Methods The Rancho Bernardo Study, a cohort of Caucasian, middle to upper-middle class, community-dwelling Everolimus adults in Southern California, was established in 1972; details of the initial study have been published [11]. Between 1992 and 1996, approximately 80% (n = 1,778) of surviving local residents participated in a research clinic visit. A total of 527 men and 805 women, aged 30 to 97 (mean age = 73.8, SD = 9.2) completed standardized questionnaires about medical history, including osteoporotic fractures and were examined for ABI and BMD. Seventy-seven percent (n = 1,096) of surviving participants

returned for a follow-up visit in 1997–2000. Of these, 322 men and 515 women LY3039478 had BMD measurement repeated and were queried about interim OP fractures. Main reasons for nonparticipation among survivors included moving away, being too sick or too busy, or being institutionalized. Data on the following variables were collected at baseline: age, height, weight, alcohol intake (drink alcohol three or more times/week), smoking status (current vs. not current), medications, physical activity (exercise three or more times/week), history

of bone fractures and diabetes, fasting lipid levels, renal function, intermittent learn more claudication (a symptom of severe PAD) based on the Rose questionnaire [12], BMD, and ABI (see below). Radiographs of the thoracic and lumbar spine were obtained and read by a single skeletal radiologist.

Serum creatinine levels were measured by Smith Kline Beecham clinical laboratories. Creatinine clearance was calculated by the modified Cockcroft–Gault formula: [140 − age (in years)] × weight (in kilograms) / [72 × serum creatinine (mg/dl)] and corrected for body surface area. For women, the product was multiplied by 0.85 (a correction factor recommended for females) [13]. BMD was measured at the hip and lumbar spine using DXA (Hologic QDR model 1000; Hologic Inc., Bedford, MA, USA). Total hip BMD included the greater trochanter, femoral neck, and intertrochanter area. Bone densitometers were calibrated daily and measurements maintained within the manufacturers’ precision standards. The BMD T scores were expressed in standard deviations why using the peak bone mass from the manufacturer’s reference population. Osteoporosis was defined as BMD at the femoral neck or the hip ≥2.5 standard deviations (SD) below the young adult mean. Incident fractures and repeated BMD were determined at a follow-up visit an average of 4 years (range 1–7) later. Bone change was calculated as BMD percent change per year. Non-vehicular accident fractures occurring after age 45 were classified as osteoporotic. Ninety-five percent of self-reported fractures were confirmed by radiology reports. ABI measurements The ABI is a simple noninvasive method to assess the presence and extent of atherosclerosis in the lower leg.