Although this study used a convenient rather than a random community sample and might have biased towards recruiting healthier subjects, the prevalence of osteoporosis at the femoral neck of 3.2% in this cohort was similar to the 2.0% reported in Caucasian White subjects in the population-based NHANES

2005–2006 survey in the US [13]. The prevalence of osteoporosis at the spine and hip were similar in this cohort. Similar to other populations, fractures of the hip, forearm, vertebrae, and humerus were among the most frequent sites of incident fractures in men. In comparison with postmenopausal women in the same population [5], the absolute fracture incidence was lower in men. The reason for this difference Z-VAD-FMK mw in the US population was postulated to be related to an increased frequency

of falls Ixazomib concentration in women [14, 15], and fracture risk after a fall was 2.2 times higher in women than men [16]. The relation of fracture risk after a fall in the two sexes was nonetheless reversed in Chinese. Although falls were recorded more often in women [5], the relative risk of fracture in subjects with one or more falls in 12 months was 14.5 for Chinese men and 4.0 for Chinese women. This study also identified the clinical risk factors for fracture in Chinese men and the interaction between risk factors and BMD. These risk factors partly overlap with those reported for Caucasian population of the MrOs study which are the use of tricyclic antidepressant, history of fracture, inability to complete a narrow walk trial, falls in previous year, age ≥ 80 years, depressed mood and decreased total hip BMD [12]. The risk factors for Chinese men are also slightly different from those identified by the Dubbo study which includes increasing age, decreased femoral neck BMD, quadriceps strength, body sway, previous falls,

previous fractures, weight, height, alcohol use, physical activity index and thiazide use [6]. Similar to previous observations of other ethnic groups [17, 18], each SD reduction in BMD T-score is associated with a 1.8 to 2.6-fold increased risk of osteoporotic fractures PLEK2 in Chinese men. The relative risk prediction for osteoporotic fracture was better with BMD measurement at the hip than the spine: this concurs with the findings in Caucasian populations [6, 19]. However, subjects with a femoral neck BMD T-score < −2.5 had a 13.8-fold increased risk of fracture. The WHO FRAX model utilizes ten clinical risk factors with or without BMD for fracture risk prediction. In areas where BMD measurements are not available, WHO proposes to use BMI to replace BMD as it provides a similar risk profile for fracture prediction. Interestingly, our data revealed that addition of BMD information to clinical risk factors enhanced fracture prediction in this male cohort. This observation concurs with other US Caucasian male studies [20].