Validation of the quality of life questionnaire of the European foundation for osteoporosis (QUALEFFO-31) in Chinese

QUALEFFO-31 is a recently developed disease-specific instrument derived from QUALEFFO-41 and intended to have improved efficacy and response rates. We aimed to validate QUALEFFO-31 in Chinese and examine the use of QUALEFFO-31 in clinical practice. This questionnaire was translated into Chinese and applied to 118 case-control pairs aged between 50 and 85 years with prevalent osteoporotic vertebral fractures to evaluate its validity, repeatability, and discriminatory ability. It was also used to evaluate the quality of life (QOL) of 69 case-control trios with prevalent clinical and morphometric fractures. The QOL of all subjects was concurrently assessed using SF-36 for comparison. QUALEFFO-31 had good internal consistency with adequate convergent and discriminatory validity. The median test-retest repeatability ranged from 0.65-0.85. In general, there were good correlations between QUALEFFO-31 and SF-36. ROC curve analysis revealed that QUALEFFO-31 had significant ability to discriminate between clinical fracture subjects versus morphometric fracture subjects and controls. QUALEFFO-31 also demonstrated higher discriminatory capacity for pain. Subjects with clinical vertebral fractures (CVFs) had a significant reduction in QOL compared with other subjects. The QUALEFFO-31 is a useful tool for assessing QOL in Chinese. It was well accepted and significantly predictive of subjects with CVFs. © 2010 Clinical Rheumatology.published_or_final_versionSpringer Open Choice, 21 Feb 201

Assessment of absolute fracture risk and osteoporosis in Chinese: is there any difference between the application of Chinese normative database and NHANES III Caucasian database?

Presentation no. Sa312WHO and ISCD recommend the use of a uniform Caucasian (non-race adjusted) female normative database for women of all ethnic groups as reference for BMD T- scores determination and fracture risk assessment. The objectives of the study were (1) to compare the Southern Chinese and NHANES III normative database in identifying subjects with osteoporosis and fractures in postmenopausal Southern Chinese women in Hong Kong; and (2) to examine the relation of BMD thresholds and clinical risk factors (CRF) evaluation and incident osteoporosis fracture rate and hip fracture rate. 2226 postmenopausal Hong Kong Southern Chinese women aged 45 and above were prospectively followed for incident low trauma fracture. Bone mineral density (BMD) was determined at the hip and spine by dual-energy X-ray absorptiometry (DXA). New fractures were recorded and verified by either retrieval of x-ray report or from the computerised patient record system of the Hospital Authority of the Hong Kong Government. The mean age at baseline was 62.1 ± 9.3 yr. After 4.3 ± 2.2 yr (range 3-12 yr) of follow-up, 137 new osteoporotic fractures were reported. Compared to Southern Chinese database, NHANES III Caucasian female database at the femoral neck overestimated the percentage of women with osteoporosis (18.2%vs 28.8%). However, the overall osteoporotic fracture rate and hip fracture rate were similar between the two reference databases. Although fracture rates were highest in women with femoral neck BMD T-score ≤ -2.5 SD, these women only experienced 56% of the osteoporotic fractures and 61% of the hip fractures. Addition of one or more CRF (>65 yr of age, BMI <19, previous fracture, 1 or more falls in the past 12 months, exercise <30min/day) improved the detection rate of osteoporotic fractures to 80% and hip fractures to 88%. Lowering the BMD T score threshold to -2.0 together with CRF further increased the detection rates to 86% and 91% respectively. The NHANES III Caucasian database can be applied to Southern Chinese for absolute fracture risk assessment. BMD T-score threshold at -2.0 together with CRF assessment could identify the majority of women at high risk of osteoporotic fracture

FRAX™ and the assessment of Ten-Year Fracture Probability in Hong Kong Southern Chinese according to age and BMD Femoral Neck T-Scores

Presentation no. Su264At present, studies using Asian subjects to estimate the probability of osteoporotic fracture remain sparse. Although the WHO algorithms (FRAX™) risk assessment tool has data for Chinese population, the absolute fracture risk estimated for Chinese living in mainland China may not be applicable to southern Chinese in Hong Kong because of differences in lifestyle habits and subject characteristics. The objective of this study was to estimate the 10-year probability of osteoporotic fracture in Hong Kong southern Chinese according to age and BMD T-score at the femoral neck based on the methodology of FRAXTM risk assessment tool calibrated to the epidemiology of Hong Kong. Fracture data was obtained from the Clinical Data Analysis Reporting System (CDAS) of the Hospital Authority of Hong Kong while population size and death rates were taken from the Hong Kong Government Census and Statistics Department. Fracture probability was calculated using the cut-off values for T-scores derived from the NHANES III data for Caucasian women aged 20-29 years for BMD at the femoral neck. We found that the 10-year probability of osteoporotic fracture in Hong Kong southern Chinese men and women increased markedly with increasing age and decreasing femoral neck BMD T-score. Furthermore, the results showed that the 10-year absolute fracture risk for Hong Kong southern Chinese was substantially higher than the mainland Chinese and was comparable to Caucasians in other developed countries like USA and UK. Based on this evidence and until we have Hong Kong southern Chinese population-specific information, we recommend the application of the Caucasian risk profile to calculate the absolute fracture risk for Hong Kong southern Chinese subjects

Overexpression and point mutations of p53 tumor suppressor gene in hepatocellular carcinomas in Hong Kong Chinese people

Background. Gene deletion, point mutations, and abnormalities in expression of the tumor suppressor gene p53 in hepatocellular carcinoma have been reported to occur with varying frequency in different geographic regions. Methods. To assess the expression and point mutation of the p53 gene, 31 patients with hepatocellular carcinomas were examined using Northern blotting, immunohistochemical methods, and DNA sequencing. All patients were Chinese, and 90.3% were positive for hepatitis B surface antigen (HBsAg). Results. p53 transcript or protein was found in 14 (48.4%) of the 31 patients. Detectable p53 mRNA transcripts were found in 10 patients, and p53 protein was detected in 8 patients. In most cases of patients who had detectable p53 mRNA transcripts, the transcripts in the tumors were exhibited at a higher level than they were in the corresponding nontumorous livers. No p53 protein was detected in the nontumorous livers in all 31 patients. Six (23.1%) of the 26 tumors sequenced showed point mutation scattered in exons 5-9. Of these, only two were at codon-249, and the nature of these two mutations was G-to-T transversions. All but one of the six patients with point mutations had overexpression of the gene. Conclusions. Our results show that scattered point mutations are not uncommon in hepatocellular carcinomas in patients from Hong Kong. The distribution pattern of the mutations seems to have no particular correlation with HBsAg status despite a high prevalence rate of HBsAg positivity in our patients. Consistent with a low aflatoxin exposure, aflatoxin-related specific mutation at codon-249 is much less related to the pathogenesis of hepatocellular carcinoma in Hong Kong Chinese people than in other regions with a high-aflatoxin exposure.link_to_subscribed_fulltex

Ten-year fracture probability in Hong Kong Southern Chinese according to age and BMD femoral neck T-scores

This study estimated the 10-year probability of osteoporotic fracture in Hong Kong Southern Chinese based on a simplified model of the recently developed WHO fracture risk prediction tool (FRAX®). Thus, the data provides further insights into potential development of a population-specific FRAX® model for Hong Kong in the future. Introduction: The purpose of this paper was to estimate the 10-year probability of osteoporotic fracture in Hong Kong (HK) Southern Chinese according to age and bone mineral density (BMD) T-score at the femoral neck based on the methodology of the FRAX® risk assessment tool calibrated to the epidemiology of HK. Methods: Hip fracture data was obtained from the Clinical Data Analysis Reporting System (CDAS) of the Hospital Authority of HK and population size and death rates were taken from the HK Government Census and Statistics Department. Fracture probability was calculated using the cut-off values for T-scores derived from the NHANES III data for Caucasian women aged 20-29 years for BMD at the femoral neck. Results: In this study, the 10-year probability of osteoporotic fracture in HK Southern Chinese increased markedly with increasing age and decreasing femoral neck BMD T-scores in both women and men. Interestingly, at low T-scores, the increase in 10-year probability of osteoporotic fracture in women with age was greater than in men. Fracture probabilities were substantially higher than those from mainland China. Conclusions: Based on this evidence, and until we have HK Southern Chinese population-specific information, we recommend the application of the Caucasian risk profile to calculate the absolute fracture risk for HK Southern Chinese subjects. © 2009 International Osteoporosis Foundation and National Osteoporosis Foundation.link_to_subscribed_fulltex

Examining factor structure of the Chinese version of the PIRLS 2011 home questionnaire

2016-2017 > Academic research: refereed > Publication in refereed journal201811_a bcmaVersion of RecordPublishe

BMD enhances clinical risk factors in predicting ten-year risk of osteoporotic fractures in Chinese men: the Hong Kong Osteoporosis Study

Poster presentations: Poster 2Introduction: Clinical risk factors with or without bone mineral density (BMD) measurements are increasingly recognized as reliable predictors of absolute fracture risk. Clinical risk factors may be population specific. The purpose of this prospective study was to determine the risk factors for osteoporotic fractures and to predict the 10-year risk of fractures in Southern Chinese male population. Materials and Methods: This is a part of the Hong Kong Osteoporosis Study. 1,525 community-dwelling, treatment-naive Southern Chinese men aged 50 or above were recruited. Baseline demographic characteristics and clinical risk factors were obtained, and BMD at the spine and hip were measured. Subjects were prospectively followed for incident low trauma fracture. Ten-year risk of major osteoporotic fracture and hip fracture was calculated using Cox proportional hazards models. Results: The mean age of subjects was 68 ± 10 years. After 3.5 ± 3 (1–14) years of follow-up, 36 non-traumatic incident fractures were reported. The incident rates for osteoporotic fractures and hip fracture were 676/100,000 and 132/100,000 person-years respectively. The most significant predictors of osteoporotic fracture were history of fall (odds ratio 14.5) and fragility fracture (odds ratio 4.4). Other predictive factors included outdoor activity <60 minutes/day, BMI < 20 kg/cm2, difficulty bending forward, use of walking aid, and age ≥ 65 years. Each SD reduction in BMD at spine or hip was associated with 1.7 to 2.6-fold increase in fracture risk. Subjects with 5 or more clinical risk factors had an absolute 10-year risk of osteoporotic fracture of 6.2%, which increased to 18.2% if they also had total hip BMD T-score ≤ -2.5. Addition of BMD information (total hip T-score score ≤ -2.5) significantly enhanced fracture risk prediction when compared to clinical risk factors only (omnibus test p=0.001). Men with multiple risk factors and low BMD T-scores have a higher absolute fracture risk while men with no risk factors and normal BMD have a lower fracture risk than that predicted by FRAX. Conclusions: Clinical risk factors are population specific and the addition of BMD measurement to risk factor assessment improves fracture risk prediction in Southern Chinese men.The 11th Regional Osteoporosis Conference (ROC), Hong Kong, 15-16 May 2010