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OBJECTIVE: Foot pain is a common complaint in adults. Evidence suggests that body composition is involved in the development of foot pain. However, whether this is the case in men remains unclear because previous studies mainly examined women. The aim of this cross-sectional study was to determine the relationship between body composition and foot pain in men while accounting for important risk factors. METHODS: Among 978 men (median age 60 yrs, range 24-98) from the Geelong Osteoporosis Study who participated in a followup study in 2006 to 2011, 796 provided responses to questions on health status and foot pain. Foot pain was determined using the Manchester Foot Pain and Disability Index, and body composition was measured using dual-energy x-ray absorptiometry. RESULTS: Of the 796 respondents, 177 (22%) had foot pain. Risk factors for foot pain were age (OR 1.03, 95% CI 1.02-1.04), self-reported depression (OR 2.05, 95% CI 1.30-3.20), decreased mobility (OR 1.54, 95% CI 1.05-2.24), and lower education (OR 1.47, 95% CI 1.03-2.09). Foot pain was associated with body mass index (OR 1.05, 95% CI 1.00-1.10), fat mass (OR 1.02, 95% CI 1.03-1.05), and fat mass index (OR 1.08, 95% CI 1.01-1.15), but not fat-free mass (OR 1.01, 95% CI 0.98-1.04) or fat-free mass index (OR 1.05, 95% CI 0.95-1.15) after appropriate adjustments were made. CONCLUSION: Fat mass is associated with foot pain in men. These findings complement those in studies that have mainly examined women, and provide further evidence for the relationship between obesity and foot pain.

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BACKGROUND: Psychotropic agents known to cause sedation are associated with an increased risk of falls, but the role of psychiatric illness as an independent risk factor for falls is not clear. Thus, this study aimed to investigate the association between psychiatric disorders, psychotropic medication use and falls risk. METHODS: This study examined data collected from 1062 women aged 20-93 yr (median 50 yr) participating in the Geelong Osteoporosis Study, a large, ongoing, population-based study. Depressive and anxiety disorders for the preceding 12-month period were ascertained by clinical interview. Current medication use and falls history were self-reported. Participants were classified as fallers if they had fallen to the ground at least twice during the same 12-month period. Anthropometry, demographic, medical and lifestyle factors were determined. Logistic regression was used to test the associations, after adjusting for potential confounders. RESULTS: Fifty-six women (5.3%) were classified as fallers. Those meeting criteria for depression within the past 12 months had a 2.4-fold increased odds of falling (unadjusted OR = 2.4, 95% CI 1.2-4.5). Adjustment for age and mobility strengthened the relationship (adjusted OR = 2.7, 95% CI 1.4-5.2) between depression and falling, with results remaining unchanged following further adjustment for psychotropic medication use (adjusted OR = 2.7, 95% CI 1.3-5.6). In contrast, past (prior to 12-month) depression were not associated with falls. No association was observed between anxiety and falls risk. Falling was associated with psychotropic medication use (unadjusted OR = 2.8, 95% CI 1.5-5.2), as well as antidepressant (unadjusted OR = 2.4, 95% CI 1.2-4.8) and benzodiazepine use (unadjusted OR = 3.4, 95% CI 1.6-7.3); associations remained unchanged following adjustment for potential confounders. CONCLUSION: The likelihood of falls was increased among those with depression within the past 12 months, independent of psychotropic medication use and other recognised confounders, suggesting an independent effect of depression on falls risk. Psychotropic drug use was also confirmed as an independent risk factor for falls, but anxiety disorders were not. Further research into the underlying mechanisms is warranted.

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BACKGROUND: Osteoporosis is a skeletal disorder characterised by low bone mineral density and increased fracture risk. Nationally the total costs of this chronic disease are currently estimated at $2.754 billion annually. Effective public health messages providing clear recommendations are vital in supporting prevention efforts. This research aimed to investigate knowledge change associated with the translation of preventive guidelines into accessible messages for the community. FINDINGS: We delivered a community-based information session that translated recommended guidelines for osteoporosis prevention into lay terms; items focused on dietary calcium, vitamin D, physical activity, alcohol, smoking and general osteoporosis-related knowledge. We developed a 10-item questionnaire reflecting these key points (score range 0-10) and investigated knowledge change associated with the session. Pre- and post-test questionnaires were completed by 47 participants (51% female), aged 21-94 years. Relatively high pre-test scores were observed for questions regarding sedentary activity and calcium intake. The lowest pre-test scores were observed for the item concerning whether swimming and cycling strengthened bones, and the highest possible score post-test was achieved for three of the items: calcium-rich food as a protective factor, and excessive alcohol and smoking as risk factors. The overall increase in knowledge change was a mean score of +2.08 (95%CI 1.58-2.42). CONCLUSIONS: An increase in knowledge regarding osteoporosis prevention was demonstrated over the short-term. Our findings suggest that the guidelines concerning dietary calcium are generally well understood; however, the asymptomatic nature of osteoporosis and the types of physical activity that assist with bone strength are less well understood.

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PURPOSE: The WHO fracture risk prediction tool (FRAX®) utilises clinical risk factors to estimate the probability of fracture over a 10-year period. Although falls increase fracture risk, they have not been incorporated into FRAX. It is currently unclear if FRAX captures falls risk and whether addition of falls would improve fracture prediction. We aimed to investigate the association of falls risk and Australian-specific FRAX. METHODS: Clinical risk factors were documented for 735 men and 602 women (age 40-90 yr) assessed at follow-up (2006-2010 and 2000-2003, respectively) of the Geelong Osteoporosis Study. FRAX scores with and without BMD were calculated. A falls risk score was determined at the time of BMD assessment and self-reported incident falls were documented from questionnaires returned one year later. Multivariable analyses were performed to determine: (i) cross-sectional association between FRAX scores and falls risk score (Elderly Falls Screening Test, EFST) and (ii) prospective relationship between FRAX and time to a fall. RESULTS: There was an association between FRAX (hip with BMD) and EFST scores (ß = 0.07, p < 0.001). After adjustment for sex and age, the relationship became non-significant (ß = 0.00, p = 0.79). The risk of incident falls increased with increasing FRAX (hip with BMD) score (unadjusted HR 1.04, 95% CI 1.02, 1.07). After adjustment for age and sex, the relationship became non-significant (1.01, 95% CI 0.97, 1.05). CONCLUSIONS: There is a weak positive correlation between FRAX and falls risk score, that is likely explained by the inclusion of age and sex in the FRAX model. These data suggest that FRAX score may not be a robust surrogate for falls risk and that inclusion of falls in fracture risk assessment should be further explored.

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PURPOSE: There is a paucity of research examining the relationship between personality disorders (PDs) and chronic physical comorbidities. Consequently, we investigated associations between individual PDs and PD Clusters, and various common disease groups [cardiovascular disease (CVD), diabetes, arthritis and gastrointestinal disease (GI)] in a nationally representative survey of adults from the United States. METHODS: This study utilized pooled data (n = 34,653; ≥20 years) from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. PDs were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Physical conditions were based on self-reports of being diagnosed by a health professional. Unadjusted and adjusted logistic regressions examined the relationship between PDs and physical conditions. RESULTS: After adjustment (sociodemographic factors, past-year mood, anxiety and substance use disorders), Clusters A, B and C PDs were each associated with physical conditions (all p ≤ 0.01). Of the individual PDs, schizoid, schizotypal, narcissistic, borderline and obsessive-compulsive PDs were associated with CVD (all p ≤ 0.01) among younger adults. Paranoid, antisocial, borderline and avoidant PDs and younger adults with schizoid, schizotypal and obsessive-compulsive PDs were each associated with arthritis (all p ≤ 0.01). Significant associations were seen between paranoid, schizoid and schizotypal PDs and diabetes (all p ≤ 0.01). Finally, schizotypal, antisocial, borderline and narcissistic PDs were associated with GI conditions (all p ≤ 0.01). CONCLUSIONS: PDs were consistently associated with physical conditions. Investigation of PDs and their relationship with physical health outcomes warrant further research attention as these findings have important clinical implications.

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OBJECTIVE: Excessive daytime sleepiness (EDS) has been associated with singular independent symptoms of metabolic syndrome, such as insulin resistance and diabetes. The aim of this study was to assess whether this relationship is sustained among individuals who meet criteria for the whole syndrome. MATERIALS/METHODS: 994 Women aged 21-94 years (median 50.2 years, IQR 34-65) and 840 men aged 24-92 years (median 60.4 years, IQR 47-73) who resided in the Barwon Statistical Division, South-Eastern Australia, and participated in the Geelong Osteoporosis Study (GOS) between the years of 2001 and 2008. Anthropometric measurements, lifestyle, mood, demographic and health-related factors were obtained. Sleep duration was categorized as short (<6 h), average (6-9 h) and long (>9 h). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of ≥ 10 indicated EDS. The presence of metabolic syndrome was assessed using a modified version of criteria as outlined by the International Diabetics Federations recommendations (2005). RESULTS: Women: 138 (14.0%) of the women reported EDS; those with EDS were heavier, had a greater body mass index (BMI) and were more likely to have metabolic syndrome. The association between EDS and metabolic syndrome was sustained following adjustment for age and hours sleep (adjusted OR=1.90, 95% CI 1.16-3.09), however BMI attenuated the relationship (adjusted OR=1.64, 95% CI =1.05-2.57). These findings were independent of smoking status, alcohol intake, medication use, socioeconomic status, physical activity and current diagnosis of a depressive illness. Men: 111 (13.2%) of the men reported EDS; those with EDS had a greater waist circumference and were more likely to have metabolic syndrome. Analysis of age-stratified data (<60 years vs. ≥60 years) revealed that the older men with EDS were more likely to have metabolic syndrome (OR=1.71, 95% CI 1.01-2.92), however, age explained this association (age adjusted OR=1.51, 95% CI 0.88-2.60). In the younger age group, no association was detected between EDS and metabolic syndrome. For both men and women, the prevalence of combined EDS and metabolic syndrome increased progressively with age. CONCLUSION: For women, the association between EDS and metabolic syndrome appears to be driven by adiposity measures; while for men, the association is somewhat attributed to older age. Additional research is required to assess temporal associations with underlying sleep pathology.

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There are few data documenting the pattern of prevalent fracture across the entire adult age range, so we aimed to address this gap by investigating the prevalence of fractures in an Australian cohort. All-cause (ever) fractures were identified for males and females enrolled in the Geelong Osteoporosis Study (Australia) using a combination of radiology-confirmed and self-reported data. First fractures were used to generate age-related frequencies of individuals who had ever sustained a fracture. Of 1,538 males and 1,731 females, 927 males and 856 females had sustained at least one fracture since birth. The proportion of all prevalent fractures in the 0-10 year age group was similar for both sexes (~10%). In males, the proportion with prevalent fracture increased to 34.1% for age 11-20 year. Smaller increases were observed into mid-life, reaching a plateau at ~50% from mid to late life. The age-related prevalence of fracture for females showed a more gradual increase until mid-life. For adulthood prevalent fractures, approximately 20% of males had sustained a first adulthood fracture in the 20-30 year age group, with a gradual increase up to the oldest age group (49.1%), while females showed an exponential pattern of increase from the 20-30 year age group (6.8%) to the oldest age group (60.4%). In both sexes, those who had not sustained a fracture in childhood or early adulthood generally appeared to remain fracture-free until at least the sixth decade. When considering the prevalence of adulthood fractures across the age groups, males showed a gradual increase while females showed an exponential increase.

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Osteoporosis is a major health concern, estimated to affect millions worldwide. Bone mineral density (BMD) assessment is not practical for many large-scale epidemiological studies resulting in the reliance of self-report methods to ascertain diagnostic information. The aim of the study was to assess the validity of self-reported diagnosis of osteoporosis in a population-based study. This study examined data collected from 906 men and 843 women participating in the Geelong Osteoporosis Study. Osteoporosis was self-reported and compared against results of BMD scans of the hip and spine. Validity was examined by calculating sensitivity, specificity, positive predictive value, negative predictive value, and kappa statistic. Osteoporosis was self-reported by 118 (6.7%) participants and identified using BMD results for 64 (3.7%) participants. Specificity and negative predictive value were good (95.1% and 96.0%, respectively), whereas sensitivity and positive predictive value were poor (35.9% and 31.4%, respectively). The overall level of agreement (kappa) was 0.29. The results changed only slightly when we included participants with osteopenia and adult fracture as osteoporotic. Reliance on self-report methods to ascertain osteoporosis status is not recommended.

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BACKGROUND: Excessive daytime sleepiness (EDS) is often associated with increased adiposity, particularly when assessed in the context of samples of sleep-disordered patients; however, it is unclear if this relationship is sustained among non-clinical, population-based cohorts. This study aimed to investigate the relationship between EDS and a number of body composition markers among a population-based sample of men and women. METHODS: This study assessed 1066 women aged 21-94 yr (median = 51 yr, IQR 35-66), and 911 men aged 24-92 yr (median = 60 yr, IQR 46-73) who participated in the Geelong Osteoporosis Study (GOS) between the years 2001 and 2008. Total body fat mass was determined from whole body dual-energy X-ray absorptiometry scans, and anthropometric parameters (weight, height, and waist circumference) were measured. Lifestyle and health information was collected via self-report. Sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Scores of ≥ 10 were considered indicative of EDS. RESULTS: Women: After adjusting for age, alcohol intake, antidepressant medication use and physical activity, EDS was associated with greater waist circumference and body mass index (BMI). EDS was also associated with 1.5-1.6-fold increased odds of being overweight or obese. Men: After adjusting for age, alcohol use, physical activity and smoking status, EDS was associated with greater BMI. These findings were not explained by the use of sedative or antidepressant medication. EDS was also associated with 1.5-fold increased likelihood of being obese, independent of these factors. No differences in lean mass, %body fat, or %lean mass were detected between those with and without EDS for men or women. CONCLUSIONS: These data suggest that EDS is associated with several anthropometric adiposity profiles, independent of associated lifestyle and health factors. Among women, symptoms of EDS are pervasive at both overweight and obese BMI classifications; suggesting a need for further clinical examination to assess possible temporal associations with underlying sleep pathology.

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BACKGROUND: Relatively little is known about the social distribution of total knee joint replacement (TKR) uptake in Australia. We examine associations between socioeconomic status (SES) and TKR performed for diagnosed osteoarthritis 2003-10 for all Australian males and females aged ≥ 30 yr. METHODS: Data of primary TKR (n=213,018, 57.4% female) were ascertained from a comprehensive national joint replacement registry. Residential addresses were matched to Australian Census data to identify area-level social disadvantage, and categorised into deciles. Estimated TKR rates were calculated. Poisson regression was used to model the relative risk (RR) of age-adjusted TKR per 1,000py, stratified by sex and SES. RESULTS: A negative relationship was observed between TKR rates and SES deciles. Females had a greater rate of TKR than males. Surgery utilisation was greatest for all adults aged 70-79 yr. In that age group differences in estimated TKR per 1,000py between deciles were greater for 2010 than 2003 (females: 2010 RR 4.32 and 2003 RR 3.67; males: 2010 RR 2.04 and 2003 RR 1.78). CONCLUSIONS: Identifying factors associated with TKR utilisation and SES may enhance resource planning and promote surgery utilisation for end-stage osteoarthritis.

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We investigated the reasons for referral of older Australians aged 70 years and older to dual energy X-ray absorptiometry (DXA). The most common clinical indication was being aged 70 years and older, followed by monitoring for fracture or low bone mineral density (BMD). Compared to males, females were twice as likely to have osteoporotic BMD. PURPOSE/INTRODUCTION: Little is known about reasons for the referral of older Australians to dual energy X-ray absorptiometry (DXA) for bone mineral density (BMD) measurements. Thus, we aimed to document the reasons for referral to DXA in Australian men and women aged 70 years and older and investigate any differences between the sexes. METHODS: Reasons for DXA referral were examined in 5438 patients aged ≥ 70 years (78.5 % female), referred to the Geelong Bone Densitometry Service, south-eastern Victoria, 2003-2010. Clinical indication codes derived from patient records were used to ascertain reasons for referral. We ascertained age, sex and BMD measures at the femoral neck and spine for each patient. RESULTS: The most common reason for DXA referral was being aged ≥ 70 years (64.6 %), followed by monitoring of fracture or low BMD. In this referred population, a greater proportion of men than women had BMD in the normal range (men 30.2 % vs. women 10.9 %, p < 0.001), whereas sex differences in the opposite direction were seen for BMD in the osteopenic range (women 47.7 % vs. men 44.3 %, p = 0.04) and in the osteoporotic range (women 41.4 % vs. men 25.5 %, p < 0.001). After age adjustment, women were twice as likely to have BMD in the osteoporotic range compared to men (odds ratio (OR) 2.25, 95% confidence interval (95%CI) 1.95-2.61). CONCLUSION: For both sexes, the most common reason for referral was being aged 70 years or older. Referred women were twice as likely as men to have BMD in the osteoporosis range. These data suggest that even more women may need to be referred to DXA.

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We systematically reviewed 12 epidemiological studies to determine whether an association exists between diet quality and patterns and mental health in children and adolescents; 9 explored the relationship using diet as the exposure, and 3 used mental health as the exposure. We found evidence of a significant, cross-sectional relationship between unhealthy dietary patterns and poorer mental health in children and adolescents. We observed a consistent trend for the relationship between good-quality diet and better mental health and some evidence for the reverse. When including only the 7 studies deemed to be of high methodological quality, all but 1 of these trends remained. Findings highlight the potential importance of the relationship between dietary patterns or quality and mental health early in the life span.

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Prospective observational studies uniformly link vitamin D deficiency with the incidence of type 2 diabetes mellitus (T2DM), yet trials supplementing participants at risk of T2DM with vitamin D to reduce progression to T2DM have yielded inconsistent results. Inconsistencies between supplementation trials may be due to insufficient dosing or small sample sizes. Observational studies may also have reported spurious associations due to uncontrolled confounding by lifestyle or genetic factors. Alternatively, observational and intervention studies may not be entirely comparable. Observational studies show an association between higher vitamin D status, which is predominantly derived from sun exposure, and decreased incidence of T2DM. Trials intervene with vitamin D supplementation, and therefore may be missing alternate causes of the effect of sun exposure, as seen in observational studies. We propose that sun exposure may be the driving force behind the associations seen in observational studies; sun exposure may have additional benefits beyond increasing serum 25-hydroxyvitamin D (25OHD) levels. We performed an electronic literature search to identify articles that examined associations between sun exposure and T2DM and/or glucose metabolism. A best evidence synthesis was then conducted using outcomes from analyses deemed to have high methodological quality. Ten eligible full-text articles were identified, yielding 19 T2DM-related outcomes. The best evidence analysis considered 11 outcomes which were grouped into six outcome types: T2DM, fasting glucose, glucose tolerance, fasting insulin, insulin secretion and insulin sensitivity. There was moderate evidence to support a role of recreational sun exposure in reducing odds of T2DM incidence. High-level evidence was lacking; evidence presented for other outcomes was of low or insufficient level. This review highlights significant gaps in research pertaining to sun exposure and T2DM-related outcomes. Further research is encouraged as we aim to identify novel preventative strategies for T2DM.

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OBJECTIVES: Excessive daytime sleepiness (EDS) is associated with significant personal and medical burden. However, there is little indication of the impact of these symptoms in the broader population. PARTICIPANTS AND METHODS: We studied 946 men ages 24-92 years (median age, 59.4 [interquartile range {IQR}, 45-73 years]) and 1104 women ages 20-94 years (median age, 50 [IQR, 34-65 years]) who resided in the Barwon Statistical Division, South-Eastern Australia, and participated in the Geelong Osteoporosis Study (GOS) between the years of 2001 and 2008. EDS was defined as an Epworth Sleepiness Scale (ESS) score of ⩾ 10. Lifestyle factors, history of medical conditions, and medication history were documented by self-report. RESULTS: For men, the age-specific prevalence of EDS was 5.1% (ages 20-29 years), 6.4% (ages 30-39 years), 9.8% (ages 40-49 years), 15.5% (ages 50-59 years), 12.0% (ages 60-69 years), 12.0% (ages 70-79 years), and 29.0% (ages ⩾ 80 years). For women, the age-specific prevalence of EDS was 14.7% (ages 20-29 years), 8.7% (ages 30-39 years), 15.0% (ages 40-49 years), 16.0% (ages 50-59 years), 12.6% (ages 60-69 years), 13.2% (ages 70-79 years), and 17.0% (ages ⩾ 80 years). Overall standardized prevalence of EDS was 10.4% (95% confidence interval, 9.7-11.2) for men and 13.6% (95% confidence interval, 12.8-14.4) for women. CONCLUSIONS: The prevalence of EDS increased with age, affecting approximately one-third of those aged ⩾ 80 years. Because EDS has been associated with poorer health outcomes in the older age strata, these findings suggest that routine screening may be beneficial in ongoing health assessments for these individuals. Overall, more than one-tenth of the Australian adult population has EDS, which is indicative of possible underlying sleep pathology.

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OBJECTIVES: High levels of disability, functional impairment and mortality are independently associated with fracture and depression, however the relationship between fracture and depression is uncertain. The aim of this study was to investigate whether fracture is associated with subsequent depressive symptoms in a population-based sample of women. DESIGN: A study of age-matched fracture versus non-fracture cohorts of women. SETTING: Barwon Statistical Division, southeastern Australia. PARTICIPANTS: Two samples of women aged ≥35 years were drawn from the Geelong Osteoporosis Study (GOS). The fracture cohort included women with incident fracture identified from radiology reports and the non-fracture cohort were randomly selected from the electoral roll during 1994-1996. OUTCOME MEASURE: Symptoms of depression for women with and without fracture during the 12-month period 2000-2001 were identified by self-report questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. RESULTS: A total of 296 women with fracture (12 hip, 48 vertebral, 91 wrist/forearm, 17 upper arm, 7 pelvis, 11 rib, 62 lower leg and 48 other fractures) and 590 women without fracture were included. Associations between fracture and depression differed between younger (≤65 years) and older (>65 years) women. Age and weight-adjusted odds ratio for depression following fracture among younger women was 0.62 (0.35 to 1.11, p=0.12) and 3.33 (1.24 to 8.98, p=0.02) for older women. Further adjustment for lifestyle factors did not affect the results. CONCLUSIONS: This study demonstrated that differences in mood status exist between older and younger women following fracture and that fracture is associated with increased depression in older women. Assessment of mood status in both the short and long term following fracture in the elderly seems justified, with early detection and treatment likely to result in improved outcomes.

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BACKGROUND: A self-report method seeking a binary response for assessing depression is a cost-effective and time-efficient way to obtain a psychiatric history, yet the reliability of this method is largely unknown. The aim of the study was to compare and assess the validity of two methods for identifying a past history of depression in a population-based study. METHODS: This study examined data collected from 891 men and 1086 women participating in the Geelong Osteoporosis Study. Self-reports of depression were compared with results obtained using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition (SCID-I/NP). RESULTS: Using the SCID-I/NP, 146 (16.4%) men and 285 (26.2%) women met criteria for a lifetime depression. Of those participants, 61.0% (n=263) self-reported a history of depression. The level of agreement between self-reporting depression and the SCID-I/NP depression module was reasonably high; 61% sensitivity, 89.5% specificity and the overall level of agreement (kappa) was 0.5. LIMITATIONS: Results may not be generalizable to other self-report instruments or be suitable for use in clinical samples. CONCLUSION: The SCID-I/NP remains the gold standard for identifying depression; however, given the moderate level of agreement between the self-report questionnaire and SCID-I/NP in our current study, we conclude that simple self-report methods can be used to identify depression with some degree of confidence.

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BACKGROUND: To examine fracture incidence in women with rheumatoid arthritis (RA) for an entire geographical region of south-eastern Australia. METHODS: Women aged 35 years and older, resident in the Barwon Statistical Division (BSD) and clinically diagnosed with RA 1994-2001 were eligible for inclusion as cases (n = 1,008). The control population (n = 172,422) comprised the entire female BSD population aged 35 years and older, excluding those individuals identified as cases. Incident fractures were extracted from the prospective Geelong Osteoporosis Study Fracture Grid. We calculated rate ratios (RR) and 95% confidence intervals (CI) to compare the age-adjusted rate of fracture between the RA and non-RA populations, and used a chi-square test to compare proportions of fractures between women with and without RA, and a two-sided Mann-Whitney U-test to examine age-differences. RESULTS: Among 1,008 women with RA, 19 (1.9%) sustained a fracture, compared to 1,981 fractures sustained by the 172,422 women without RA (1.2%). Fracture rates showed a trend for being greater among women diagnosed with RA (age-adjusted RR 1.43, 95%CI 0.98-2.09, p = 0.08). Women with RA sustained vertebral fractures at twice the expected frequency, whereas hip fractures were underrepresented in the RA population (p < 0.001). RA status was not associated with the likelihood of sustaining a fracture at sites adjacent to joints most commonly affected by RA (p = 0.22). CONCLUSION: Given that women with RA have a greater risk of fracture compared to women without RA, these patients may be a suitable target population for anti-resorptive agents; however, larger studies are warranted.

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The aim of this study was to develop reference ranges for total and appendicular lean mass measured using dual-energy X-ray absorptiometry (DXA) from a randomly selected population-based sample of men and women residing in southeastern Australia. Men (n = 1,411) and women (n = 960) aged 20-93 years, enrolled in the Geelong Osteoporosis Study, were randomly selected from the Barwon Statistical Division using the electoral roll as a sampling frame in 2001-2006 (67 % participation) and 1993-1997 (77 % participation), respectively. Using DXA (Lunar DPX-L or Prodigy Pro) at baseline for men and at the 10-year follow-up for women (2004-2008), total and appendicular lean mass were measured. Means and standard deviations for each lean mass measure (absolute and relative to height squared) were generated for each age decade, and cutpoints equivalent to T scores of -2.0 and -1.0 were calculated using data from young adult men and women aged 20-39 years. Young adult reference data were derived from 374 men and 308 women. Cutpoints for relative appendicular lean mass equal to T scores of -2.0 and -1.0 were 6.94 and 7.87 kg/m(2) for men and 5.30 and 6.07 kg/m(2) for women. The proportions of men and women aged ≥80 years with a T score less than -2.0 were 16.0 and 6.2 %, respectively. These reference ranges may be useful for identifying lean mass deficits in the assessment of muscle wasting and sarcopenia.

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