by Chan Yat Heung. / Thesis submitted in: December 1998. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 81-88). / Abstract also in Chinese. / Declaration --- p.2 / Abstract --- p.3 / Abstract in Chinese --- p.5 / Acknowledgements --- p.7 / Chapter Chapter 1. --- Introduction --- p.12 / Chapter Chapter 2. --- Literature review on the prevalence of vertebral deformity --- p.16 / Chapter 2.1 . --- Prevalence of vertebral deformity in women --- p.16 / Chapter 2.2. --- Prevalence of vertebral deformity in men --- p.21 / Chapter Chapter 3. --- Literature review on the risk factors for osteoporosis and vertebral deformity --- p.25 / Chapter 3.1. --- Dietary calcium intake --- p.25 / Chapter 3.1.1 --- Epidemiological studies --- p.25 / Chapter 3.1.2 --- Intervention studies --- p.26 / Chapter 3.1.3 --- Calcium intake and osteoporosis in Chinese --- p.28 / Chapter 3.2. --- Physical Activity --- p.30 / Chapter 3.2.1 --- Epidemiological studies --- p.30 / Chapter 3.2.2 --- Intervention studies --- p.33 / Chapter 3.2.3 --- Physical activity and osteoporosis in Chinese --- p.34 / Chapter 3.3. --- Cigarette smoking --- p.35 / Chapter 3.4. --- Alcohol consumption --- p.37 / Chapter Chapter 4. --- Subjects and Methods --- p.39 / Chapter 4.1. --- Objectives --- p.39 / Chapter 4.2. --- Study Subjects --- p.40 / Chapter 4.3. --- Radiology and digitization protocol --- p.41 / Chapter 4.4. --- Diagnosis of vertebral deformity --- p.43 / Chapter 4.5. --- Definition of cases and controls --- p.48 / Chapter 4.6. --- Questionnaire and measurement of risk factors --- p.49 / Chapter 4.6.1. --- Dietary calcium intake --- p.49 / Chapter 4.6.2. --- Physical activity --- p.49 / Chapter 4.6.3. --- Cigarette smoking --- p.50 / Chapter 4.6.4. --- Alcohol consumption --- p.50 / Chapter 4.7. --- Pilot study --- p.51 / Chapter 4.8. --- Statistical methods --- p.52 / Chapter Chapter 5. --- Results of Prevalence study --- p.54 / Chapter 5.1 . --- Demographic characteristics --- p.54 / Chapter 5.2. --- Vertebral height and vertebral height ratio --- p.55 / Chapter 5.3. --- Distribution of deformity --- p.59 / Chapter 5.4. --- Comparison of prevalence between Chinese and Caucasian populations --- p.61 / Chapter Chapter 6. --- Results of study on risk factors --- p.62 / Chapter 6.1. --- Dietary calcium intake --- p.62 / Chapter 6.2. --- Physical activity --- p.63 / Chapter 6.3. --- Cigarette smoking --- p.65 / Chapter 6.4. --- Alcohol consumption --- p.67 / Chapter 6.5. --- Results of Multiple logistic regression --- p.69 / Chapter Chapter 7. --- Discussion --- p.70 / Chapter 7.1. --- Study sample --- p.70 / Chapter 7.2. --- Digitization method and definition of vertebral fracture --- p.71 / Chapter 7.3. --- Prevalence of vertebral deformity in Chinese men --- p.72 / Chapter 7.4. --- Risk factors --- p.74 / Chapter 7.4.1. --- Calcium intake --- p.74 / Chapter 7.4.2. --- Physical activity --- p.75 / Chapter 7.4.3. --- Cigarette Smoking --- p.77 / Chapter 7.4.4. --- Alcohol consumption --- p.78 / Chapter Chapter 8. --- Conclusion --- p.80 / Reference --- p.81 / Appendix --- p.89

Background. Diabetes seems to be associated with an increased risk of fractures in the general population. We aimed to determine whether pre-transplant diabetes increases the risk of fractures among patients receiving solid organ transplantation. / Methods. We conducted a nested case-control study in a cohort of subjects 18 years and older who received a first solid organ transplantation in Quebec between January 1st 1986 and July 31st 2005, and who were covered by the RAMQ drug plan at least 1 year before the transplantation and 3 months after the date of discharge from the transplantation hospitalization. Cases were subjects from the cohort who had sustained a fracture between the date of discharge from the hospitalization for transplantation and the end of the study period or the patient's death. The fracture date was the case index date. All incidental fractures were included except fractures of the skull, phalanges of the hand and foot, multiple fractures and pathological fractures, and were identified by medical service claims. Controls were matched to cases on the type of organ transplanted and on the date of the transplantation (+/- 3 months). Crude and adjusted odds ratios (OR) were obtained with univariate and multivariate conditional logistic regression models. / Results. The study included 238 cases and 873 controls. Pre-transplant diabetes was present in 30% of the cases and 22% of the controls (crude OR: 2.16, 95% CI: 1.7--2.8). After adjusting for potential confounders, pre-transplantation diabetes remained a significant risk factor for fractures (adjusted OR: 1.94, 95% CI: 1.5--2.6). / Conclusion. Pre-transplant diabetes appeared to significantly increase post-transplant fractures among adults receiving solid organ transplantation.

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