Romosozumab or alendronate for fracture prevention in East Asian patients: a subanalysis of the phase III, randomized ARCH study.

Romosozumab, a sclerostin antibody, exerts dual effect to increase bone formation and decrease bone resorption. Among high-risk postmenopausal East Asian women, romosozumab followed by alendronate was associated with lower incidences of fractures vs alendronate alone. Romosozumab demonstrates potential to address an unmet need in osteoporosis management in Asia. INTRODUCTION: Romosozumab, a sclerostin antibody, exerts dual effect to increase bone formation and decrease bone resorption. The global ARCH study demonstrated superiority of romosozumab followed by alendronate in reducing fracture risk in high-risk postmenopausal osteoporotic women vs alendronate alone. We report outcomes among ARCH East Asian patients. METHODS: In ARCH, 4093 postmenopausal osteoporotic women with fragility fracture were randomized 1:1 to monthly romosozumab 210 mg or weekly alendronate 70 mg for 12 months, both followed by open-label alendronate. Primary endpoints were incidence of new vertebral fracture (VF) at 24 months and clinical fracture at primary analysis (confirmed fractures in ≥ 330 patients and all patients had opportunity to attend month 24 visit). This post hoc analysis was not powered to detect fracture-rate differences. RESULTS: This analysis included 275 patients from Hong Kong, Korea, and Taiwan. Romosozumab followed by alendronate reduced risk of new VFs at 24 months by 60% (P = 0.11) and clinical fractures at primary analysis by 44% (P = 0.15) vs alendronate alone. Romosozumab followed by alendronate significantly increased mean bone mineral density at 24 months from baseline by a further 9.0%, 3.3%, and 3.0% at the lumbar spine, total hip, and femoral neck vs alendronate alone. Adverse event (AE) rates, including positively adjudicated serious cardiovascular AEs (1.6% vs 1.4% at 12 months for romosozumab vs alendronate), were similar across treatment groups. CONCLUSIONS: Consistent with the global analysis, romosozumab followed by alendronate was associated with lower incidences of new vertebral, clinical, non-vertebral, and hip fractures vs alendronate alone among East Asian patients.

Prevalence of vertebral fracture in Asian men and women: comparison between Hong Kong, Thailand, Indonesia and Japan.

OBJECTIVES: Little is known about the prevalence of vertebral fracture among Asians. This study investigated the prevalence of radiographically defined vertebral fracture, and identified associated risk factors in the aged population of four Asian countries. STUDY DESIGN: In total, 1588 males and females aged ≥ 65 years were recruited from Hong Kong, Thailand, Indonesia and Japan. METHODS: Standard X-rays for the spine were taken and vertebral heights were measured. Vertebral fracture was defined as a reduction of >3 standard deviations in vertebral height ratio. Bone mineral density (BMD) of the hip was measured by dual energy X-ray absorptiometry, and anthropometric measurements were taken in Hong Kong and Japan. Other relevant data were entered in a standard questionnaire. RESULTS: The prevalence of vertebral fracture for both males and females was highest in Japan for younger (65-74 years) and older (≥ 75 years) age groups (36.6% and 37.6% for males; 18.8% and 28.7% for females). Lower hip BMD was associated with vertebral fracture in both sexes. Older age, lower quality of life score on Short Form-12 (physical), past longest occupation as a farmer, and history of cataract were significantly associated with vertebral fracture in females. However, smoking did not appear to be an important risk factor for vertebral fracture. CONCLUSIONS: Radiographic assessments for vertebral fracture were performed in all four Asian countries. The prevalence of vertebral fracture was highest in Japan. Lower hip BMD, poorer physical condition and past longest occupation as a farmer were associated with vertebral fracture.

Effects of 25-hydroxyvitamin D level and its change on parathyroid hormone in premenopausal Chinese women.

UNLABELLED: Optimal levels of 25-hydroxyvitamin D [25(OH)D] were investigated in premenopausal Chinese women. Parathyroid hormone (PTH) change at 3 months was associated with change in 25(OH)D but not with baseline levels, and PTH fell even when starting levels of 25(OH)D were >40 nmol/L, consistent with optimal values for 25(OH)D of ≥40 nmol/l. INTRODUCTION: The upper level of 25-hydroxyvitamin D [25(OH)D] which constitutes a long-term bone health risk by causing elevated PTH levels is uncertain. Although many studies have addressed this question using cross-sectional data, the present study is one of few employing a prospective approach to determine 25(OH)D levels required to minimize PTH. METHODS: Relationships among baseline values and 3-month changes (Δ) in PTH and 25(OH)D were assessed in 221 Chinese women, aged 28.0±4.4 years (mean±SD), taking part in a placebo-controlled dairy product intervention delivering 200 IU vitamin D(3)/day. RESULTS: Baseline 25(OH)D was 34±11 nmol/L and was inversely related to baseline PTH (r=-0.18, P=0.007), with a plateau in PTH levels when 25(OH)D was >40 nmol/L. After 3 months intervention, PTH fell 11% and neither Δ25(OH)D nor ΔPTH differed between treatment and control groups. ΔPTH was inversely related to Δ25(OH)D (P<0.001) but not to baseline 25(OH)D. Similarly, ΔPTH differed between quartiles of Δ25(OH)D (P<0.001), but not between quartiles of baseline 25(OH)D and no interaction was observed between quartiles of baseline 25(OH)D and Δ25(OH)D. Even in the highest quartile of baseline 25(OH)D (>40 nmol/L), PTH fell 0.4±0.1 pmol/L (mean±SEM; P=0.008). CONCLUSIONS: We conclude that vitamin D deficiency is common in young women in Hong Kong. The cross-sectional analysis indicates that optimal 25(OH)D is >40 nmol/L, and the longitudinal data is consistent with a higher optimal value which is not defined in this study's results.

A comparison of teriparatide and calcitonin therapy in postmenopausal Asian women with osteoporosis: a 6-month study.

OBJECTIVE: The number of hip fractures is expected to double in the next 20 years, with current estimates that Asia will account for 37% of these cases. As bone mineral density (BMD) may be used as a measure of fracture risk, we sought to compare the effects of teriparatide with salmon calcitonin treatment on changes in BMD, biochemical bone markers, and safety in postmenopausal Asian women with osteoporosis. METHODOLOGY: A total of 104 patients (n = 47 teriparatide [20 g/day subcutaneously] and n = 57 calcitonin [100 IU/day subcutaneously]) were enrolled in Hong Kong, Singapore, Philippines, Malaysia, and Thailand. Calcium (> or = 500 mg/day) and vitamin D (200-400 IU/day) supplements were taken throughout the 6-month controlled, randomized study. RESULTS: Teriparatide was associated with a 5.03 +/- 4.77% increase in lumbar spine BMD (p < 0.0001, mean +/- SD change from baseline), whereas changes in lumbar spine BMD for patients on calcitonin were not statistically significant (mean change of 0.36 +/- 4.12%, p = 0.16). Comparison of the two groups indicated that teriparatide treatment improved lumbar spine BMD statistically significantly more than calcitonin (p < 0.0001). No statistically significant changes were observed for total hip or femoral neck BMD. Serum bone-specific alkaline phosphatase (BSAP) increased by 55.9% (median change from baseline, p < 0.0001) in the teriparatide group, and remained stable with calcitonin (5.0% change, p = 0.24); osteocalcin increased by 156.15% (median change from baseline, p < 0.0001) with teriparatide, and decreased with calcitonin (-15.25%, p = 0.03). Similar rates of adverse events were observed, with nausea and dizziness the most commonly reported for both groups (teriparatide versus calcitonin, 13.0% versus 23.2% p = 0.21, 10.9% versus 21.4% p = 0.19, respectively). There were no clinically relevant changes observed in laboratory parameters. CONCLUSIONS: Both treatments were similarly tolerated, however teriparatide was associated with greater increases in lumbar spine BMD and bone formation markers, demonstrating the unique mechanism of action and safety of this treatment for osteoporosis in these Asian women.

Reduced bone mineral density in male Severe Acute Respiratory Syndrome (SARS) patients in Hong Kong.

During the Severe Acute Respiratory Syndrome (SARS) outbreak in Hong Kong in 2003, patients were treated with very high doses of corticosteroid and ribavirin. The detrimental effects of such treatment on the bone mineral density (BMD) of SARS patients are unknown. To compare the BMD of SARS patients with normal range data, a cross-sectional survey was conducted. The bone mineral density of 224 patients with SARS, who were treated with an average of 2753 mg (SD = 2152 mg) prednisolone and 29,344 mg (SD = 15,849 mg) of ribavirin was compared to normal data. Six percent of men had a hip BMD Z score of < or =-2 (P = 0.057 for testing the hypothesis that >2.5% of subjects should have a Z score of < or =-2). Moreover, there was a negative association (r = -0.25, P = 0.023) between the duration of steroid therapy and BMD in men. We conclude that male SARS patients had lower BMD at the hip than normal controls, and this could be attributed to prolonged steroid therapy.

Methylenetetrahydrofolate reductase polymorphism (MTHFR C677T) and bone mineral density in Chinese men and women.

The relationship between MTHFR (C677T) genotypes of the methylenetetrahydrofolate reductase, bone mineral density (BMD), and vertebral fracture was studied in 657 Chinese men and women. No association between MTHFR (C677T) and BMD was found in postmenopausal women (aged 55-59 years, n=178), elderly women (aged 70-79 years, n=247), or elderly men (aged 70-79 years, n=232) at the hip, spine, or total body (P >0.05 by ANCOVA). In all study groups, there was no effect of an interaction between MTHFR (C677T) and daily dietary calcium intake on BMD (P >0.05 for the interaction effects by two-way ANCOVA). No statistically significant association was observed between MTHFR (C677T) genotypes and vertebral fracture. The MTHFR (C677T) genotypes for CC, CT, and TT among elderly women with or without vertebral fracture were 5%, 33%, 62%; 6%, 37%, and 57%, respectively, and those for elderly men with and without vertebral fracture were 9%, 31%, 60%; 5%, 35%, and 60%, respectively. The prevalence of TT in our study group was 5% compared to 8% in the Danish or 18.6% in the Japanese. We found no association between MTHFR (C677T) and BMD of Chinese men or women. It would be interesting to study the interactions with folate, B12, and homocysteine.

Milk supplementation prevents bone loss in postmenopausal Chinese women over 3 years.

Previously published results from a 2 year randomized, controlled clinical trial on supplementing the diet of postmenopausal Chinese women with high-calcium milk powder (containing 800 mg of calcium) showed that bone loss, as measured by bone mineral density (BMD), was prevented. To determine whether the effect of calcium supplementation could be sustained, the study was extended for 1 additional year. According to the intention-to-treat analysis, the differences in the rate of bone loss (percentage decrease in control group--percentage decrease in milk supplementation group) in the third year of the study were: total body BMD, 0.23% (95% confidence interval [CI] 0.07%-0.39%); total spine BMD, 0.31% (95% CI - 0.02%-0.65%); and total hip BMD, 0.44% (95% CI 0.19%-0.69%). Analysis by the per-protocol method showed a similar effect size. These results indicate that the effects of milk supplementation in preventing bone loss in postmenopausal Chinese women were sustained after 2 years.

Efficacy of lignocaine 2% gel in chalazion surgery.

BACKGROUND/AIMS: To determine whether topical 2% lignocaine (lidocaine) gel is an effective anaesthetic agent for chalazion surgery. METHODS: In a randomised controlled clinical trial, 57 subjects aged 12 years or over requiring incision and curettage for chalazion were recruited over an 8 month period. Patients were randomised into two groups. One group received 1.5 ml of lignocaine 2% injection and the other 1.5 ml of lignocaine 2% gel topically. Standard incision and curettage was then performed. The primary outcome of interest was the total pain experienced during the entire procedure including anaesthetic administration as well as incision and curettage. The pain from the local anaesthetic administration and during incision and curettage was assessed independently using a visual analogue scale (0-100). The sum of these two scores would be the total pain score out of 200. "Fear of injection" score (0-100) was also assessed. RESULTS: There was a statistically significant difference in the mean total pain scores between the injection and the gel groups (95.6 v 57.0) (p <0.001) (alpha = 0.05) (1 - beta = 0.9394). There was a statistically significant difference in the mean scores on "pain of anaesthetic administration" (47.0 v 5.5) (p <0.000). There was no statistically significant differences in the mean scores on "fear of injection" (43.9 v 47.7) (p = 0.668) and "pain during incision and curettage" (48.28 v 51.4) (p=0.679). CONCLUSIONS: Lignocaine 2% gel is effective in chalazion surgery especially in lowering the pain caused by anaesthetic administration.

Preventing osteoporosis in every day life.

Osteoporosis is a condition characterized by low bone mineral density, microarchitectural deterioration of bone tissue, and a consequent increase in fracture risk. The public health impact of osteoporosis stems from its association with fractures of the hip, spine and forearm. Between 10 and 20 percent of hip fracture patients die within a year of the event, and among those who survive, almost two-thirds remain disabled. The medical costs of osteoporosis and its attendant fractures have been placed at 5.2 billion dollars each year in the US and 615 million pound sterling each year in the UK. In Asia, osteoporosis is rapidly becoming a major public health problem with an increasing incidence of hip fracture and a rapidly aging population. By the year 2050, more than half of the hip fracture around the world would occur in Asia, with the total number approaching 3.2 million. Osteoporosis can be attributed to both genetic factors and environmental factors. While it is difficult to modify genes, much can be done to prevent osteoporosis in our every day life. These are discussed below.

The determinants of bone mineral density in Chinese men--results from Mr. Os (Hong Kong), the first cohort study on osteoporosis in Asian men.

Mr. Os (Hong Kong) is the first study to address the risk factors for osteoporosis in Asian men. A standardized, structured interview and dual X-ray densitometry (DEXA) were performed on 2,000 Chinese men aged 65-92. By multiple regression, the following factors were found to be positively associated with BMD at both the total hip and the spine: body weight, grip strength and a history of diabetes mellitus. The following factors were found to be negatively associated with BMD at both the total hip and spine: cigarette smoking, a history of gastrectomy or bowel resection, current use of inhaled steroid and a history of fracture after 50 years. Moreover, a history of chronic obstructive pulmonary disease (COPD) was negatively associated with BMD at the total hip, and age, the use of an alpha-blocker, thiazide diuretic and nitrate were associated with a higher BMD at the spine. A total of 21.8% of the variance in total hip and 31.5% of the variance in total spine BMD was accounted for in the multivariate analysis.

Bone mineral density reference norms for Hong Kong Chinese.

The aim of this study was to establish bone mineral density (BMD) reference norms for Hong Kong Chinese using Hologic QDR 2000 and 4500 densitometers, and to estimate the prevalence of osteoporosis in the population. Altogether, 4,274 subjects (2,415 females and 1,859 males), aged 9-94 years old, were recruited using a combination of private solicitation and public advertising from schools, community centers, nursing homes, housing estates, and the general community in Hong Kong. Among females, BMD increased by 20% at the total hip and 48% at the lumbar spine between ages 10 and 20 but remained essentially constant between ages 20 and 40. Between ages 40 and 70, BMD declined by 17% at the total hip and 23% at the spine. Total hip BMD continued to drop after age 70 but little change in spine BMD was observed. Among males, BMD increased by 45% at the total hip and 77% at the spine between age 10 and 30. Between ages 30 and 80, total hip BMD decreased by 20%. Lumbar spine BMD decrease was milder, showing a loss of 4% between ages 30 to 50 and remaining relatively constant afterwards. The prevalence of osteoporosis was consistently overestimated when using Hologic-supplied Caucasian cutoffs as compared with local Chinese cutoffs. The prevalence of osteoporosis among Chinese women 50 years or older was 37% and 16% at the spine and total hip, respectively, while that among Chinese men 50 years or older was 7% and 6% at the spine and total hip, respectively. Prior studies have been limited by size or restricted to women. This study represents the largest sample of Hong Kong Chinese amassed to date, provides continuous BMD reference values from ages 10 to 85 for both women and men, and yields more reliable estimates of the prevalence of osteoporosis for the population.

An osteoporosis screening tool for Chinese men.

Several osteoporosis risk instruments have been proposed to select women for bone densitometry, but no validated instruments are currently available for men. This study aims to address this deficiency by developing and validating a Male Osteoporosis Screening Tool (MOST) for Chinese men. Two thousand ambulatory men, aged 65 and above, were recruited from the general community in Hong Kong, and a cohort of 1,970 men with valid total hip and lumbar spine dual-energy X-ray absorptiometry (DXA) measurements was included in the current analysis. A 60% random sample was selected as the training sample for developing the screening tool, and the remaining 40% constituted the validation sample. Logistic regression and receiver operating characteristic (ROC) analysis were used to identify the simplest combination of risk factors to be included in the screening tool for predicting osteoporosis at the femoral neck, total hip, or lumbar spine. Body weight and quantitative ultrasound index (QUI) were found to contribute significantly to the area under the ROC curve (AUC), yielding an AUC of 0.823 in the training sample. The resulting MOST had a sensitivity of 94% and a specificity of 46% when using a cutoff score of 3. MOST had an AUC of 0.839 in the validation sample. The risk of osteoporosis was 1% among those with MOST scores < or = 2, but 72% among those with MOST scores > 7. Using a cutoff of 3, the negative predictive value was 97.5% which suggests that the 42% with MOST scores < or = 3 may be accurately screened out as being without osteoporosis, thus saving two fifths of our DXA resources. The positive predictive value was 72% when using a cutoff of 7, implying that MOST cannot replace DXA for case-finding purposes. Nevertheless, for resource allocation and patient satisfaction, it is prudent and economical to offer DXA screening first to the 6% with MOST scores > 7.

Vitamin D receptor start codon polymorphism (Fok I) and bone mineral density in Chinese men and women.

The relationship between Fok I polymorphism of the vitamin D receptor start codon, bone mineral density (BMD) and vertebral fractures was studied in 684 Chinese men and women. A significant trend was observed only in Chinese women aged 70-79 years. The mean BMD at the total body was 0.85 +/- 0.01 g/cm2, 0.82 +/- 0.01 g/cm2 and 0.84 +/- 0.01 g/cm2 for elderly women of the FF, Ff and ff genotypes respectively (p = 0.06 by ANOVA). Similar but statistically non-significant trends were observed at the hip and spine. However, no association between BMD and the Fok I genotype was observed in younger women (aged 50-59 years) and elderly men (aged 70-79 years). In all study groups, there was no effect of an interaction between Fok I polymorphism and calcium intake on BMD (p > 0.05 for the interaction effects by two-way ANOVA). No significant association was observed between Fok I polymorphism and vertebral fracture in elderly men or women (p > 0.05 by the chi-square test). We conclude that the Fok I polymorphism may have a weak effect on the BMD of elderly Chinese women.

Benefits of milk powder supplementation on bone accretion in Chinese children.

Low dietary calcium intake has been demonstrated to be a risk factor for hip and vertebral fractures in studies conducted among Hong Kong Chinese. Few studies have demonstrated the effect of milk supplementation in bone accretion in Chinese children. The aim was to examine the effects of milk powder supplementation in enhancing bone accretion in Chinese children. Three hundred and forty-four children, aged 9-10 years old, were randomized to receive milk powder equivalent to 1300 mg and 650 mg calcium, and to a control group, respectively. Bone mineral density (BMD) at the proximal femur, lumbar spine and total body were measured at 6 months, 12 months and 18 months. The treatment effects were modeled using linear mixed effect models and compared using linear contrast F-tests, by intention-to-treat. Subjects randomized to milk powder equivalent to 1300 mg calcium had significantly higher increase in BMD at both the total hip (7.4 +/- 0.4% in treatment group versus 6.3 +/- 0.4% in the control) and the spine (8.4 +/- 0.5% in the treatment group versus 7.0 +/- 0.5% in the control group). Subjects randomized to milk powder equivalent to 650 mg calcium had smaller increases in BMD at the total hip and spine, although the increase in BMD at the total body was significantly higher (3.1 +/- 0.3% in treatment group versus 2.4 +/- 0.2% in controls). It is concluded that supplementing the diet of Chinese children with milk powder was effective in enhancing bone accretion.

The epidemiology of cigarette smoking in Hong Kong Chinese women.

BACKGROUND: Smoking in women is a well-recognized public health problem. In many developed countries, cigarette smoking is now the single most important preventable cause of premature death in women. There are relatively few data on the epidemiology of cigarette smoking in Asian women, and this study examined the prevalence of and factors predisposing Chinese women to smoke cigarettes in Hong Kong. METHOD: A territory-wide random telephone survey of 26,716 households in Hong Kong was conducted. A total of 1064 current smokers and 291 ex-smokers were identified in these household, and in-depth interviews of 791 current smokers, 221 ex-smokers, and 1012 controls were conducted. RESULTS: The prevalence of cigarette smoking was 4.5% in women who were 25 years or younger, 2.6% in women aged 46-65 years, and 2.2% in women aged 65 years or older. Sixty-four percent of current smokers started when they were 19 years or younger. The main reasons for the initiation of cigarette smoking were the influence of friends, curiosity, feeling bored, or being idle. Current smokers and ex-smokers tended to have positive images of women who smoked. The following risk factors were found to be significant for cigarette smoking: less than university education, unemployment, being divorced, having a husband who smoked, and a low score on the perceived harms of cigarette smoking. CONCLUSION: Cigarette smoking is more prevalent in younger women in Hong Kong; and psychosocial issues should be addressed to prevent future epidemics.

Areal and volumetric bone density in Hong Kong Chinese: a comparison with Caucasians living in the United States.

It is a common perception that Asians have lower bone density than Caucasians. However, such relationships could be confounded by bone size. In this study, the skeletal status of a convenience sample of 482 men and 887 women living in Hong Kong is compared with published data for Caucasians living in Rochester, Minnesota. Areal bone mineral density (BMD, g/cm(2)) and volumetric bone mineral apparent density (BMAD, g/cm(3)) were determined for the lumbar spine and proximal femur, using the Hologic QDR 2000 instrument. Cross-calibration was performed by measuring a common phantom, and the Hong Kong data were adjusted by a multiplication factor. Lumbar spine and femoral neck BMD and BMAD of Chinese men and women were all significantly lower ( P<0.001 by t-test) than those of Caucasians, but the differences in BMAD were on average only about half the size of the differences in BMD. For instance, in postmenopausal Chinese women, BMD at the femoral neck and lumbar spine were 15.2% and 18.8% lower respectively, but BMAD at the femoral neck and lumbar spine were only 7.8% and 12.4% lower respectively. Similar trends were observed in men. After adjusting for age, body height and weight, the difference in BMAD between Caucasians and Chinese was further reduced and only statistically significant among postmenopausal women and among men younger than age 50 years for the lumbar spine. For instance, the adjusted BMAD in postmenopausal Chinese women at the femoral neck and lumbar spine were 3.9% ( P=0.03 by ANCOVA) and 7.3% ( P<0.001 by ANCOVA) lower respectively, while the adjusted BMAD at the lumbar spine for Chinese men younger than 50 years was 11.7% lower ( P<0.01 by ANCOVA). Predictors of BMAD in Hong Kong Chinese women include body weight, age at menarche, cigarette smoking, and oral contraceptive use ( P<0.001), while body weight was the only independent predictor of BMAD in Hong Kong Chinese men ( P<0.001). We conclude that bone density is lower in Hong Kong Chinese men and women than in Caucasians, although such differences were attenuated by adjustments for bone size, body weight and height.

The relationship between COLI A1 polymorphisms (Sp 1) and COLI A2 polymorphisms (Eco R1 and Puv II) with bone mineral density in Chinese men and women.

Polymerase chain reaction was used to amplify across variable restriction sites of the COLI A1 and COLI A2 genes that encode the alpha 1 and 2 subunits of type I collagen. The relationship between these polymorphisms and bone mineral density (BMD) was studied in 683 Chinese men and women. In 100 men and women, COLI A1 Sp1 polymorphism was not found, which was consistent with other previous studies in Asian populations. However a statistically significant relationship was observed between COLI A2 Eco R1 and Puv II genotypes among the Chinese men studied. The mean BMD was consistently lower in men of the EE and PP genotype (P < 0.05 by analysis of variance [ANOVA]) than in men of the ee and pp genotypes. However, no association between BMD and the Eco R1 or Puv II genotypes was observed in Chinese women (P > 0.05 by ANOVA). We conclude that the COLI Al Sp1 binding site is absent in Hong Kong Chinese, whereas the COLI A2 Eco R1 and Puv II genetic polymorphisms may be associated with the BMD of elderly Chinese men.

Epidemiology of irritable bowel syndrome in Chinese.

Irritable bowel syndrome (IBS) is common in Caucasians and Japanese, but its epidemiology has not been studied in urbanized Chinese populations. Our aim was to compare diagnostic criteria and study the epidemiology of IBS in Hong Kong Chinese. In all, 964 subjects from public housing and 334 subjects from private housing were recruited for face-to-face interviews in Shatin, Hong Kong. A structured questionnaire was used to measure the prevalence of IBS according to the Manning, Rome I, and Rome II criteria. The SF-36 scale was used to measure quality of life (QOL) in subjects with IBS and in normal controls. The results were compared by the analysis of covariance (ANCOVA). Relevant medical consultations and absence from work were recorded. There was fair agreement between the Manning and Rome II criteria (K = 0.23; P < 0.001), but good agreement between the Rome I and Rome II criteria (kappa = 0.5; P < 0.001). The prevalence of IBS, based on the Rome II criteria, was 3.6% (95% CI = 2.0-5.2) in men and 3.8% (95% CI = 2.5-5.2) in women. Men with IBS had significantly lower vitality scores on the SF-36 scale than the controls (P < 0.05 by ANCOVA), and women with IBS had significantly lower mental health scores than controls (P < 0.05 by ANCOVA). In conclusion, IBS is quite prevalent in Hong Kong Chinese, and the QOL of subjects with IBS was significantly affected.

Trends in breast cancer incidence in Hong Kong between 1973 and 1999: an age-period-cohort analysis.

Hong Kong has the highest breast cancer incidence in Asia and studying secular changes in its rates may lead to hypotheses regarding disease aetiology and also predictions of future trends for China. We examined statistics from the Hong Kong Cancer Registry based on 26 566 cases of invasive breast cancer from 1973 to 1999. The trends in breast cancer incidence were studied using log-linear longitudinal models. We further analysed the independent effects of chronological age, time period and birth cohort on incidence trends using age-period-cohort modelling. The average annual per cent change of the age-standardised incidence was 3.6% during 1973-1999. Age-period-cohort modelling indicated the incidence development was predominantly a cohort effect, where the rise in relative risk was seemingly linear in successive birth cohorts, showing a 2-3-fold difference when comparing women born in the 1960's with those born around 1900. Our results suggest that direct and indirect consequences of westernisation may have been responsible for most of the observed increase in breast cancer incidence. As China moves towards a more westernised way of life, we can expect an emerging epidemic of breast cancer as Hong Kong's experience has demonstrated.