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Background: Associations of chronic and intrusive pain with sarcopenia and disability in older men are unclear. Method(s): 1452 community-dwelling men aged >=70 years self-reported chronic pain (pain every day for >=3 months) and intrusive pain (pain interfering with normal activities in the last 4 weeks) at baseline and five years later, and were classified as having no, prevalent (baseline only), incident (follow-up only) or persistent (both baseline and follow-up) pain. Appendicular lean mass (ALM), hand grip strength and gait speed were assessed. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP2) and Sarcopenia Diagnosis and Outcomes Consortium (SDOC) definitions. Activity of daily living (ADL) and instrumental activity of daily living (IADL) impairment were assessed by questionnaires. Result(s): Approximately 11% of men reported both chronic and intrusive pain. Gait speed, but not ALM or hand grip strength, significantly mediated the relationship of chronic pain and intrusive pain with ADL and IADL disability by 12-57%. Over five years, incident (odds ratio: 1.84; 95% CI: 1.10-3.10) and persistent (3.02; 1.55-5.88) intrusive pain, and persistent chronic pain (2.29; 1.30-4.04), were associated with increased likelihood of incident sarcopenia (SDOC). Incident and persistent intrusive pain were associated with incident ADL (1.91; 1.04-3.52 and 3.78; 1.90-7.51, respectively) and IADL (2.98; 1.81-4.90 and 4.63; 2.22-9.65, respectively) impairment. Conclusion(s): Older men with incident and persistent intrusive pain have increased risk for incident sarcopenia and disability over five years. The association of pain with disability appears to be mediated by gait speed.Copyright © 2021 Elsevier Inc.

Background & aims: Mediterranean dietary patterns may exert favourable effects on various health conditions. This study aimed to determine associations of adherence to Mediterranean diet as well as its components, with circulating cytokine levels, musculoskeletal health and incident falls in community-dwelling older men. Method(s): Seven hundred ninety-four (794) community-dwelling men with mean age 81.1 +/- 4.5 years, who participated in the five-year follow-up of the Concord Health and Ageing in Men Project (CHAMP) were included in the cross-sectional analysis, and 616 attended follow-up three years later. Adherence to Mediterranean diet was assessed using MEDI-LITE (literature-derived Mediterranean diet) score which was obtained using a validated diet history questionnaire. Twenty-four evaluable circulating cytokines were analyzed using Bio-Plex Pro Human Cytokine 27-plex Assay kit. Appendicular lean mass (ALM) and bone mineral density (BMD) were measured using dual-energy x-ray absorptiometry (DXA). Three-year changes in gait speed and hand grip strength were assessed by walking a 6-m course and using a dynamometer respectively and analyzed using linear mixed-effects models. Incident falls over three years were determined through telephone interviews every four months. Multivariable linear regression was utilized to determine the cross-sectional associations between MEDI-LITE scores and circulating cytokines, bone mineral density, ALM, and ALMBMI. Linear mixed-effects models were performed to estimate associations between MEDI-LITE scores and three-year change in hand grip strength and gait speed while negative binomial regression was applied to estimate associations between MEDI-LITE scores and three-year incident falls as well as associations between each MEDI-LITE component and three-year incident falls. Adjustments for multiple comparisons were performed using Benjamini-Hochberg adjustment for multiple testing. Result(s): A higher MEDI-LITE score, indicating

BACKGROUND: Type 2 diabetes mellitus (T2DM) increases falls and fracture risk. Our objective was to compare incidence and risk factors for falls and fractures in community-dwelling older men with and without T2DM. METHOD(S): A total of 1705 men (471 with T2DM; 1234 without T2DM) aged >=70 years were assessed at baseline. Men were contacted every 4 months for 6.0 +/- 2.2 years to ascertain incident falls and fractures, with the latter being confirmed by radiographic reports. Hip fractures were ascertained via data linkage (follow-up: 8.8 +/- 3.6 years). Risk factors for falls and fractures included physical activity and function, body composition, medications, and vision measures. RESULT(S): Men with T2DM had similar fall (incident rate ratio [IRR]: 0.92 [95% confidence interval {CI}: 0.70, 1.12], n = 1246) and fracture rates (hazard ratio [HR]: 0.86 [95% CI: 0.56, 1.32], n = 1326) compared to men without T2DM after adjustment for significant risk factors. In men with T2DM, depression (IRR: 1.87 [95% CI: 1.05, 3.34], n = 333), sulphonylurea usage (IRR: 2.07 [95% CI: 1.30, 3.27]) and a greater number of prescription medications (IRR: 1.13 [95% CI: 1.03, 1.24]) were independently associated with increased fall rates, and higher total hip bone mineral density was independently associated with lower fracture rates (HR: 0.63 [95% CI: 0.47, 0.86], n = 351). Interaction terms demonstrated that better contrast sensitivity was independently associated with lower fracture rates (HR: 0.14 [95% CI: 0.02, 0.87]) in men with T2DM compared to men without T2DM. CONCLUSION(S): Fall and fracture rates were similar in men with and without T2DM after adjusting for significant risk factors. Vision assessments including contrast sensitivity measures may improve fracture prediction in older men with T2DM.Copyright © The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permi

High-impact physical activities with bone strains of high magnitude and frequency may benefit bone health. This study aimed to investigate the longitudinal associations between changes in loading intensities and application rates, estimated from self-reported physical activity, with bone mineral density (BMD) changes over 5 years and also with incident falls over 2 years and long-term incident fractures in community-dwelling older men. A total of 1599 men (mean age 76.8 +/- 5.4 years) from the Concord Health and Aging in Men Project (CHAMP) were assessed at baseline (2005-2007) and at 2- and 5-year follow-up. At each time point, hip and lumbar spine BMD were measured by dual-energy X-ray absorptiometry, and physical activity energy expenditure over the past week was self-reported via the Physical Activity Scale for the Elderly (PASE) questionnaire. Sum effective load ratings (ELRs) and peak force were estimated from the PASE questionnaire, reflecting the total and highest loading intensity and application rate of physical activities, respectively. Participants were contacted every 4 months over 2 years to self-report falls and over 6.0 +/- 2.2 years for fractures. Hip fractures were ascertained by data linkage for 8.9 +/- 3.6 years. Compared with sum ELR and PASE scores, peak force demonstrated the greatest standardized effect size for BMD maintenance at the spine (beta = 9.77 mg/cm2), total hip (beta = 14.14 mg/cm2), and femoral neck (beta = 13.72 mg/cm2) after adjustment for covariates, including PASE components (all p <.01). Only PASE scores were significantly associated with reduced falls risk (standardized incident rate ratio = 0.90, 95% confidence interval 0.81-1.00, p =.04). All physical activity measures were significantly associated with reduced incident fractures in univariate analyses, but none remained significant after multivariable adjustments. Older men who engaged in physical activity of high and rapid impact maintained higher BMD, while higher energ

BACKGROUND: Type 2 diabetes mellitus (T2DM) increases falls and fracture risk. Our objective was to compare incidence and risk factors for falls and fractures in community-dwelling older men with and without T2DM. METHOD(S): A total of 1,705 men (471 with T2DM; 1234 without T2DM) aged >=70 years were assessed at baseline. Men were contacted every 4 months for 6.0 +/- 2.2 years to ascertain incident falls and fractures, with the latter being confirmed by radiographic reports. Hip fractures were ascertained via data linkage (follow up: 8.8 +/- 3.6 years). Risk factors for falls and fractures included physical activity and function, body composition, medications and vision measures. RESULT(S): Men with T2DM had similar fall (IRR: 0.92 [95%CI: 0.70, 1.12], n=1246) and fracture rates (HR: 0.86 [95%CI: 0.56, 1.32], n=1326) compared to men without T2DM after adjustment for significant risk factors. In men with T2DM, depression (IRR: 1.87 [95%CI: 1.05, 3.34], n=333), sulphonylurea usage (IRR: 2.07 [95%CI: 1.30, 3.27]) and a greater number of prescription medications (IRR: 1.13 [95%CI: 1.03, 1.24]) were independently associated with increased fall rates, and higher total hip BMD was independently associated with lower fracture rates (HR: 0.63 [95%CI: 0.47, 0.86], n=351). Interaction terms demonstrated that better contrast sensitivity was independently associated with lower fracture rates (HR: 0.14 [95%CI: 0.02, 0.87]) in men with T2DM compared to men without T2DM. CONCLUSION(S): Fall and fracture rates were similar in men with and without T2DM after adjusting for significant risk factors. Vision assessments including contrast sensitivity measures may improve fracture prediction in older men with T2DM.Copyright © The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Background: Obese older adults have higher bone mineral density (BMD), but other characteristics of obesity may predispose these individuals to fracture. We aimed to compare clinical risk factors for incident fracture in obese and non-obese older men. Method(s): Body mass index (BMI) and body fat percentage were assessed at baseline by anthropometry and dual-energy X-ray absorptiometry, respectively, in 1625 community-dwelling men aged >=70 years. Categories for non-obese and obese were <30 kg/m2and >=30 kg/m2 for BMI, and <30% and >=30% for body fat percentage. Sociodemographic, medical, physical function and blood biochemistry parameters were collected at baseline. Self-reported incident fractures of any type and cause (excluding pathological fractures and fractures of hands, fingers, feet, toes and the skull) were confirmed by radiographic reports and recorded up to 9 years. Hip fractures were followed for 14 years using data linkage. Result(s): Prevalence of obesity was 27% according to BMI and 44% according to body fat percentage. There were no differences in incidence of any fracture between non-obese and obese men by BMI (10.7 vs 9.3%, respectively; P > 0.05) or body fat percentage (10.2 vs 10.6%, respectively; P > 0.05). Significant interactions were observed demonstrating that dementia increased hazard for incident any and hip fracture in non-obese men (adjusted hazard ratio 7.08; 95% CI 3.27-15.36 and 8.36; 3.13-22.31, respectively) but not obese men. Past-year falls increased hazard for any fracture in obese men (2.86; 95% CI 1.60-5.10) but not non-obese men while higher luteinizing hormone concentrations reduced hazard for hip fracture in obese men (0.91; 0.85-0.97 per IU/L) but not non-obese men. Conclusion(s): In community-dwelling older men, obesity does not protect against incident fracture. Assessments of falls history and gonadotrophin levels, in addition to established clinical risk factors for fracture, may contribute to improvements in fracture

Background: The relations between diet, chronic inflammation, and musculoskeletal health are unclear, especially among older men. Objective(s): This study aimed to determine associations of the Dietary Inflammatory Index (DII) with inflammatory biomarkers, musculoskeletal health, and falls risk in community-dwelling older men. Method(s): The cross-sectional analysis included 794 community-dwelling men, mean age 81.1 +/- 4.5 y, who participated in the 5-y follow-up of the Concord Health and Aging in Men Project. Of these, 616 were seen again 3 y later for the longitudinal analysis. Energy-adjusted DII (E-DII) was calculated from a validated diet history questionnaire. Bone mineral density (BMD) was measured using DXA. Twenty-four inflammatory biomarkers were analyzed. Incident falls over 3 y were determined through telephone interviews every 4 mo. Multiple regression, linear mixed effects models, negative binomial regression, and mediation analysis were utilized in this study. Result(s): A higher E-DII score (indicating a more proinflammatory diet) was associated with higher concentrations of IL-6 (beta: 0.028 pg/mL; 95% CI: 0.003, 0.053), IL-7 (beta: 0.020 pg/mL; 95% CI: 0.002, 0.037), and TNF-alpha (beta: 0.027 pg/mL; 95% CI: 0.003, 0.051). A higher E-DII score was also associated with lower appendicular lean mass adjusted for BMI (ALMBMI) (beta: -0.006 kg/m2; 95% CI: -0.010, -0.001). For every unit increase in E-DII (range: -4.91 to +3.66 units), incident falls rates increased by 13% (incidence rate ratio: 1.13; 95% CI: 1.05, 1.21) over 3 y. Mediation analysis showed that the association between E-DII and 3-y incident falls was influenced by the concentrations of IL-7 by 24%. There was no association between E-DII and BMD. Conclusion(s): Consumption of a proinflammatory diet was associated with increased concentrations of IL-6, IL-7, and TNF-alpha; increased falls risk; and lower ALMBMI in community-dwelling older men. The association between incident falls and E

BACKGROUND: Weight loss increases fracture risk in older adults. We aimed to determine associations of 2-year body composition trajectories with subsequent falls and fractures in older men. METHOD(S): We measured appendicular lean mass (ALM) and total fat mass (FM) by dual-energy X-ray absorptiometry at baseline and Year 2 in 1,326 community-dwelling men aged >=70 and older. Body composition trajectories were determined from residuals of a linear regression of change in ALM on change in FM (higher values indicate maintenance of ALM over FM), and a categorical variable for change in ALM and FM (did not lose [>=-5% change] versus lost [<-5% change]). Bone mineral density (BMD), hand grip strength, and gait speed were assessed at Years 2 and 5. After Year 2, incident fractures (confirmed by radiographical reports) and falls were recorded for 6.8 years. RESULT(S): Compared with men who did not lose ALM or FM, men who did not lose ALM but lost FM, and men who lost both ALM and FM, had reduced falls (-24% and -34%, respectively; both p < .05). Men who lost ALM but did not lose FM had increased falls (incidence rate ratio = 1.73; 95% CI 1.37-2.18). ALM/FM change residuals were associated with improved lumbar spine BMD (B = 0.007; 95% CI 0.002-0.012 g/cm2 per SD increase) and gait speed (0.015; 0.001-0.029 m/s), and reduced hip fractures (hazard ratio = 0.68; 95% CI 0.47-0.99). CONCLUSION(S): Fracture risk may be increased in older men who lose higher ALM relative to FM. Weight loss interventions for obese older men should target maintenance of lean mass.Copyright © The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.