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Introduction: Hip fracture is a major public health problem, annually affecting over 350,000 persons in the United States and 1.6 million worldwide. Consequences include decreased survival, loss of independence, and increased risk of subsequent fractures. A substantial decline in bone mineral density (BMD) also occurs, yet the magnitude of the decline specifically attributable to hip fracture has not been documented. Methods: To determine the amount of BMD decline attributable to hip fracture, the rate of decline in BMD in a cohort of hip fracture patients was compared with that in a cohort of women of similar age and BMD but without hip fracture. All subjects were community dwelling when enrolled. Hip fracture patients in the Baltimore Hip Studies (BHS) came from two hospitals in Baltimore, Maryland, from 1992 through 1995; comparison subjects came from the Study of Osteoporotic Fracture (SOF) enrolled in four areas of the United States during the same period. Eighty-four white, female hip fracture patients 65 years and older from the BHS were compared with 168 SOF participants matched on age, race, and BMD at baseline. BMD of the femoral neck and total hip was measured by dual-energy x-ray absorptiometry. Results: Hip fracture patients had a greater decline in BMD during the 12-month postfracture follow-up than that expected on the basis of the nonfracture cohort: 4.9% vs. 0.4% at the femoral neck and 3.5% vs. 0.7% for the total hip. The decline in BMD in hip fracture patients was 11.8 times the amount expected at the femoral neck (matched on age and baseline BMD and adjusted for between-cohort differences in smoking prevalence) and 4.9 times that expected for the total hip at the end of 1 year after the hip fracture. Conclusion: In this sample of older women, bone loss over the year following hip fracture far exceeded that expected and is an important clinical management concern. Keywords Aging * Body composition * Bone mineral density * Epidemiology * Orthopaedics * Osteoporosis

Men comprise an estimated 25% of informal caregivers in the U.S., but research on them is scarce. This study compared physical health in male caregivers (CGs) and non-caregivers (NCGs). 694 men, aged 64-93 years, who participated in the Baltimore Men's Osteoporosis Study completed a standardized questionnaire. CGs were men who helped a relative or friend, without pay, with greater then 1 instrumental and/or basic activity of daily living (IADLs/ADLs), NCGs were men who helped no one with IADLs/ADLs; 117 (17%) men were CGs. CGs and NCGs did not differ on age (mean=74 yrs), race (28% black), being married (80%), self-rated health (49% rated excellent/very good), mean body mass index or grip strength. When stratified by race and marital status, spouse CGs were significantly older than other white (78 vs 74 yrs) and black men (75 vs 72 yrs). Souse CGs helped with more ADLs/IADLs among whites; non-spouse CGs helped with more among blacks. Married men were more likely than unmarried men to rate their health as excellent or very good, and to have been physically active in the past week, regardless of caregiver status. Compared to the 120 unmarried NCGs, they adjusted odds ratio for health rated as excellent/very good was 1.6(95% CI=0.8-3.2) in 47 spouse CGs, 1.4(0.9-2.2) in 456 married NCGs, 0.8 (0.4-1.6) in 51 married nonspouse CGs, and 0.9(0.3-2.7) in 19 unmarried CGs. Based on these results, studies of male CGs and NCGs should account for effects of marital status and race.

It is well established that caregiving for an older adult is stressful. However, by treating caregivers (CGs) as a homogenous group, it is possible that factors related to stress are misrepresented for some CGs. The current study utilized a sample of 246 CGs (mean age = 81) to examine multiple group path models of perceived stress for all CGs, CGs of adults with dementia (n = 72), and CGs of adults without dementia (n = 174). The sample was taken from the Caregiver Study of Osteoporotic Fractures (CG-SOF), an ancillary study of SOF, a 4-site cohort study of 9704 women. CGS were SOF respondents who helped a relative or friend, without pay, with > 1 instrumental and/or basic activity of daily living. Preliminary results indicate a significantly higher mean level of stress on the Perceived Stress Scale (PSS) in CGs to persons with dementia than without (19.67 vs. 17.45). For CGs overall and CGs of persons without dementia, the effects of the main predictors of stress, number of caregiving hours/day and number of care recipient behavioral problems, are mediated through feelings of role captivity. However, for CGs of persons with dementia, there is a direct relationship between stress and these factors. Results confirm the impact of the care recipient's disability on the experience of caregiving. Such findings are important for developing and targeting caregiver interventions.

Affective status is commonly assessed by measures of depression. However, emotional vitality, a recently proposed measure of global affective well being, may be better to use in elderly caregivers (CGs) who are less likely than. younger Gs to report depressive symptoms. Factors associated with depression (Center for Epidemiologic Studies Depression Scale (CES-D)), and emotional vitality (CES-D; Pearlin's Mastery Scale; Perceived Stress Score, PSS)were examined in 246 CGs from an ancillary study of the Study of Osteoporotic Fractures (SOF). SOF is a 4-site cohort study of women aged gt; 65 years at baseline in 1986. CGs were SOF respondents who aided a friend or relative without pay with gt; 1 basic and/or instrumental activities of daily living. CGs had a mean age of 81 years, and 87% were white. To date, 37 CGs reported high depressive symptoms (CES-Dgt; 16), and 145 had low emotional vitality (CES-Dgt; 16, mastery gt; 10, PSS gt;12). In multivariate analyses, high depression and low emotional vitality were associated with higher levels on Pearlin's Role Captivity Scale and more problematic behaviors in care recipients. T-here were trends toward decreased social activity, caring for co-residents, and caring for persons with dementia. Co-residency was related more strongly to low emotional vitality than depression. Although emotional vitality and CES-D were associated with similar factors, emotional vitality might be a preferable outcome measure as it captures more CGs.