Lower urinary tract symptoms and risk of non-spine fractures among older community dwelling US men

PURPOSE - Among older men, moderate and severe lower urinary tract symptoms (LUTS) are associated with increased fall risk compared to mild LUTS. Falls are a major risk factor for fractures. Therefore, we assessed associations of LUTS with fracture risk in community dwelling U.

S. men aged 65 years or older.

MATERIALS AND METHODS - We conducted a prospective study in the Osteoporotic Fractures in Men (MrOS) cohort. Men were enrolled at six U.S. sites. The American Urological Association Symptom Index (AUA-SI), LUTS medication use, fracture risk factors and potential confounders were recorded at baseline and every two years thereafter for a total of four assessments. LUTS severity was categorized from the AUA-SI as mild (0-7 points), moderate (8-19 points), or severe (≥20 points). Associations of LUTS severity with fracture rate were estimated with hazard ratios (HR) and 95% confidence intervals (CI) from extended proportional hazards regression.

RESULTS - Among 5,989 men with baseline AUA-SI score and hip bone mineral density (BMD) measures, 745 incident non-spine fractures occurred during 43,807 person-years of follow-up. In a multivariable model adjusted for age, enrollment site, baseline hip BMD, falls in the past year, and prevalent fracture before baseline, there were no significant associations of moderate (HR 0.9, 95% CI 0.8-1.1) or severe (HR 1.0, 95% CI 0.8-1.3) LUTS with fracture risk. None of the individual LUTS assessed on the AUA-SI including nocturia and urgency was associated with increased fracture risk.

CONCLUSIONS - In this cohort of older US men, LUTS were not independently associated with fracture risk.

The Journal of urology. 2016 Feb 20 [Epub ahead of print]

Lynn M Marshall, Jodi A Lapidus, Jack Wiedrick, Elizabeth Barrett-Connor, Douglas C Bauer, Eric S Orwoll, J Kellogg Parsons, Osteoporotic Fractures in Men (MrOS) Research Group

Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR., Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, OR., Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, OR., Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA., Department of Medicine and Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA., Department of Medicine, Bone and Mineral Unit, Oregon Health and Science University, Portland, OR., Division of Urologic Oncology, Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, CA; Division of Urology, San Diego Veterans Affairs Medical Center, La Jolla, CA.

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