Ethnic Differences in the Risk of Fracture and Vascular Disease

描述(由应聘者提供)：K23候选人的职业目标是成为一名风湿病流行病学家。在指导性研究的背景下，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，以增强他在与大型纵向研究相关的分析技术方面的方法论技能。在经验丰富的导师的监督下，柯蒂斯博士将获得指导和分析为期4年的R01“中风的地理和种族差异原因”研究的实践培训，该研究由NINDS资助，招募了30,000名非裔美国人和高加索人。尽管非裔美国人和男性的骨折风险通常比高加索女性低，但他们的骨折后发病率和死亡率更高。估计男性和非高加索人的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较低。既往骨折似乎是随后中风和心肌梗死的一个独立风险，但在高危、研究不足的人群中，骨和血管疾病之间的联系还知之甚少。K23项目的具体目标是：1)确定3个高危人群(普遍骨折、既往中风、使用糖皮质激素)在4年内相对和绝对骨折发病率与总体队列相比的种族/种族差异；2)确定普遍骨折患者中风和ML风险的种族/种族差异。生存分析将按种族/种族和性别比较首次和复发骨折和血管事件的发生率和风险因素。骨和血管疾病的共同风险因素将在发送给整个队列的辅助问卷的基础上，在几个次级假设中进行检验。该项目产生的数据将为未来的研究建议提供一个框架。更好地了解非裔美国人和男性中与骨折和相关血管事件的风险因素相关的绝对和相对危险，可能会导致对潜在生物学的更好理解，并有助于减少在骨质疏松症护理方面的种族/种族和性别差异。除了该奖项的培训目标外，最终目标是通过改进对骨质疏松性骨折和相关血管疾病不良预后的高风险人群的识别，更好地进行预防。

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.