***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 thous and Hong Kong men aged 65 to 92 years were recruited from the community . Depression was diagnosed by face-to-face interview , using a vali date d 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 prospect i ve studies Osteoporosis is a significant health problem and contributor to disability and premature mortality among older men . Incidence rates for hip fracture have stabilized in women , but continue to increase in men . A major risk factor for hip fracture is bone mineral density level . The determinants of bone mineral density ( BMD ) are well defined in women , but not in men . The primary goal of the current research was to increase our underst and ing of the determinants of BMD of the proximal femur in a large community-based sample of older male volunteers . Eligibility requirements included age of 50 years or older , ambulatory , and not having undergone a bilateral hip replacement . Five hundred twenty-three men , mean mean age 66.6 years , met all eligibility requirements and participated in the Study of Osteoporotic Risk in Men or STORM . Information on demographics , medical history , anthropometry , leisure-time and occupational physical activity , muscular strength , cigarette smoking , alcohol consumption , dietary calcium intake , and medication use ( thiazide diuretics and glucocorticoids ) were obtained by question naire , interview , and examination , BMD of the proximal femur ( femoral neck , greater trochanter , and Ward 's triangle ) was measured by dual-energy X-ray absorptiometry using the Hologic QDR-1000 and QDR-2000 . The cross-sectional determinants of BMD included age , blond hair color , current body weight , thiazide diuretic use , historical physical activity , and quadriceps strength . Several variables commonly thought to be determinants of BMD were not related to BMD in this population of older men , including current cigarette smoking , alcohol consumption , current leisure-time physical activity , dietary calcium intake , vitamin D use , and caffeine intake . However , failure to find associations among BMD and some of the potential determinants may be due to lack of statistical power . Identification of the determinants of BMD could lead to the development of interventions aim ed at maximizing BMD in men and could potentially decrease the risk of hip fractures BACKGROUND Risedronate increases bone mineral density in elderly women , but whether it prevents hip fracture is not known . METHODS We studied 5445 women 70 to 79 years old who had osteoporosis ( indicated by a T score for bone mineral density at the femoral neck that was more than 4 SD below the mean peak value in young adults [ -4 ] or lower than -3 plus a nonskeletal risk factor for hip fracture , such as poor gait or a propensity to fall ) and 3886 women at least 80 years old who had at least one nonskeletal risk factor for hip fracture or low bone mineral density at the femoral neck ( T score , lower than -4 or lower than -3 plus a hip-axis length of 11.1 cm or greater ) . The women were r and omly assigned to receive treatment with oral risedronate ( 2.5 or 5.0 mg daily ) or placebo for three years . The primary end point was the occurrence of hip fracture . RESULTS Overall , the incidence of hip fracture among all the women assigned to risedronate was 2.8 percent , as compared with 3.9 percent among those assigned to placebo ( relative risk , 0.7 ; 95 percent confidence interval , 0.6 to 0.9 ; P=0.02 ) . In the group of women with osteoporosis ( those 70 to 79 years old ) , the incidence of hip fracture among those assigned to risedronate was 1.9 percent , as compared with 3.2 percent among those assigned to placebo ( relative risk , 0.6 ; 95 percent confidence interval , 0.4 to 0.9 ; P=0.009 ) . In the group of women selected primarily on the basis of nonskeletal risk factors ( those at least 80 years of age ) , the incidence of hip fracture was 4.2 percent among those assigned to risedronate and 5.1 percent among those assigned to placebo ( P=0.35 ) . CONCLUSIONS Risedronate significantly reduces the risk of hip fracture among elderly women with confirmed osteoporosis but not among elderly women selected primarily on the basis of risk factors other than low bone mineral density BACKGROUND The objective of this study was to examine the association of Joint National Committee ( JNC-V ) blood pressure and National Cholesterol Education Program ( NCEP ) cholesterol categories with coronary heart disease ( CHD ) risk , to incorporate them into coronary prediction algorithms , and to compare the discrimination properties of this approach with other noncategorical prediction functions . METHODS AND RESULTS This work was design ed as a prospect i ve , single-center study in the setting of a community-based cohort . The patients were 2489 men and 2856 women 30 to 74 years old at baseline with 12 years of follow-up . During the 12 years of follow-up , a total of 383 men and 227 women developed  CHD , which was significantly associated with categories of blood pressure , total cholesterol , LDL cholesterol , and HDL cholesterol ( all P<.001 ) . Sex-specific prediction equations were formulated to predict CHD risk according to age , diabetes , smoking , JNC-V blood pressure categories , and NCEP total cholesterol and LDL cholesterol categories . The accuracy of this categorical approach was found to be comparable to CHD prediction when the continuous variables themselves were used . After adjustment for other factors , approximately 28 % of CHD events in men and 29 % in women were attributable to blood pressure levels that exceeded high normal ( > or = 130/85 ) . The corresponding multivariable-adjusted attributable risk percent associated with elevated total cholesterol ( > or = 200 mg/dL ) was 27 % in men and 34 % in women . CONCLUSIONS Recommended guidelines of blood pressure , total cholesterol , and LDL cholesterol effectively predict CHD risk in a middle-aged white population sample . A simple coronary disease prediction algorithm was developed using categorical variables , which allows physicians to predict multivariate CHD risk in patients without overt CHD Several osteoporosis risk instruments have been proposed to select women for bone densitometry , but no vali date d instruments are currently available for men . This study aims to address this deficiency by developing and validating a Male Osteoporosis Screening Tool ( MOST ) for Chinese men . Two thous and ambulatory men , aged 65 and above , were recruited from the general community in Hong Kong , and a cohort of 1,970 men with valid total hip and lumbar spine dual-energy X-ray absorptiometry ( DXA ) measurements was included in the current analysis . A 60 % r and om sample was selected as the training sample for developing the screening tool , and the remaining 40 % constituted the validation sample . Logistic regression and receiver operating characteristic ( ROC ) analysis were used to identify the simplest combination of risk factors to be included in the screening tool for predicting osteoporosis at the femoral neck , total hip , or lumbar spine . Body weight and quantitative ultrasound index ( QUI ) were found to contribute significantly to the area under the ROC curve ( AUC ) , yielding an AUC of 0.823 in the training sample . The result ing MOST had a sensitivity of 94 % and a specificity of 46 % when using a cutoff score of 3 . MOST had an AUC of 0.839 in the validation sample . The risk of osteoporosis was 1 % among those with MOST scores ≤2 , but 72 % among those with MOST scores > 7 . Using a cutoff of 3 , the negative predictive value was 97.5 % which suggests that the 42 % with MOST scores ≤3 may be accurately screened out as being without osteoporosis , thus saving two fifths of our DXA re sources . The positive predictive value was 72 % when using a cutoff of 7 , implying that MOST can not replace DXA for case-finding purpose s. Nevertheless , for re source allocation and patient satisfaction , it is prudent and economical to offer DXA screening first to the 6 % with MOST scores > 7 OBJECTIVE To examine prognostic factors and outcomes after hip fracture in men aged 60 years and older . DESIGN AND SETTING Cohort study of all men presenting to St George Hospital ( a 650-bed tertiary care centre ) with hip fractures in 1995 , recruited retrospectively from medical records and evaluated prospect ively at six and 12 months after fracture . PATIENTS 51 men aged 60 years or more ( and , for comparison , 51 age-matched women ) who presented with hip fracture not caused by high impact injuries or local bone disease . MAIN OUTCOME MEASURES Prognostic factors ( such as pre-existing illness and osteoporotic risk factors ) and outcome data ( such as fracture-related complications , mortality , and level of function as measured by the Barthel index of activities of daily living at six and 12 months postfracture ) . RESULTS Median age of the 51 men was 80 years ( interquartile range , 74 - 86 years ) ; four were aged under 70 years . Outcome assessment was possible for 41 men ( 80 % ) . Similar proportions of men and women came from institutions ( 32 % v. 28 % ) , and similar additional proportions required institutionalisation after discharge ( 18 % v. 14 % ) . Fracture-related complications affected similar proportions of men and women ( 30 % v. 32 % ) , and mean length of hospital stay was similar . Fourteen per cent of men died in hospital compared with only 6 % of women ( P = 0.06 ) . Men had more risk factors for osteoporosis ( P < 0.01 ) . Physical functioning ( measured by the Barthel index ) deteriorated significantly in men from 14.9 at baseline to 13.4 at six months ( P < 0.05 ) and 12.4 at 12 months ( P < 0.05 ) after fracture . CONCLUSION Compared with women , elderly men presenting with hip fracture have higher mortality and have more risk factors for osteoporosis . Like women with hip fracture , men are usually fragile , with pre-existing medical illness and fracture-related complications contributing to their overall poor outcomes Abstract : Quantitative ultrasound ( QUS ) measurement , a different approach to bone fragility assessment , has already been attempted in women with osteoporosis but rarely in men . In order to test its value and ability to identify osteoporotic men , a case – control prospect i ve study was conducted using the Lunar Achilles , a device that measures attenuation and velocity parameters . Broadb and ultrasound attenuation ( BUA ) , speed of sound ( SOS ) and stiffness index ( SI ) , a composite parameter , were assessed through the heel of 66 osteoporotic patients , and compared with the results in 35 controls . Patients had sustained a low-trauma fracture and /or had a lumbar and /or femoral bone mineral density ( BMD ) more than 2.5 SD below the young male reference value . As expected , all  QUS parameters were statistically lower in patients , as were the dual-energy X-ray absorptiometry ( DXA ) measurements at the hip and lumbar spine . The two methods were compared for their ability to predict the risk of osteoporotic fractures . The odds ratios ( ORs ) , with their 95 % confidence limits , for fractures per 1 SD decrease were significant , especially for SOS and SI ( OR = 2.3 [ 1.4–3.6 ] and 2.1 [ 1.3 - 3.3 ] respectively ) and to a lesser extent for BUA ( 1.6 [ 1.0–2.4 ] ) . Our study suggests that QUS is associated with a  history of low-trauma fracture in men ; sensitivity is , however , less than when results are compared with BMD measurements ( OR = 2.8 [ 1.6–5.0 ] and 3.4 [ 
    Output:
    
Clearly , factors other than low bone mass are important in identifying patients at elevated risk for osteoporotic fracture .
An increased risk for falling may explain why some factors are identified as risk factors for osteoporotic fractures independent of bone mineral density ( BMD ) ( for example , tricyclic antidepressants ) ( 6 ) .
Although imperfect , a strong and grade d relationship exists between DXA-determined BMD and future osteoporotic fracture in women and men ( 7 , 8) .
Additional important high-risk factors are physical inactivity , corticosteroid use , and