 1.1%). Our findings suggest that there is under-ascertainment and under-treatment of osteoporosis and modifiable secondary causes in older men with fractures. Information systems merging diagnostic and treatment information can help delineate gaps in patient management. Interventions showing promise in other conditions should be evaluated to improve care for osteoporosis.     

资阳地区定量超声跟骨骨量测定的流调分析

目的调查四川资阳地区健康人群骨密度值及骨质疏松患病率,为骨质疏松的诊断和防治提供科学依据。方法对资阳地区人群亚群抽样1976例,应用日本FURUNO公司生产的超声骨量测定仪CM100测试受试者的右跟骨的超声速度(SOS)值。结果男女骨量峰值(PBM)均出现在20～39岁组,随年龄增加骨量逐渐下降。女性50岁以后骨量丢失明显加快,60～69岁年龄组骨量丢失最快;男性70岁以后骨量丢失明显加快。80岁以前各年龄组女性骨量丢失明显高于男性,80岁以后男性骨量丢失高于女性,但累计骨量丢失女性仍明显高于男性。结论骨量随年龄增长而下降,骨质疏松发病率也随之增加。女性骨量丢失明显高于男性,女性骨质疏松发病率也明显高于男性。     

Longitudinal changes in bone mass after one year as measured by different techniques in patients with osteoporosis

Summary Bone mass was measured in 49 post-menopausal women by the following techniques: single photon absorptiometry at the radius (SPA), dual photon absorptiometry at the lumbar spine (DPA), quantitative computed tomography at the lumbar spine with an area of interest of only trabecular bone (QCT) or of an integrated cross-section of the vertebral body (QCTi), and total body calcium by neutron activation analysis (TBCa). Each women had two measurements with a one-year interval. Half of them were treated with calcium supplementation only; the other half also received calcitriol (1,25 dihydroxycholecalciferol). The aim of this report was to compare the changes of bone mass as measured by the different techniques. The DPA and QCTi values were significantly lower at one year than at baseline (by paired t-tests). The mean percent changes (±SD) for the measurements were: TBC, −0.4 ±4.6%; SPA-1, 1.2±7.1%; SPA-2, 0.7±6.0%; DPA, −2.5±11%; QCT, 6.5±23%; and QCTi, −6.0±9%. The percent changes by one technique did not show significant correlation to the percent changes by the other methods. We conclude that the precision of the methods in this clinical setting is not sufficient to show correlations after only one year; in additon, there may have been different rates of changes at different sites of the skeleton.     

Lumbar spine peak bone mass and bone turnover in men and women: a longitudinal study

Summary  Peak bone mass is an important determinant of bone mass in later life, but the age of peak bone mass is still unclear. We found that bone size and density increase and bone turnover decreases until age 25. It may be possible to influence bone accrual into the third decade. Introduction  Peak bone mass is a major determinant of bone mass in later life. Bone growth and maturation is site-specific, and the age of peak bone mass is still unclear. It is important to know the age to which bone accrual continues so strategies to maximise bone mass can be targeted appropriately. This study aims to ascertain the age of lumbar spine peak bone mass. Methods  We measured lumbar spine BMC, estimated volume and BMAD by DXA and biochemical markers of bone turnover in 116 healthy males and females ages 11 to 40, followed up at an interval of five to nine years. Results  The majority of peak bone mass was attained by the mid-twenties. Increases in BMC in adolescents and young adults were mostly due to increases in bone size. Bone turnover markers decreased through adolescence and the third decade and the decreasing rate of change in bone turnover corresponded with the decreasing rate of change in lumbar spine measurements. Conclusions  Skeletal maturation and bone mineral accrual at the lumbar spine continues into the third decade.     

上海市居民经3年干预后骨密度值测定及骨质疏松患病率的调查

目的　研究综合性干预措施对居民骨密度值 (BMD)及骨质疏松 (OP)患病率的影响 ,为OP的防治提供科学依据。方法　用整群随机抽样方法从上海市卢湾区 30～ 86岁健康人群中抽取5 98例为研究对象 ,将他们随机分为干预组和未干预组。要求干预组居民平时适当运动、合理营养 ,多食含钙、含VitD较高的食物等 ,干预时间为 3年 (2 0 0 0年 3月～ 2 0 0 3年 3月 )。两组居民均采用美国Lunar公司生产的双能X线骨密度仪测试L2 4和髋部的BMD ,然后进行统计、比较与分析。　结果干预组和未干预组骨量峰值 (PBM)均出现在 30～ 39岁 ,前者PBM值显著高于后者 (P <0 0 5 ) ;干预组所有部位BMD值均高于未干预组 (P <0 0 5 ) ,原发性OP患病率干预组显著低于未干预组 (P <0 0 5 )。结论　综合性的干预措施和加强健康教育、合理营养和运动 ,可提高青春期居民的骨峰值 ,对4 0岁以上中老年人可以减少其骨量丢失和减缓原发性OP的发生。     

宁波男性骨密度和骨质疏松影响因素的研究

目的评价宁波市男性健康人群的骨量和骨质疏松(OP)的发病情况。方法794名健康男性采用Sunlight的超声骨密度测定胫骨的超声速度值(SOS)。并按年龄、民族、生活习惯进行分组,以10岁为1个年龄组,生活习惯包括吸烟、酗酒、户外活动(大于1h/d)和喝咖啡者。结果宁波市男性骨SOS峰值年龄在30～39岁,60岁以后OP患病率23.4%,过量吸烟、饮酒和喝咖啡者骨SOS值低于同年龄组,户外活动者(如爬山、慢跑)平均日照不少于1h/d,骨质情况优于同年龄组其他人,骨质疏松患病率也较低,本市的不同民族男性各年龄段的骨质差异无显著性。结论宁波市健康男性骨质状况良好,但生活不良嗜好是本地区影响骨密度的重要因子,应当提倡良好的生活习惯。     

Prevalence and risk factors of distal radius and calcaneus bone mineral density in Korean population

To estimate the prevalence and the related risk factors of low bone mineral density of the calcaneus and the distal radius, a community-based study was conducted in three rural areas of Korea. A total of 1420 women and 732 men aged 40 years and older participated in this study. Information on sociodemographic characteristics and the potential risk factors for osteoporosis were collected by an interviewer-administered standardized questionnaire. Bone mineral density (BMD) of the calcaneus and the distal radius were measured by dual-energy X-ray absorptiometry (DXA). Three hundred and seventeen women and 183 men aged 20–29 years who participated in a regular health check-up were used as a reference population. Osteoporosis was defined using WHO criteria. Odds ratios of the risk factors of osteoporosis were calculated by the unconditional logistic regression model. The standardized prevalence of osteoporosis of the calcaneus was 8.4% for males and 27.3% for females using the Korean population of year 2000 as a standard population. The standardized prevalence of osteoporosis of the distal radius was 4.2% for males and 18.8% for females. Older age and lower body mass index (BMI) were related with low BMD in both the calcaneus and distal radius in males and females. The duration after menopause and the number of live births were an independent risk factor for osteoporosis of the calcaneus (OR=1.1, 95% CI=1.00–1.11; the duration after menopause; OR=2.0, 95% CI=1.20–3.35, the number of live birth) and a familial history of non-traumatic fractures or osteoporosis among the first-degree relatives was significantly related to a increased risk of osteoporosis of the distal radius in females (OR=2.9, 95% CI=1.36–6.31).     

Depression and bone mineral density in a community sample of men: Geelong Osteoporosis Study

Background

Previous research in psychiatric and community samples has demonstrated reduced bone mineral density (BMD) in individuals with both clinical depression and depressive symptoms, although the findings are equivocal. This study aimed to investigate the association between self-reported depression and BMD in a community sample of men aged 20-96 years enrolled in the Geelong Osteoporosis Study.

Methods

A self-report questionnaire based on DSM-IV criteria was used to determine lifetime prevalence rates of depression within the study sample at baseline. Those currently taking oral glucocorticoids, testosterone or bisphosphonates were excluded from the analysis (n = 23) resulting in a sample of 1279 men.

Results

In this sample, 155 men reported a lifetime history of depression (LHX). There were no differences in age, weight, height, calcium intake, smoking rates or unadjusted BMD at the femoral neck between the cases and the controls, whereas unadjusted BMD at the spine was significantly lower in those with a LHX (1.254 ± 0.187 vs 1.293 ± 0.194 g/cm²). BMD adjusted for age, weight, calcium intake and smoking was 3.6% lower at the spine (1.255 ± 0.016 vs 1.295 ± 0.006 g/cm²) and 3.4% lower at the femoral neck (0.973 ± 0.011 vs 1.007 ± 0.004 g/cm²) in those with a LHX compared to controls.

Conclusion

These data are consistent with previous findings of diminished BMD in people with depressive disorders and symptoms and suggest that depression may be a risk factor for reduced BMD in community-dwelling adult men.     

广州地区中老年人群骨量减少及骨质疏松患病率的调查

目的：了解广州地区中老年人骨量减少（Osteopenia）及骨质疏松（Osteoporosis,OP），患病率的变化规律，为防治OP提供科学依据。方法：居住广州市内及郊区农村20年以上的40岁以上人群进行整群随机抽样，样本共1160人，准确记录其性别和年龄后，用美国Lunar公司的DEXA测试受试者L2－4和髋部的骨密度（BMD），然后进行统计、比较与分析。结果：40岁组女性L2－4及Ward‘s区BMD高于男性，该组骨量减少患病率男女性都超过样本数的1／3，50岁以男性高于女性，男性70岁组L2－4下降才明显，女性L2－4及髋部BMD从50岁起加速下降，L2－4BMD70岁以后减慢，男性60岁以后髋部BMD下降明显，不论男、女性髋部BMD下降直到80岁以上都较显著，骨质疏松患病率随年龄的增长而增加，女性50岁组起变化开始明显，60岁组OP患病率85％，并一起以重度OP占多数，农村患病率高于城市，男性在70岁组起OP患病率显著上升，结论：广州地区中老年人骨量减少及OP患病率与北京、上海、成都等地区近似，老年女性以重度OP占多数，50岁以上男性OP患病率达到30％，应得到足够的重视。     

广州地区1 530例骨密度分析及骨质疏松发病率研究

目的为了解广州地区正常人群骨密度(BMD)的变化规律和骨质疏松(OP)的患病率.方法采用美国Lunar公司的双能X线骨密度仪对广州地区1 530名20～89岁居民进行腰椎2-4和髋部骨密度测量.结果男性腰椎骨密度峰值在20～29岁,女性腰椎骨密度峰值在30～39岁,男性与女性髋部骨密度峰值均在30～39岁,峰值后随年龄增加而骨密度下降,女性在50～59岁出现明显加速,男性没有加速下降现象.广州地区男性50～89岁骨质疏松患病率26.53%,女性50～89岁骨质疏松患病率42.64%,两者之间差异有非常显著性(P＜0.01).结论广州地区女性骨质疏松患病率高于男性,预防骨质疏松的重点在女性,但对男性骨质疏松患者也不容忽视.     

浙北地区6330例跟骨骨密度测定及骨质疏松患病率分析

目的 分析浙北地区人群骨密度(BMD)变化规律及骨质疏松(OP)患病率。方法 使用美国进口的Dove3000骨密度仪对浙北地区20～93岁的居民6330人进行跟骨BMD测定，然后进行比较和统计分析。结果 男女性骨峰值在30—39岁年龄段，峰值后随年龄增长BMD逐渐下降，女性在50岁后可见明显的骨质丢失加速，而男性丢失是逐渐和缓慢的。浙北地区50～79岁人群骨质疏松症发病率男性为35．8％，女性为67．3％。结论 骨质疏松研究的重点在中老年妇女，但对于男性也不能忽视；骨质疏松的预防应从青少年开始。     

Relation of height and weight to the regional variations in bone mass among Japanese-American men and women

We examined the magnitude of regional variations in bone mass among elderly, Japanese-American men and women. All subjects had bone measurements at the calcaneus, and at the distal and proximal radius sites. A subset of the women had, in addition, spine bone mass measurements. To provide a common measurement scale, the bone measurements were converted to age- and sex-specificZ-scores. TheZ-scores between pairs of bone sites were then subtracted to yield the differences in bone mass between bone sites (expressed inZ-score units). For most individuals the differences were less than 1.0Z-score; however, 12%–20% of the differences were at least 1Z-score apart. The most similar sites were the distal and proximal radius: different regions within the same bone. Among the other bone pairs, the calcaneus and spine were the most similar to one another. The magnitudes of the differences in bone mass were associated with height and weight. Heavier subjects, for instance, had greater calcaneus than radius bone mass measurements, and greater spine than radius measurements. The spine and calcaneus are more weight-bearing than the radius sites. Associations were observed up to 0.25Z-score per 10 kg difference in weight. Height was associated with bone mass differences in an opposite direction to weight. Taller subjects had greater bone mass at the radius sites than expected from their calcaneus or spine bone measurements (0.1 to 0.2Z-score difference per 5 cm difference in height). Bone width partly explained the associations with height; that is, adjusting the radius widths reduced the associations with height. Overall, our results indicate that small to moderate differences between bone sites were common among our study population, and that the magnitudes of the differences were associated with height and weight.     

Forearm bone mineral density in an unselected population of 2,779 men and women—The HUNT Study, Norway

The fracture incidence in Norway is among the highest in Europe, presumably due to osteoporosis. As part of a multipurpose health study in the county of Nord-Trøndelag, Norway (the HUNT study), a 5% randomly selected sample (n=4,646) of the population >19 years of age was invited to undergo single X-ray absorptiometry (SXA) of the forearm. A total of 1,274 men (50.5 years) and 1,505 women (49.9 years) participated (60%). The aim of the study was to describe the variation in bone mineral density (BMD) and the prevalence of forearm BMD 2.5 standard deviations (SD) below the mean value for young adults in an unselected population sample. In women the BMD remained stable until the age of 50 years, whereupon a strong decline in BMD was observed. In men, a BMD increase was observed until about the age of 40 years; the decline after the age of 65 was, however, similar to that in women. Based on age and gender-specific reference values, the age-adjusted prevalence of T-scores <–2.5 SD in women and men aged 50–69 years was 16.0% and 5.6%, respectively. In the age group of 70 years or older the prevalence was 65.8% and 30.6% for women and men, respectively. The accelerated BMD reduction in women aged 50–65 explains the higher prevalence of T-score <–2.5 SD in elderly women than in men. Further studies on bone loss and falls are required to explain the high fracture incidence in Norway.     

Bone mineral density and osteoporosis among a predominantly Caucasian elderly population in the city of São Paulo, Brazil

This cross-sectional study covered 301 individuals over 70 years of age—207 women (W) and 94 men (M)—living in the city of São Paulo, Brazil. Our aims were to evaluate the prevalence of low bone mineral density (BMD) in this population and the possible factors that influence BMD. The subjects were submitted to a bone densitometry scan (DXA) to evaluate the BMD at lumbar spine (LS), femoral neck (FN), trochanter (T), total femur (TF) and total body composition. At the time, the participants filled in a questionnaire about lifestyle habits, diet and medical history, as well as having blood samples taken to check hormone and biochemical levels. Anthropometric parameters were measured. Osteopenia and osteoporosis were defined in accordance with the criteria suggested by the World Health Organization. In the different sites studied, the prevalence of osteopenia and osteoporosis varied, in men ranging 33.3–57.4% and 6.4–16.1%, respectively, and in women ranging 36.6–56.5% and 22.2–33.2%, respectively. Weight was the variable that most strongly correlated with BMD at the proximal femur in both sexes (men, r =0.44–0.52; women, r =0.48–0.52) and with BMD at LS in women ( r =0.44). Height was the parameter that best correlated with BMD at LS in men ( r =0.34). In men follicle-stimulating hormone, growth hormone and glycemia correlated with BMD at T and TF, while plasma albumin only correlated with BMD at T. In women glycemia correlated with BMD at LS, and follicle-stimulating hormone correlated with BMD at FN, T and TF. In conclusion, we found a high prevalence of osteopenia and osteoporosis in this population, with weight being the best predictor of BMD. The prevalence of osteoporosis and osteopenia at FN was as high in men as that observed in women.     

中国部分地区中老年人群原发性骨质疏松症患病率研究

目的 调查中国部分地区中老年人群原发性骨质疏松症 (primary osteoporosis, POP)患病率的分布情况。方法采用分层多阶段整群抽样调查方法对中国五大行政区的 5 602例 40岁以上男女人群进行骨密度测量和问卷调查。结果我国部分地区 POP总患病率 (按骨密度累计丢失率最高部位计算 )为 12.4％。其中男性 8.5％,女性 15.7％,两者之间差异有非常显著性意义 (P< 0.01);不同地区、不同年龄组男女 POP患病率差异亦有非常显著性意义 (P< 0.01);城乡之间 POP患病率差异无显著性意义 (P >0.05)。结论我国女性 POP患病率高于男性, POP的防治重点在中老年女性,对男性 POP患者也不容忽视。     

Effects of physical activity and dietary calcium intake on bone mineral density and osteoporosis risk in a rural Thai population

The objective of the study was to determine the effects of modifiable risk factors on bone mineral density in postmenopausal Thai women. Dietary calcium intake (g/day), energy expenditure (kcal/day), and sunlight exposure (h/day) were assessed in 129 rural Thai women aged 63 years (range 50 to 84 years). Bone mineral density (BMD) at the femoral neck, lumbar spine, and distal radius were measured by dual-energy X-ray absorptiometry (DXA). The average dietary calcium intake was 236 ± 188 g/day (mean ± SD), while the energy expenditure was 2,118 ± 656 kcal/day with 1.1 ± 1.7 h of sunlight exposure. In multiple linear regression analysis, dietary calcium intake, energy expenditure, and years since menopause were significant and independent predictors of BMD at various sites. The three factors together accounted for between 35% and 45% of the variance of BMD. The prevalence of osteoporosis (defined as BMD T-scores –2.5) was 33% at the femoral neck, 42% at the lumbar spine, and 35% at the distal radius. The risk of osteoporosis was higher in women with lower dietary calcium intake (138 mg/day; prevalence rate ratio [PRR], 1.4; 95% confidence interval [CI], 1.0 to 1.9), lower energy expenditure (1,682 kcal; PRR, 1.7; 95% CI, 1.2 to 2.3), and greater years since menopause (6 years; PRR, 2.6; 95% CI, 1.2 to 5.8). The population attributable risk fraction of osteoporosis risk due to the three factors was 70%. These results suggest that in the Thai population, low dietary calcium intake and low physical activity together with advancing years since menopause were independent risk factors for low BMD.     

广西南宁地区汉壮族人群骨密度及骨质疏松患病率研究

目的 评估广西南宁地区汉壮族健康人群骨量和骨质疏松(OP)的发病情况。方法 l084名健康人群采用双能x线骨密度仪检测腰椎正位、髋部、前臂的骨密度(BMD)值。按民族、年龄、性别进行分组，以10岁作为1个年龄段。结果 骨峰值年龄分布：男女汉壮族各部位骨峰值年龄在30-39岁，60岁后OP患病率(WHO)汉族男性23．36％，壮族男性25．00％，汉族女性31．69％，壮族女性44．44％，汉壮族男女各年龄段和总体OP患病率差异无显性。结论 广西南宁地区汉壮族男女健康人群峰值骨密度水平及骨质疏松检出率差异无显性。     

Factors associated with the lumbar spine and proximal femur bone mineral density in older men

Bone mass is a major determinant of fracture, but there have been few comprehensive studies of the correlates of bone mineral density (BMD) in older men. The objective of the current cross-sectional analysis was to determine the factors associated with BMD of the lumbar spine and proximal femur in a large population-based sample of older men enrolled in The Osteoporotic Fractures in Men Study, Mr.OS. We enrolled 5,995 men 65 years of age or older, 89% Caucasian, in Mr.OS at six US clinical centers. Demographic, medical and family history and lifestyle information was obtained by interview and physical function and anthropometric data by examination. Spine and hip BMD was measured using dual-energy X-ray absorptimetry. The multivariable linear regression models predicted 19 and 10% of the overall variance in BMD of the femoral neck and spine, respectively. African-American men had 6 to 11% higher BMD than Caucasian men independent of multiple factors. Hip BMD declined with advancing age, while spine BMD increased. Body weight (per 10 kg) and self report of diabetes were each associated with 2 to 4% higher BMD, while history of a non-trauma fracture and current use of selective serotonin reuptake inhibitors, but not other antidepressants, were associated with at least 4% lower BMD. Both maternal and paternal histories of fracture were associated with 1.4–1.7% lower BMD. Osteoarthritis, physical activity, grip strength, alcohol intake, and dietary calcium were positively related to BMD, while a history of chronic lung disease, prostate cancer, and kidney stones was associated with lower BMD. Smoking, caffeine intake, and thiazide diuretics were not related to BMD in older men. A number of lifestyle and behavioral characteristics and medical conditions were associated with BMD in older men. Identification of these correlates could improve methods to identify men at risk for fracture and improve our understanding of fracture etiology.The authors represent the Osteoporotic Fractures in Men (Mr.OS) Research Group. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provided support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), and the National Cancer Institute (NCI), under the following grant numbers: UO1 AG18197-02, UO1 AR45580-02, UO1 AR45614, UO1 AR45632, UO1 AR45647, UO1 AR45654, UO1 AR45583, and M01 RR00334.