Ethnic Differences in the Risk of Fracture and Vascular Disease

描述（由申请人提供）：K23候选人的职业目标是成为风湿病流行病学家。在指导研究的背景下，柯蒂斯博士将研究与骨质疏松症相关的发病率，风险因素和结果，重点是非洲裔美国人和男性。为了实现这一目标，柯蒂斯博士设计了一个教学培训计划，以提高他在大型纵向研究相关分析技术方面的方法论技能。在经验丰富的导师的监督下，Curtis博士将获得进行和分析4年R01 "卒中地理和种族差异的原因"研究的辅助研究的实践培训，该研究由NINDS资助，招募了30，000名非洲裔美国人和白人。虽然骨折的风险通常低于白人女性，但非洲裔美国人和男性的骨折后发病率和死亡率更高。估计男性和非白种人绝对骨折风险的能力有限，因为这些人在骨质疏松症队列中的代表性相对不足。既往骨折似乎是随后卒中和心肌梗死（MI）的独立风险，但在高风险、研究不足的人群中，骨与血管疾病之间的相关性知之甚少。K23项目的具体目的是1）确定与整个队列相比，3个高风险组（普遍骨折;既往卒中;糖皮质激素使用）中4年内相对和绝对骨折发生率的种族/种族差异; 2）确定普遍骨折患者中卒中和MI风险的种族/种族差异。生存分析将按种族/人种和性别比较首次和复发性骨折和血管事件的发生率和风险因素。基于发送给整个队列的辅助问卷，将在几个次要假设中检查骨和血管疾病的共同风险因素。该项目产生的数据将为未来的研究提案提供一个框架。更好地了解与非裔美国人和男性骨折和相关血管事件风险因素相关的绝对和相对危害，可能会提高对潜在生物学的理解，并有助于减少骨质疏松症护理中与种族/种族和性别相关的差异。除了该奖项的培训目标外，最终目标是通过更好地识别那些因骨折和相关血管疾病而导致不良结局的最高风险人群来更好地预防。

DESCRIPTION (provided by applicant): The career objective of the K23 candidate is to become a rheumatic disease epidemiologist. In the context of mentored research, Dr. Curtis will examine the incidence, risk factors, and outcomes related to osteoporosis, with an emphasis on African Americans and men. To achieve this objective, Dr. Curtis has designed a didactic training program to augment his methodologic skills in analytic techniques relevant to large longitudinal studies. With supervision of experienced mentors, Dr. Curtis will obtain hands-on training in the conduct and analysis of an ancillary study to the 4 year R01 "Reasons for Geographic and Racial Differences in Stroke" study funded by the NINDS enrolling 30,000 African Americans and Caucasians. Although typically at lower risk for fractures than Caucasian women, African Americans and men suffer greater post-fracture morbidity and mortality. The ability to estimate absolute fracture risk among men and non-Caucasians is limited since these persons are relatively underrepresented in osteoporosis cohorts. Prior fracture appears to be an independent risk for subsequent stroke and myocardial infarction (Ml), but the association between bone and vascular disease in high risk, understudied populations is poorly understood. The specific aims of the K23 project are 1) Define ethnic/racial differences in relative and absolute fracture incidence over 4 years in 3 high risk groups (prevalent fracture; prior stroke; glucocorticoid use) compared to the overall cohort; 2) Determine ethnic/racial differences in stroke and Ml risk among those with prevalent fracture. Survival analysis will compare rates and risk factors for first and recurrent fractures and vascular events by ethnicity/race and gender. Shared risk factors for both bone and vascular disease will be examined in several secondary hypotheses based on an ancillary questionnaire sent to the entire cohort. Data generated from this project will provide a framework for future research proposals. Better understanding of the absolute and relative hazards associated with risk factors for fracture and associated vascular events in African Americans and men may lead to improved understanding of the underlying biology and help reduce ethnic/racial and gender-related disparities in osteoporosis care. Beyond the training objective of this award, the ultimate goal is better prevention through improved identification of those at highest risk for poor outcomes from osteoporotic fractures and associated vascular disease.