Biomedical subjects

Li-Yung Lui

Publications and source records attributed to Li-Yung Lui.

24 records · Page 2Linked to original sources

PubMed2003

BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures.

UNLABELLED: In a large cohort of U.S. women aged 65 and older, we report the relationships of BMD measured at several sites, and subsequent fracture risk at multiple sites over > 8 years of follow-up. Although we found almost all fracture types to be related to low BMD, the overall proportion of fractures attributable to low BMD is modest. INTRODUCTION: Although several studies have reported the relationship between bone mineral density (BMD) and subsequent fracture risk, most have been limited by short follow-up time, BMD measures at only one or two sites, or availability of data for only select fracture types. MATERIALS AND METHODS: In the multicenter Study of Osteoporotic Fractures (SOF), we studied the relationship of several different BMD measures to fracture risk of multiple types in 9704 non-black women aged 65 and older. We previously reported on the relationship of peripheral BMD measures to risk of several types of fracture during an average 2.2-year follow-up period. In this expanded analysis, we present results of the relationship of both peripheral and central BMD measures and fractures of multiple types during 10.4 and 8.5 years of follow-up, respectively. We also report population attributable risk (PAR) estimates for osteoporosis and risk of several types of fracture. RESULTS: Our results show that almost all types of fractures have an increased incidence in women with low BMD. However, hip BMD is somewhat more strongly related to most of the fracture types studied than spine or peripheral BMD measures. Nonetheless, the proportion of fractures attributable to osteoporosis (based on a standard definition of osteoporosis) is modest, ranging from < 10% to 44% based on the most commonly used definition of osteoporosis (BMD T-score < -2.5). CONCLUSION: Finding effective prevention strategies for fractures in older women will require additional interventions beside preventions for bone loss, such as prevention of falls and other fracture risk factors.

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PubMed2002

Very low prevalence of hip osteoarthritis among Chinese elderly in Beijing, China, compared with whites in the United States: the Beijing osteoarthritis study.

OBJECTIVE: To compare the prevalence of osteoarthritis (OA) of the hip among elderly persons in China and the US. METHODS: We recruited a population-based sample of 1,506 persons (82% of those enumerated) ages > or = 60 years living in Beijing, China. Subjects answered questions about joint symptoms and underwent radiography of the pelvis. Radiographs of the Beijing subjects were intermingled with hip radiographs of white women ages > or = 65 years from the Study of Osteoporotic Fractures (SOF) and white men and women ages 60-74 years from the First National Health and Nutrition Examination Survey (NHANES-I) and were then interpreted. Radiographic hip OA was defined as the presence of 1 of the following 3 findings in either hip: minimum joint space of < or = 1.5 mm, definite osteophytes and joint space narrowing, or > or = 3 radiographic features of OA. Symptomatic hip OA was defined as both radiographic OA and hip pain. RESULTS: The crude prevalence of radiographic hip OA in Chinese ages 60-89 years was 0.9% in women and 1.1% in men; it did not increase with age. Chinese women had a lower age-standardized prevalence of radiographic hip OA compared with white women in the SOF (age-standardized prevalence ratio 0.07) and the NHANES-I (prevalence ratio 0.22). Chinese men had a lower prevalence of radiographic hip OA compared with white men of the same age in the NHANES-I (prevalence ratio 0.19). There were no cases of symptomatic hip OA in the Chinese men and only 1 case in the Chinese women; 35 cases were expected in both sexes. CONCLUSION: This is the first population-based study of hip OA in China to use standardized radiographic methods and definitions. We found that hip OA was 80-90% less frequent than in white persons in the US. Identification of the genetic and environmental factors that underlie these differences may help elucidate the etiology and prevention of hip OA.

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PubMed2002

Sex hormones and cognitive function in older men.

OBJECTIVES: Recent studies have suggested that estrogen may improve cognitive function or prevent cognitive decline in older women. Little research has been conducted on exogenous or endogenous sex hormones and cognition in older men, yet it has been hypothesized that testosterone, either directly or by conversion to estrogens, may improve cognitive function. We investigated whether serum level of testosterone and estradiol is associated with cognition in older community-dwelling men. DESIGN: A cross-sectional study. SETTING: Population-based listings in the Monongahela Valley near Pittsburgh, Pennsylvania. PARTICIPANTS: Three hundred ten men (mean age +/- standard deviation = 73.0 +/- 7.1) who were part of a cohort study. MEASUREMENTS: We measured cognitive function using the Mini-Mental State Examination (MMSE), Trails B, and Digit Symbol. Sex hormone levels were determined by radioimmunoassay from serum obtained at the time of cognitive testing and analyzed by tertile. RESULTS: No consistent association between total testosterone level and cognitive test scores was observed. However, men with high bioavailable (loosely protein-bound) testosterone had better cognitive test scores on all three tests (P < or =.001). Total estradiol levels were associated with worse cognitive scores on Digit Symbol (P <.001) and Trails B (P =.002), but bioavailable estradiol levels were not associated with cognitive function. Level of sex hormone binding globulin (SHBG) was negatively associated with cognitive scores on all three tests (P < or =.001). After adjusting for age and education, the statistical significance lessened for bioavailable testosterone (MMSE, P =.086; Digit Symbol, P =.047; Trails B, P =.076) and became nonsignificant for SHBG (all cognitive tests P>.10). CONCLUSIONS: Our findings support the hypothesis that higher levels of bioavailable testosterone, but not of bioavailable estradiol, are associated with better cognitive function in older men. In addition, bioavailable measures of testosterone may better reflect hormone levels available to the brain and thus be more closely associated with central nervous system outcomes such as cognition. Future studies, especially randomized trials, should be undertaken to determine whether testosterone may protect against cognitive decline in older men.

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PubMed2002

The effects of acute illness on ADL decline over 1 year in frail older adults with and without cognitive impairment.

BACKGROUND: Acute illness may lead to long-term losses in older adults' ability to independently perform activities of daily living (ADLs). The magnitude of these losses may differ for patients with and without cognitive impairment. These relationships have not been described for the frailest of older adults whose high rates of acute illness and cognitive impairment put them at the greatest risk for loss of ADL functioning. METHODS: We conducted a prospective study of 2593 patients enrolled in a nationwide medical and psychosocial program for frail, community-living, nursing home-eligible patients. We determined the independent and interactive effects of baseline cognitive impairment and admission for an acute illness on change in ADL functioning over 1 year. RESULTS: ADL decline over 1 year occurred in 53% of cognitively impaired patients who were admitted for an acute illness, 38% of cognitively impaired patients who were not admitted for an acute illness, 42% of noncognitively impaired patients who were admitted for an acute illness, and 25% of noncognitively impaired patients who were not admitted for an acute illness (p <.001). The amount of additional decline in ADLs associated with an admission for an acute illness was similar between patients with and without cognitive impairment (-.85 vs -.74; p for interaction =.86). Among patients who were admitted for an acute illness, significant decline in ADL functioning occurred only in the quarter surrounding the acute illness with no evidence of recovery in the months after the acute illness episode. CONCLUSIONS: Among frail older adults, loss of ADL functioning over 1 year is independently associated with both acute admission for an acute illness and cognitive impairment. Frail elders, especially those with cognitive impairment, are in need of interventions that reduce the long-term functional consequences of acute illness.

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PubMedDate not supplied

Social networks and marital status predict mortality in older women: prospective evidence from the Study of Osteoporotic Fractures (SOF).

OBJECTIVE: To assess the relationship between social network size and prospective mortality risk among a large sample of older, Caucasian women. METHOD: The study included 7524 Caucasian community-dwelling women, age 65 or older (mean age = 74.1), who participated from four U.S. communities. Study participants completed a protocol that included anthropomorphic and health assessments at baseline and the Lubben Social Network Scale at year 2. We followed participants for an average of 6 years after they had completed the year-2 assessment. We used hospital records and a copy of the participant's official death certificate to document mortality and cause of death in accordance to ICD-9 revision codes. RESULTS: A total of 1451 deaths (19.3% of sample) were observed over follow-up, 215 (3.4%) due to cardiovascular causes. Higher social network scores were a robust predictor of lower multivariate-adjusted mortality (RR = 0.92, 95% CI = 0.86-0.98), controlling for age, comorbid disease, body mass, smoking, depression, and education. However, social network benefits were attenuated after controlling for marital status. Married participants showed lower total (RR = 0.83, 95% CI = 0.74-0.94) and CVD (RR = 0.59, 95% CI = 0.43-0.81) covariate-adjusted death rates compared with unmarried participants. CONCLUSIONS: Social network scores and marriage were each associated with reduced prospective mortality risk among older women. The relationships shown here suggest that much of the protection afforded by larger social networks in older women results from marriage rather than other forms of social relationships. Mechanisms at the physiological or behavioral level explaining social relationship benefits remain important areas for future research.

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PubMedDate not supplied

Depressive symptoms and risk of mortality in frail, community-living elderly persons.

OBJECTIVE: Depression and depressive symptoms have been associated with increased rates of mortality in a variety of populations, but have not been studied in frail, community-living elderly persons. The authors determined whether depressive symptoms were associated with mortality in a frail, multi-ethnic cohort. METHODS: Authors conducted a prospective study of 250 participants enrolled in a program for patients in the community eligible for nursing home placement, determining the occurrence of depressive symptoms at enrollment and survival after 18 months of follow-up, using Cox proportional-hazards models to determine whether depressive symptoms were independently associated with mortality. RESULTS: At enrollment, 73 of the participants (29%) were judged to have depression. Among depressed participants, 26% died, versus 17% of those with fewer depressive symptoms. After they adjusted for various demographic factors, 18-month mortality was almost 70% higher in those with depressive symptoms than in those with fewer symptoms. Women with more depressive symptoms showed nearly a 2.5-fold increase in risk of mortality than women with fewer symptoms, whereas more depressed men were not at increased risk of mortality compared with less depressed men. CONCLUSION: Depressive symptoms constitute a risk factor for mortality in frail elderly persons.

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