Effects of transferrin on the modulation of cytokine production on mouse spleen cells

OBJECTIVE: Restorative proctocolectomy for mucosal ulcerative colitis is well established. However, the effect of age on physiologic sphincter parameters is poorly understood. Our objective was to determine whether age at the time of restorative proctocolectomy correlates with physiologic changes. SUMMARY BACKGROUND DATA: In the approximately 20 years during which restorative proctocolectomy has been performed for ulcerative colitis, the indications have changed. Initially, the procedure was recommended only in patients under approximately 50 years. However, the procedure has been considered in older patients because of the increasing age of our population, the increasing frequency of recognition of patients during the "second peak" of mucosal ulcerative colitis, and the decreasing morbidity rates, due to the learning curve and to newer techniques, such as double-stapling. Few authors have presented data analyzing the effects of this operation in older patients. METHODS: One hundred twenty-two patients who had undergone a two-stage restorative proctocolectomy for mucosal ulcerative colitis were divided into three groups according to age: group I (>60 years), 11 men, 6 women; group II (40-60 years), 29 men, 18 women; and group III (<40 years) 29 men, 29 women. The patients were prospectively evaluated using anal manometry and subjective functional results. Comparisons were made before surgery, after colectomy and before closure of ileostomy, and at 1 or more years after surgery. RESULTS: There were no significant differences among the groups relative to manometric results, frequency of bowel movements, incontinence scores, or overall patient satisfaction. The postoperative mean and maximum resting pressures were significantly reduced (p < 0.001), and conversely the sensory threshold (p < 0.005) and capacity (p < 0.001) were increased in all groups up to 1 year after surgery. There were no statistically significant changes in the squeeze pressure or length of the high-pressure zone in any group at any point in time. After surgery, the mean and maximum resting pressures had returned to 80% of their original values. CONCLUSION: Although anorectal function is transiently somewhat impaired after restorative proctocolectomy, the impairment is not an age-related phenomenon.     

Physical fitness of Danish men and women aged 50 to 80 years

Maximal power in sustained work in originally randomly selected men and women, born in 1914, was studied five times between the ages of 50 and 80 years in a longitudinal design. Of the originally 514 men and 461 women in 1964 living in the Western suburbs of Copenhagen, 23 men and 18 women performed a bicycle test at age 50, 60, 70, 75 and 80. The mean annual decline in body mass adjusted maximal power in sustained work (W/kg) was 1.43% in the 18 men and 1.64% in the 23 women. Based on "cross-sectional" comparisons of all subjects tested at any age, the mean annual decline in men was 1.56%; in women the corresponding figure was 1.80%. When the results of the "longitudinal" and "cross-sectional" analyses were compared with each other, a rather similar picture of the age-related decline in maximal power was obtained, especially in women. In the longitudinal data only moderate (women) or zero (men) correlations were observed between the submaximal test results at the ages of 50 and 60 years and the maximal test results at higher ages. The physical work load at the age of 50 years had no significant correlation with maximal power at that age or thereafter. There were only minor changes in mean body height, body mass and BMI during the follow-up.     

Comparison of laparoscopic and open nephroureterectomy for benign disease

PURPOSE: We report our experience with laparoscopic nephroureterectomy for benign disease and compare the results to a contemporary group of patients undergoing open nephroureterectomy. MATERIALS AND METHODS: Between October 1994 and March 1997, 12 women and 4 men with a mean age of 50 years (range 22 to 70) underwent laparoscopic nephroureterectomy at our hospital. Indications for operation were nonfunctioning kidneys due to vesicoureteral reflux with recurrent episodes of pyelonephritis or analgesic nephropathy before a planned renal transplantation. In comparison 11 women and 4 men with a mean age of 40 years (range 18 to 64) underwent open nephroureterectomy for various benign diseases. RESULTS: Laparoscopic and open nephroureterectomy had no significant differences regarding operative times (100 versus 124 minutes) and complication rates (25 versus 20%). In the laparoscopy group conversion to open surgery was not necessary. Patients who underwent laparoscopic nephroureterectomy had significantly less consumption of morphine equivalent for postoperative pain control (12 versus 40 mg.), shorter time to achieve mobilization and oral intake (11 versus 39 hours), shorter hospital stay (6 versus 12.7 days) and faster return to normal activities (21 versus 39 days). CONCLUSIONS: Laparoscopic nephroureterectomy in patients with benign disease has similar operative results but obvious postoperative advantages compared to the open approach.     

Age preferences and mate choice among homosexuals and heterosexuals: A case for modular psychological mechanisms.

Age preferences expressed by homosexuals and heterosexuals in 783 singles ads were compared. In line with earlier cross-cultural findings, heterosexual women at all ages tend to prefer men from their own age to several years older. Heterosexual men change with age; young men show an interest in both older and younger women, but older men express progressively stronger interest in women younger than themselves. Homosexual men's preferences were very similar to those of heterosexual men and homosexual women showed a pattern somewhat between that of heterosexual women and men. Results combine with previous literature to suggest that homosexual choice is not a simple and general reversal of heterosexual roles, and fit with an emerging view that sexual behavior is controlled by a number of independently evolved psychological mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early and long-term results of 233 heart transplant patients in University Bordeaux in France: quality of life following heart transplantations

Between March 1986 and December 1993 we had 233 heart transplant patients who were 218 males and 15 females and had a mean age of 50.9 years (range, 2 to 65 years). We analyzed the actuarial survival for these patients and investigated the status of rehabilitation and return-to-work from the view point of quality of life after heart transplant. Actuarial survival (Kaplan-Meier) was 81.7% at 1 year, 76.3% at 3 years, and 72.2% at 5 years. In 57 dead patients 24 patients (42%) died in 1 month after heart transplant. In 176 living patients 165 patients (53%) returned to life. In 129 patients except 76 retired patients only 69 patients (53%) returned to work. In 60 patients, who didn't return to work, 38 patients (63%) were physically able to work.     

Congenital tethered spinal cord syndrome in adults

OBJECT: The management of tethered spinal cord syndrome with onset of symptomatology occurring in adulthood remains controversial, although the necessity of early surgery in the pediatric tethered cord syndrome population is well established. To ascertain the results of surgery in adult patients with this anomaly, the authors undertook a retrospective review of 34 cases. METHODS: The authors studied the hospital records of 34 consecutive patients who presented in adulthood with tethered cord syndrome and conducted follow-up phone interviews with 28 of them. The population consisted of 12 men and 22 women, ranging in age from 18 to 70 years (mean 34 years). The most common presenting feature was pain, followed by weakness and incontinence. All patients underwent surgery. The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies. Long-term surgical results and patient outcome ratings were encouraging. After a mean clinical follow-up period of 4 years, significant improvement occurred in 22 of 27 patients presenting with pain, 13 of 27 patients with motor or sensory dysfunction, and 11 of 18 patients with bowel and bladder disturbance. In addition, telephone interviews were obtained after a period of 8.6 years. Twenty-two (79%) of 28 patients called the operation a long-term success; 21 (75%) of 28 patients believed that they had significant postoperative improvement (and not just stabilization) in pain and/or neurological function. Surgical complications were generally minor. Nineteen (86%) of 22 employed patients returned to work after surgery. Two (33%) of six patients who were not employed before surgery worked full time postoperatively. Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work. CONCLUSIONS: Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. Because neurological deficits are generally irreversible, early surgery is recommended.     

Trends in rates of occupational fatal injuries in the United States (1983-92)

Recent advancements in laparoscopic surgery have made laparoscopic splenectomy possible. We retrospectively compared the outcomes of laparoscopic versus open splenectomy in patients with idiopathic thrombocytopenic purpura (ITP) or beta-thalassemia. From July 1993 to July 1997, 52 patients (ITP, 43 cases; beta-thalassemia, 9 cases) underwent either laparoscopic (30 patients, 9 men, 21 women; average age, 36.9 years) or conventional open splenectomy (22 patients, 5 men, 17 women; average age, 34.3 years). The two groups were similar in terms of sex, age, diagnosis, duration of disease, preoperative platelet count, and spleen size. The mean surgical time, estimated amount of blood loss, duration of postoperative recovery, analgesic usage, and complications were compared between the two groups. Laparoscopic splenectomy was successful in 29 (97%) of the 30 patients. The mean surgical time in the laparoscopy group was longer than in the open splenectomy group (190.6 vs 113.9 minutes, p < 0.01). The laparoscopy group had earlier postoperative oral intake (15.2 vs 52.6 hours, p < 0.01), less usage of analgesics (meperidine 50 mg/unit, 1.1 vs 2.8 units, p < 0.01) and a shorter postoperative hospital stay (4.1 vs 6.8 days, p < 0.01). The estimated blood loss, incidence of accessory spleen, surgical complication rate, and recurrence rate of thrombocytopenia were similar in the two groups. Our findings show that laparoscopic splenectomy in patients with ITP or beta-thalassemia is as safe as the open approach. While laparoscopy required a longer surgical time, the recovery period was shorter, analgesic use was less, and physical discomfort was less severe.     

Employment after coronary angioplasty or coronary bypass surgery in patients employed at the time of revascularization

BACKGROUND: Patients who undergo coronary angioplasty have a shorter convalescence than those who undergo coronary bypass surgery. This may improve subsequent employment. OBJECTIVE: To compare employment patterns after coronary angioplasty or surgery. DESIGN: Multicenter, randomized clinical trial. SETTING: Seven tertiary care hospitals. PATIENTS: 409 employed patients with multivessel coronary artery disease. INTERVENTION: Coronary bypass surgery or balloon angioplasty. MEASUREMENTS: Time to return to work and time spent working during 4 years of follow-up. RESULTS: Patients who underwent angioplasty returned to work 6 weeks sooner than patients who underwent coronary bypass surgery (P < 0.001), but long-term employment did not differ significantly (P > 0.2). Long-term employment was significantly lower among patients who were 60 to 64 years of age (P < 0.001), those who worked less than full-time at study entry (P < 0.001), and those who had less formal education (P = 0.005). Patients with only one source of health insurance were more likely to continue working (P = 0.005). CONCLUSIONS: Faster recovery after angioplasty speeds return to work but does not improve long-term employment, which is primarily associated with nonmedical factors.     

Psychological predictors of young adults' drinking behaviors.

Path analyses using data from 72 men and 78 women between 22 and 32 years of age compared two models linking personality (conflict resolution styles, intimacy maturity, and occupational identity status) and social roles (family and work status) to young adults' alcohol use. Poor conflict resolution skills and less adult work statuses best accounted for men's excessive drinking, and problems with intimacy best accounted for women's use of alcohol to alleviate emotional distress. In addition, poor conflict resolution skills partly mediated the effects of parents' drinking on sons' alcohol consumption. Occupational identity status and intimacy maturity correlated with men's use of drugs rather than men's alcohol use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Normal T lymphocyte and monocyte function after minimally invasive surgery

BACKGROUND: The aim of this study was to evaluate immune defense mechanisms after laparoscopic (LCHE) and open cholecystectomy (CHE), particularly with regard to monocyte and T-lymphocyte function. METHODS: In a prospective study, we evaluated the following immunological data from 27 patients (21 women, six men; mean age, 47.2 years) submitted to elective LCHE and 14 patients (seven women, seven men; mean age, 60.8 years) undergoing elective CHE: T-lymphocyte proliferation (stimulated by SEA, SEB, TSST-1 with antigen presentation by patient monocytes), expression of cell surface molecules on monocytes (HLA-DR, CD80, L-Selectin), CD4+ T lymphocytes (HLA-DR, CD25, ICAM-1, L-Selectin), and granulocytes (L-Selectin). Blood samples were collected preoperatively and on postoperative days 1 and 6-7. Statistical analysis was performed using the Mann-Whitney U test for paired samples. RESULTS: HLA-DR on monocytes significantly decreased after LCHE during the early postoperative course but returned to preoperative levels within 1 week. After CHE, significant downregulation of HLA-DR expression persisted throughout the whole observation period. This decrease, however, did not alter the antigen-presenting capacity of monocytes in both groups. Moreover, the APC-independent proliferative capacity of T lymphocytes was unimpaired. CD25 expression was significantly increased on postoperative day 1 after CHE but not after LCHE. Expression of HLA-DR, ICAM1, and L-Selection on CD4+ T cells was not altered in either group. CD80 on monocytes and L-Selection on monocytes and granulocytes remained unchanged after both procedures. CONCLUSIONS: HLA-DR surface molecules on monocytes that are required for antigen presentation were significantly decreased in both groups; they returned to normal within 1 week after LCHE but not after CHE. However, the antigen-presenting capacity for monocytes remained normal in both groups. T-cell stimulation, reflected by an increase of CD25 expression, was observed only after CHE, not after LCHE. We therefore conclude that LCHE interferes less with immune defense than CHE; however, the clinical relevance of the changes noted after the open operation remains to be determined.     

Community life support training: does it attract the right people?

We first performed autogenous bone grafting for lesions of the hallux sesamoid in 1984. During the next 9 years, 21 patients (11 men and 10 women with an average age of 34 and 32 years, respectively) underwent this surgical procedure for symptomatic tibial hallux sesamoid non-unions. Successful bony union was achieved in all but two patients. The majority of patients obtained concomitant relief of preoperative symptomatology and returned to their preinjury level of activity. We believe that this procedure serves as an alternative to hallux sesamoid excision in selected cases.     

Spouse, parent, worker: Role commitments and role-related experiences in the construction of adults' well-being.

Examined relations between adults' role strain, anxiety, and depression and 5 aspects of role-related experience: commitment, demands, satisfactions, evaluations, and social support for role-related activities. Participants were 102 men (mean age 34.6 yrs) and 194 women (mean age 32.4 yrs), all employed, in dual-earner marriages, and parenting a preschool child. High commitment to roles was not uniformly associated with greater well-being (e.g., a component of work commitment reflecting absorption in work was linked with a higher role strain in men). Diverse sources of support were linked with women's psychological states, but men's well-being was responsive chiefly to wives' support. Age and role-tenure had relatively little impact on the relations between role-related experiences and well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of potential cure in acute myelogenous leukemia: development of subsequent cancer and return to work

Chemotherapy produces extended remissions, and potential cures, in a small minority of patients with acute myeloid leukemia (AML). We explored whether potentially cured patients were at increased risk of subsequent invasive cancer and were able to return to work. Potentially cured patients were defined as those in first or second complete remission (CR) for at least 3 years based on hazard rates for recurrence or death in CR, which declined sharply after this time. Patients who received allogeneic marrow transplant were excluded. We used questionnaires, phone contact, and chart review to obtain information about subsequent cancer and work status. The number of patients who developed invasive cancer was compared with the number expected based on age, gender, and years of follow-up using the Connecticut Tumor Registry. A total of 215 patients met our criteria for potential cure: 203 in first CR and 12 in second CR (of 1,663 treated between 1965 and December, 1992). At a median of 9.2 years from first or second CR, 163 (76%) remain alive in CR. Fifteen patients developed 18 invasive cancers (expected number of patients, 8.8; observed/expected, 1.70; 95% CI, 0.96 to 2.84; P = . 06). Patients initially treated between 1973 to 1979, patients above the potentially cured cohort's median age of 40 years, and those who presented with abnormalities of chromosomes 5 and/or 7 were more likely to develop subsequent cancer, whereas the observed/expected ratio for younger patients was 1.05 (95% CI, 0.13 to 3.80; P = .56). Seventy-four percent of the patients who were working full-time and who were under age 50 at time of treatment for AML have been working full-time in the last 6 months. Only 17 of 56 patients who are currently not working cited physical limitation as the reason. Patients with potentially cured AML are likely to be able to return to work, and at least if younger do not, on average, have an increased risk of invasive cancer.     

Reconstruction of renal artery aneurysms. Vessel morphology and clinical results

OBJECTIVE: To analyse retrospectively from case notes and follow-up examinations the effectiveness of vascular surgery for renal artery aneurysm (RAA). PATIENTS AND METHODS: Operations for uni- or bilateral RAA were performed, between January 1978 and December 1996, on 61 patients (39 women, 22 men; mean age 47.4 years), 81% with arterial hypertension. Extracorporeal reconstruction with renal autotransplantation was performed in 4 of the patients. Clinical examination and duplex sonography or angiography were performed a mean of 58.4 months postoperatively. RESULTS: Postoperative morbidity rate related to the surgery was 13%; there were no early postoperative death. At the time of follow-up 80% of the reconstructed renal arteries were patent. 26% of hypertensive were cured of the hypertension, while the blood pressure was significantly reduced in 40%. CONCLUSIONS: Vascular reconstruction of RAA can be effective so that primary nephrectomy is no longer indicated. Reconstruction in situ can usually be successfully performed, reducing operative time and reducing surgical trauma. The operation is indicated in any RAA of greater than 2 cm diameter, in all patients with hypertension and renal artery stenosis, and also for smaller aneurysms in patients in good general health and in women of child-bearing age.     

Lichtenstein inguinal hernia repair in a primary healthcare setting

BACKGROUND: Given the generally accepted poor outcome of inguinal hernia repair when using nylon darn, and the recent interest in low-tension mesh repair, an attempt was made to demonstrate the feasibility, outcome and patient perception of providing Lichtenstein inguinal hernia repair, using local anaesthesia, wholly within the primary healthcare sector. METHODS: A prospective study reviewed clinical outcome and patient perception in 100 adults referred with inguinal hernia only. No selection was made regarding age, sex, American Society of Anesthesiologists status or previous repairs. Recurrence, pain, infection, return to full function and associated complications were assessed at 24 h, 1 and 6 weeks, and 1 year. Local Community Health Councils assessed patient perception. RESULTS: In the first 100 patients (age range 21-83 (mean(s.d.) 60(14.7)) years; 58 of employable age; 92 men; ten recurrent hernias), no recurrences have occurred at 1 year. Infection rate was 3 per cent. Pain was maximal in the first 24-48 h (median visual analogue scale 5, range 0-10) and reduced rapidly (median 1) at 1 week. Mean time to return to work or full normal activity was 8 days. Some 85 operations were performed within 1 month of diagnosis. In all, 86 patients returned the patient satisfaction questionnaire and 98 per cent of these were 'very pleased' with the service. CONCLUSION: In highly motivated primary healthcare centres, inguinal hernia repair can be undertaken effectively, providing high patient satisfaction, minimal complications and low recurrence rates using the Lichtenstein technique.     

Results of anterior shoulder decompression surgery according to Neer for shoulder impingement syndrome; little effect on fitness for work

OBJECTIVE: To evaluate the effect of surgical treatment of the impingement syndrome of the shoulder on the fitness for work. DESIGN: Retrospective. SETTING: Academic Hospital Groningen, department of Orthopaedics, the Netherlands. PATIENTS AND METHODS: A group of 31 patients who had undergone an anterior shoulder decompression between 1 January 1984 and 31 December 1993 because of shoulder symptoms due to impingement lasting more than one year, were subjected in January 1996 to a study of the effect of the treatment on the pain, fitness for work and participation in the labour process. The results were measured using an objectivated score list for pain and function and with a comparison of the labour situations before and after the operation as described by the patients. RESULTS: End results as measured with the score list were fair to good in 97 patients (74%). The numbers of those completely fit for work before operation and at follow-up were identical, viz. 45 out of 131 (34%). Thirty-four patients (26%) had other jobs or adjusted activities and 37 (28%) were completely unfit for work (together 71 patients: 54%); 15 patients (11%) had stopped working for reasons of age. The probability to be definitely rejected for work after the operation was increased significantly by a job causing shoulder overstrain and by having been on sick leave with pay prior to the operation. CONCLUSION: Although the objective results were reasonably good, the percentage of those completely fit for work was not changed appreciably by the surgical treatment.     

Psychological distress, social support and coping behaviour among polio survivors: a 5-year perspective on 63 polio patients

The aim of the study was to seek knowledge of psychological and psychosocial aspects of coping with late effects of polio. Sixty-three polio survivors, 43 women and 20 men (mean age 55.3 years) 3-5 years ago former inpatients at the Post-Polio Program at Sunnaas Rehabilitation Hospital, participated in the study. In addition to a semi-structured interview-guide, the Hospital Anxiety and Depression scale (HAD), the Sickness Impact Profile (SIP), Cope-Scale, Brief Type-A Questionnaire (BTAQ) and the Fatigue Severity Scale (FSS) were used. As a measure of physical status, we used working capacity defined as peak O2 (oxygen) uptake. Levels of working capacity did not correlate significantly with any psychological variables, and the subjects reporting improved psychological health over the last 3-5 years did not have higher levels of working capacity or less physical decrement. A significant correlation was found between self-reported fatigue. psychological variables and social support. Compared to previous studies, low psychological distress, normal type-A scores, high adjustment and problem-focused coping characterized the respondents, pointing to the importance of timing in psychosocial research of post-polio.     

Cholesterolemia and total, cardiovascular and cancer mortality. Study of a cohort of 220,000 people]

The distribution of cholesterolemia and their relationship to total mortality, cardiovascular mortality, and cancer mortality were studied in a population of 125,513 men and 96,301 women, aged 16-90. Cholesterolemia in the population increases with age, up to age 50-60 for men and 60-70 for women. Beyond these ages, cholesterolemia decreases very significantly for men and moderately for women. Upon global examination of the entire population, the relationship between cholesterolemia and total mortality is observed as a U-shaped curve. The relationship with cancer mortality is slightly negative in men and appears as a U-shaped curve in women. The relationship with cardiovascular mortality in men is strongly positively correlated when adjusted for body mass index, blood pressure, tobacco consumption, gamma GT, and age. This relationship is not significant in women. There is a significant interaction in the relationship between cholesterolemia and mortality in men for weight, body mass index, vital capacity, maximum expiration volume per second, tobacco consumption, urea, serum albumin, hematocrit, hemoglobin, alkaline phosphatases, gamma GT, red cell volume, and sedimentation rate. Age is a fundamental variable to take into account. Thus, in men under 50 years of age at the time of inclusion, the relationship between cholesterolemia and total mortality shows a positive tendency, and the relationship with cardiovascular mortality is strongly positive. In men over 65 years of age, these relationships are negative. The same tendencies exist for cancer mortality. The reasons for these negative relationships may be related to the decreased cholesterol levels in subjects with malnutrition or diseases (essentially hepatic diseases); this is especially true in older subjects. These data push for additional in-depth analysis of these relationships and interactions, according to age categories and detailed causes of mortality. They also reinforce the idea that, in some patients, low cholesterolemia appears to be a marker for predisposition or the result, but not a cause, of cancer.     

Results of the modified Sauvé-Kapandji procedure in the treatment of chronic posttraumatic derangement of the distal radioulnar joint

We reviewed the results of a modified Sauvé-Kapandji procedure with tenodesis of the flexor carpi ulnaris to the carpus in eighteen patients who had chronic derangement of the distal radioulnar joint. There were fourteen men and four women. The mean supination of the forearm had improved from 16 degrees (range, 0 to 75 degrees) preoperatively to 76 degrees (range, 40 to 90 degrees) at the time of the latest follow-up, and the mean pronation had improved from 42 degrees (range, 0 to 80 degrees) preoperatively to 81 degrees (range, 60 to 90 degrees) at the time of follow-up. Pain relief was satisfactory, and the mean grip strength had improved from 36 percent of that on the unaffected side preoperatively to 73 percent at the time of follow-up. One patient had moderate pain over the ulnar stump associated with residual volar instability of the proximal ulnar segment, and he had a tenodesis of the extensor carpi ulnaris as a second procedure. Another patient had mild instability of the stump only after he had a second operation, which was an excision of a bone mass (ossification) in the resected area. The ulnar stump was stable in sixteen patients. Eight of the eleven patients who had performed heavy manual labor before the injury were able to return to work full-time without restrictions. According to a modification of the wrist-scoring system of the Mayo Clinic, at a mean of four years and two months (range, two years to eight years and four months), six patients had an excellent result; seven, a good result; four, a fair result; and one, a poor result. On the basis of our findings, we believe that the index operation is an excellent salvage procedure for the treatment of chronic posttraumatic derangement of the distal radioulnar joint, especially when nonoperative treatment has been unsuccessful and rotation of the forearm is severely limited.     

Bone density and fracture risk in men

We evaluated different definitions of osteoporosis in a population-based sample of 348 men (age 22-90 years) compared with 351 women (age 21-93 years). Thirty-six men (10%) and 46 women (13%) had a history of osteoporotic fracture (hip, spine, or distal forearm due to moderate trauma at >/= age 35). In logistic regression analysis, osteoporotic fracture risk was associated with bone mineral density (BMD) at all sites (neck, trochanter, total hip, lumbar spine, and total wrist) in both genders (p < 0.001) except spinal BMD in men. After adjusting for age, total hip BMD was the strongest predictor of fracture risk in women (odds ratio [OR] per 1 SD decline, 2.4; 95% confidence interval [CI], 1.6-3.7), while wrist BMD was best in men (OR, 1.5; 95% CI, 1.1-2.0). Among men but not women, bone mineral apparent density (BMAD) was a better predictor of fracture than BMD (wrist BMAD OR, 1.7; 95% CI, 1.3-2.3). Hip BMD/BMAD decreased linearly from age 20 years onward in both genders, while spinal BMD/BMAD declined after age 40 in women but not in men. In both genders, total wrist BMD/BMAD decreased after age 50. By World Health Organization criteria, the age-adjusted prevalence of osteoporosis at the hip, spine, or wrist was 35% among women >/=50 years of age. A similar approach (BMD > 2.5 SD below the young male mean) produced an osteoporosis prevalence rate in men >/=50 years of age of 19%. Thus, bone density predicts fracture risk in men as it does in women, and the prevalence of osteoporosis in men, using sex-specific normal values, is substantial. These observations indicate a need for better prevention and treatment strategies for men.