A PROSPECTIVE COHORT STUDY OF BONE LOSS AND OSTEOPOROTIC FRACTURES IN A RURAL JAPANESE COMMUNITY. THE EFFECT OF NUTRITION, PHYSICAL EXERCISE, ENVIRONMENTAL AND FAMILIAL FACTORS

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Bone mineral density (BMD) was measured over a ten year period in a cohort study in a mountain village, Wakayama Prefecture, Japan, to provide information on rate of bone loss in the mature and elderly population and to compare the temporal course of BMD between fast bone losers and normal residents.Four-hundred subjects were selected by sex and age from the full list of residents born, in 1910-1949, and BMD of the lumbar spine and proximal femur was measured using dual energy X-ray absorptiometry (DXA) at the baseline, third, severth, and 10th years. Annual rate of change in BMD (% per year) in the lumbar spine in men in their forties, fifties, sixties and seventies was 0.17, 0.55, 0.01 and -0.16, respectively, and in women, -0.87, -0.83, -0.48 and -0.48, respectively. Thus in men, BMD at the lumbar spine increased in all age strata but the oldest, when it decreased, while in women, it decreased in all age strata.MD at the proximal femur decreased in both sexes in all age strata. Our results show that bone loss rates differ depending on die site involved, demonstrating that different strategies are needed for the prevention of bone loss in the spine and hip. Fast bone losers were defined as those subjects demonstrating an excess bone loss that was the greatest tertile of the distribution of bone loss between initial three years, and the rest were classified as normal subjects. Although mean values of BMD at lumbar spine over a ten year period decreased steeply in both fast bone losers and normal subjects, those for fast bone losers was significantly lower than that of normal subjects (P<0.01). However, there was no difference of mean rate of change for BMD over ten years between fast bone losers and normal subjects.