Romosozumab (Rmab) is a potent anti-osteoporosis agent with dual effects on bone resorption and formation. Although superior to alendronate in fracture reduction, cardiovascular safety concerns have been raised. This study compared cardiovascular disease (CVD) incidence between Rmab and other anti-osteoporosis medications (AOMs) using Japan's National Database of Health Insurance Claims. Patients aged ≥ 50 years initiating Rmab, parathyroid hormone analogues (PTH), denosumab (Dmab), or bisphosphonates (BP) between March 2019 and March 2023 were identified. Outcomes were acute myocardial infarction, ischemic heart disease, and cerebrovascular disease occurring within 570 days of initiation or within 180 days after discontinuation. Patients with prior myocardial infarction or cerebrovascular disease were excluded. Hazard ratios (HRs) were derived from Cox regression with inverse probability weighting using propensity scores. The study included 25,584 men and 236,467 women receiving Rmab; 50,688 and 289,132 on PTH; 50,319 and 460,182 on Dmab; and 232,484 and 1,144,757 on BP. Cumulative incidence of outcomes was highest with PTH, followed by Dmab, BP, and lowest with Rmab. Compared with PTH, adjusted HRs for Rmab in men were 0.49 for acute myocardial infarction, 0.59 for ischemic heart disease, and 0.70 for cerebrovascular disease. Compared with Dmab, HRs were 0.62, 0.62, and 0.59, respectively. Versus BP, HRs were 0.68, 0.74, and 0.72. All HRs were similarly below 1.0 in women. After adjustment for baseline characteristics, no excess incidence of cardiovascular events was observed among patients receiving Rmab compared with those receiving other AOMs.

BACKGROUND:As the global population ages, cognitive impairment has become a growing public health concern. Although epidemiological studies have examined its association with mortality, sex-stratified analyses and community-based investigations in elderly Asian men remain scarce. Furthermore, social engagement may confound the association between cognitive impairment and mortality; yet few studies among community-dwelling elderly Asian men have simultaneously examined cognitive impairment and social engagement in relation to all-cause mortality in a prospective cohort design. This study therefore aimed to examine whether cognitive impairment is associated with an increased risk of all-cause mortality independent of social engagement among community-dwelling elderly Japanese men over a 15-year follow-up period. METHODS:This prospective cohort study enrolled 2,174 men aged ≥65 years. Follow-up assessments were conducted at five, ten, and fifteen years, with all-cause mortality as the primary outcome. Cognitive function was assessed using the Mini-Mental State Examination. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models to examine the association between cognitive function and all-cause mortality. Confounder-adjusted Kaplan-Meier survival curves were generated using inverse probability of treatment weighting. RESULTS:The final analytic sample comprised 1,741 men. High social engagement was associated with a lower risk of all-cause mortality. Compared with participants with normal cognitive function, the hazard ratios (HRs) for all-cause mortality were 1.29 (95% CI: 1.06-1.56) for mild cognitive impairment and 1.59 (95% CI: 1.10-2.29) for severe cognitive impairment, after adjusting for potential confounding factors including social engagement. CONCLUSIONS:Cognitive impairment independently predicts an increased risk of all-cause mortality in community-dwelling elderly Japanese men.

Background: Bone fractures pose a significant socioeconomic burden for both women and men in aging societies. It has been reported that lean mass (LM) measured by dual-energy X-ray absorptiometry (DXA) may be associated with fractures. However, evidence regarding the relationship between DXA-measured LM and fractures remains inconsistent. Methods: We investigated the association between DXA-measured LM and clinical bone fractures in community-dwelling elderly Japanese men from the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) cohort study. The source population consisted of 948 elderly men who underwent LM measurement by DXA at the time of the 2017-2019 survey. Among these, 780 participants who provided complete information regarding clinical fracture experience in the follow-up survey conducted in 2022-2023 were included in the analysis (mean age at the time of the 2017-2019 survey, 80.2 years; standard deviation, 3.8). Results: From the 2017-2019 survey to the 2022-2023 follow-up survey, 52 participants had experienced one or more clinical bone fractures including osteoporotic and non-osteoporotic fractures. Odds ratios of clinical bone fracture for arm LM, leg LM, and leg-to-trunk LM ratio were significantly lower than 1.0 after adjusting for potential confounding factors including age, nutrition intake, and physical performance. Conclusion: DXA-based appendicular LM predicts future clinical bone fractures in elderly Japanese men, suggesting that elderly men with low skeletal muscle mass, which can be accurately estimated from appendicular LM, may be prone to future clinical fractures. DXA-measured LM thus provides additional information useful for the management of bone fractures.

The associations between milk intake frequency and fracture risk in groups categorized by 25(OH)D levels were investigated using 20-year follow-up data. A significant association was observed only among women with 25(OH)D levels < 15 ng/mL. The measurement of blood 25(OH)D levels should be prioritized for individuals with low milk intake. To investigate the association between milk intake frequency and fracture risk in groups based on blood 25(OH)D levels. This secondary analysis of a prospective cohort study included data from 1209 postmenopausal Japanese women aged ≥ 50 years. Baseline milk intake frequency was obtained using a questionnaire. Blood 25(OH)D levels were measured using a competitive protein-binding assay. Information on fracture events was obtained from face-to-face interviews through follow-up or supplemental mail surveys. Over a median follow-up period of 16.1 years (total: 17,427 person-years), 358 and 238 women sustained at least one clinical and osteoporotic fracture, respectively. The proportions of participants with milk intake < 1 glass/day and those with 25(OH)D levels < 15 ng/mL were 31.9

Stunting in early life is associated with increased morbidity and mortality among children under 5, as well as impaired health and educational and economic performance in later life. However, few studies have investigated risk factors associated with stunting using nationwide representative data in Lao People’s Democratic Republic (Lao PDR). The present study investigated the association of the household wealth index with stunting among children under 5 in Lao PDR using data from the Lao Social Indicator Survey II (LSIS II). The present cross-sectional study used secondary data from the LSIS II in 2017. The survey used multi-stage stratified cluster sampling, covering all 18 provinces with 1170 clusters (village), resulting in a sample size of 23,400 households. The final analysis included 11,339 (weighted) children under 5. Multivariable logistic regression analysis was performed to examine associated factors. Risk factors significantly associated with stunting were no health insurance coverage, minority ethnic groups, having ≥ 7 family members in the household, a poor household wealth index, having ≥ 2 children under 5 in the household, living in rural areas, living in the southern part, and low birth weight. Among them, household wealth index was significantly associated with stunting, independent of other socioeconomic risk factors. The household wealth index was significantly associated with child stunting. Given the high prevalence of stunting in Lao PDR, there may be a need for the government to implement programs to improve household socioeconomic status in order to address stunting in Lao PDR.

BACKGROUND:Sarcopenia, defined as "decreased lean mass (LM) plus low muscle strength and/or low physical performance," is associated with a high risk of falls and fractures. Although an association between muscle strength and falls has been reported, the association between LM and falls remains unclear, with previous studies reporting conflicting findings. We investigated the association of LM measured precisely by dual-energy X-ray absorptiometry with later falls in community-dwelling Japanese men aged 65 years or more at the time of the baseline survey. METHODS:The present analyses included 507 older men who provided complete information on LM and falls in the Fujiwara-kyo Osteoporosis Risk in Men cohort study. Whole-body LM and regional LM were measured from 2017 to 2019. LM in each body region, including the legs and trunk, was recorded. The leg-to-trunk LM ratio, calculated as leg LM divided by trunk LM, was also analyzed. Information on falls that occurred in the 12 months prior to the 2022-2023 follow-up survey was obtained. RESULTS:Mean trunk LM was significantly larger, and mean leg-to-trunk LM ratio significantly smaller, in fallers than in non-fallers (P < 0.05). Multiple logistic regression analysis revealed that leg-to-trunk LM ratio was significantly inversely associated with falls after adjusting for potential confounders (P < 0.05), whereas no significant associations were observed between whole-body and regional LM and falls. CONCLUSION:Leg-to-trunk LM ratio was associated with later falls in community-dwelling older Japanese men. Older men with a larger distribution of leg LM relative to trunk LM tended to have a lower risk of later falls.

The increasing prevalence of overweight and obesity is a serious public health problem in low- and middle-income countries, closely linked to socioeconomic status, with significant disparities observed across different socioeconomic groups. However, the association between socioeconomic status and overweight or obesity has been less studied in Mongolia. The aim of this study was to examine socioeconomic inequality in overweight and obesity among adults in Mongolia. The data for this study was derived from the Mongolian National Tuberculosis Prevalence Survey, which included 41,777 participants aged 18 years and older. We used Erreyger’s concentration index to assess the degree of socioeconomic inequality in overweight and obese individuals. Socioeconomic status was measured by educational level. A decomposition analysis was applied to identify the factors contributing to inequality in overweight and obesity among Mongolian adults. Among the study population, 33.4% were overweight, and 20.7% were obese. The Erreyger’s concentration index for obesity was 0.059 (p < 0.01) among men and -0.047 (p < 0.01) among women. Furthermore, obesity was concentrated among the higher-educated men and lower-educated women. The decomposition analysis results show that education, employment status, and income were the main contributors to education-related inequalities in obesity for both men and women, except the age contribution. Education-related socioeconomic inequalities in overweight and obesity exist among Mongolian adults. Future national strategies for tackling obesity should address inequalities in the root social determinants.

BACKGROUND:High visceral fat mass (FM) is associated with a high risk of cardiometabolic morbidity. Meanwhile, loss of skeletal muscle (lean mass, LM) has been suggested to contribute to metabolic diseases. METHODS:We investigated associations between cardiometabolic diseases and dual energy X-ray absorptiometry (DXA)-measured body composition indices, including the FM index (FM/height2), percent body fat, trunk-to-appendicular fat ratio (TAR), trunk-to-leg fat ratio (TLR), LM index (LM/height2) and FM-to-LM ratio in 595 community-dwelling elderly Japanese men (mean age, 74 years; standard deviation, 6; range, 65 to 94). Hypertension was identified as high blood pressure and/or the use of antihypertensive drugs. Diabetes was identified as high hemoglobin A1c and/or the use of antidiabetic drugs. The ability of DXA-based indices to discriminate between the presence and absence of cardiometabolic diseases was evaluated using area under the curve (AUC) calculated by receiver operating characteristic curve analysis. RESULTS:Body mass index, FM index, percent body fat, TAR, TLR and FM-to-LM ratio were significantly associated with hypertension (P < 0.05). TAR and TLR, but not body mass index, FM index, percent body fat, LM index and FM-to-LM ratio, showed significant positive associations with diabetes. The AUC for the LM index was significantly lower than those for the FM index, percent body fat and FM-to-LM ratio. No associations were observed between the LM index and hypertension, dyslipidemia and diabetes. CONCLUSION:The association between cardiometabolic function and LM, which includes skeletal muscle, may not be as pronounced or stronger than associations between cardiometabolic function and FM. Further detailed studies are needed to clarify how skeletal muscle contributes to cardiometabolic disease.

CONTEXT:Studies on the relationship between serum sclerostin, a Wnt/β-catenin pathway inhibitor, and atherosclerosis have yielded inconsistent results. OBJECTIVE:We aim to longitudinally investigate the relationship between serum sclerostin levels and the risk of increased arterial stiffness in Japanese community-dwelling women from the Japanese Population-based Osteoporosis Study (JPOS). METHODS:Of 1044 women aged ≥ 50 years whose brachial-ankle pulse wave velocity (baPWV) value was available in a baseline survey in 2011-2012, we excluded 374 whose baPWV values were ≥ 1800 cm/s, set as the cutoff for increased arterial stiffness, and 8 with missing data. Of the remaining 662 women, 556 participated in the 4- to 5-year follow-up study and were included in the analysis. The coefficient of variation of the sclerostin measurement was 3.45%. We obtained odds ratios (ORs) for sclerostin at baseline, categorized by tertiles, with the high tertile as reference for increased arterial stiffness. RESULTS:Increased arterial stiffness occurred in 94 women during a mean follow-up of 4.0 years. The increased arterial stiffness rates in the low, medium, and high tertiles were 22.2%, 16.1%, and 12.4%, respectively (trend test P = .013). The ORs for the medium and low tertiles for increased arterial stiffness were 1.58 (P = .205) and 2.16 (P = .027), respectively, after adjusting for age and baseline baPWV. After further adjustment for baseline body mass index, hypertension, hyperlipidemia, diabetes mellitus, estimated glomerular filtration rate, and whole-body bone mineral content, the ORs for the medium and low tertiles were 1.65 (P = .181) and 2.50 (P = .014), respectively. CONCLUSION:Lower serum sclerostin levels were associated with elevated risks for increased arterial stiffness in Japanese community-dwelling women.

BACKGROUND & AIMS:Fermented soy foods come in different forms, each with varying effects on mortality. However, few epidemiological studies have investigated the effect of intake of individual types of fermented soy products on mortality. The present study aimed to investigate the association between intake of fermented soybeans, 'natto,' and all-cause mortality in community-dwelling elderly men, with a follow-up duration of approximately 15 years. METHODS:This prospective cohort study included 2174 men aged ≥65 years, of whom 2012 completed the baseline survey. Follow-up surveys were conducted five and 10 years later with mortality as the outcome. Participants completed a questionnaire regarding dairy natto intake. Hazard ratios (HRs) were calculated for the association between natto intake and all-cause mortality using Cox proportional hazards models. RESULTS:The final analysis population consisted of 1548 men. During a mean follow-up period of 12.0 years (18553.3 person-years), 430 deaths were identified. Compared with 'no consumption' of natto, HRs for 'several packs/week' and 'pack/day or more' were 0.603 (95 % confidence interval (CI) 0.441 to 0.825) and 0.786 (95 % CI 0.539 to 1.145), respectively. Compared with the category "No consumption at both baseline and first follow-up," the HR for the category "Combination of several packs/week and one pack/day at baseline and first follow-up or several packs/week at both baseline and first follow-up" was 0.700 (95 % CI 0.507 to 0.966). CONCLUSIONS:Habitual high intake of natto, especially over a long term, was associated with a lower risk of all-cause mortality in elderly men.

Omentin-1 (also known as intelectin-1) is a novel adipokine associated with metabolic diseases. However, its physiological role in body composition remains incompletely understood. Therefore, this study aimed to investigate the association between the circulating omentin-1 levels and whole-body and regional body composition parameters measured using dual-energy X-ray absorptiometry (DXA). A population-based cross-sectional survey was conducted among school-aged children in Hamamatsu, Japan. Serum adipokine levels were measured using enzyme-linked immunosorbent assay, and associations between omentin-1 levels and DXA-based parameters were evaluated by multiple regression analysis after adjusting for potential confounding factors. The final study included 392 participants (192 boys, 200 girls, 75.2

Identifying and managing obesity in children is essential to prevent obesity-related diseases in adulthood. This study aimed to evaluate the association between body mass index (BMI), degree of obesity, waist circumference, waist-to-height ratio, and body fat—particularly excess body fat. Participants included 660 children aged 9–12 years (349 boys and 311 girls). Fat mass, fat-free mass, and body fat percentage were assessed using bioelectrical impedance analysis. The discriminatory ability of BMI, degree of obesity, waist circumference, and waist-to-height ratio to identify excess body fat—defined as body fat percentage exceeding the 85th, 90th, or 95th percentile—was evaluated using receiver operating characteristic (ROC) curve and precision-recall (PR) curve analyses. Classification performance was further evaluated using a confusion matrix, accuracy, precision, recall, F1 score, Cohen’s kappa coefficient, and Matthews correlation coefficient (MCC). The areas under the ROC curve (AUCs) and 95

Abstract Background Maternal preconception overweight status has been reported to be associated with an increased risk of overweight offspring. However, there are no published population-based studies on the association between maternal preconception weight and offspring body fat measured by dual-energy X-ray absorptiometry (DXA). The present population-based retrospective cohort study aimed to examine the association between maternal weight at conception and offspring body fat measured by DXA. Methods The source population consisted of 5th-grade students (1244 students aged 11 years) registered at 8 municipal elementary schools in Kitakata, Fukuroi, Hamamatsu, and Himeji in Japan. The present analyses included 964 participants who provided complete information. Maternal body mass index (BMI) at conception was calculated using records in the Mother and Child Health Handbook (MCHH). Offspring body fat at age 11 years was measured with the same QDR-4500A DXA instrument in a mobile test room that was brought to each school. With regard to the prediction of excess fat in offspring, the area under the curve (AUC) calculated with receiver operating characteristic curve analysis was used to quantify the diagnostic accuracy of maternal BMI at conception. Results Adjusted odds ratios for excess body fat in offspring of the overweight mother group (odds ratios, 4.93 to 15.32) were significantly higher than those in the non-overweight mother group. For the prediction of excess offspring fat, AUCs and 95% confidence intervals for maternal BMI at conception were greater than 0.5. Conclusion Maternal overweight status at conception might be a risk factor for excess body fat in offspring. Maternal BMI values calculated using MCHH data have the potential to distinguish between the presence and absence of excess fat in the next generation.

Purpose: To compare surgical outcomes of regenerative treatment (RT) including basic fibroblast growth factor (bFGF) (Group-R) with the conventional method (Group-C) for patients with tympanic membrane perforation (TMP), both of whom underwent transcanal endoscopic ear surgery. Methods: The study population of Group-R included 61 ears of 59 patients treated with RT-TMP in which TMP edges were disrupted mechanically and a gelatin sponge immersed in bFGF was inserted into the TMP. Fibrin glue was then dripped over the sponge. Group-C consisted of 13 patients who underwent conventional surgery before adopting the RT-TMP. Patients' characteristics and outcomes including TMP closure rates, and change in hearing level were evaluated three or more weeks after the surgery. Results: The baseline characteristics including size of TMP were not significantly different between the two groups. Although Group-R had significantly shorter operating time than Group-C, the complete TMP closure rates were 69 % (9/13) and 85 % (52/61), respectively. Air-conduction hearing thresholds showed significant improvements, and analysis of variance showed that Group-R achieved significant interactions other than at 8 kHz, implying better improvement in cases with TMP closure. The air-bone gaps also improved at all frequencies in both groups. Specifically, at 4 kHz, there was a trend showing better improvement in Group-R. Conclusion: RT-TMP had a high TMP closure rate and good hearing improvement, with no significant differences compared with those of conventional surgery. This new therapy is simple and safe, and requires less operating time, and it could help improve the quality of life of patients with TMP.

Abstract Background C‐terminal agrin fragment (CAF) is a biomarker for neuromuscular junction degradation. This study aimed to investigate whether 110‐kDa CAF (CAF110) was associated with the presence and incidence of low muscle mass and strength. Methods This cross‐sectional retrospective cohort study comprised women aged ≥65 years. We measured muscle mass using a dual‐energy X‐ray absorptiometry scanner, hand‐grip strength, and blood sampling between 2011 and 2012. A follow‐up study with the same measurements was conducted between 2015 and 2017. Low muscle mass and strength were defined as an appendicular skeletal muscle mass index <5.4 kg/m2 and hand‐grip strength <18 kg, respectively. The CAF110 level was measured using enzyme‐linked immunosorbent assay kits. Results In total, 515 women (74.3 ± 6.3 years) were included in this cross‐sectional analysis. Of these, 101 (19.6%) and 128 (24.9%) women presented with low muscle mass and strength, respectively. For low muscle mass, the odds ratios (ORs) of the middle and highest CAF110 tertile groups, compared with the lowest group, were 1.93 (95% confidence interval: 1.09–3.43; P = 0.024) and 2.15 (1.22–3.80; P = 0.008), respectively. After adjusting for age, the ORs remained significant: 1.98 (1.11–3.52; P = 0.020) and 2.27 (1.28–4.03; P = 0.005), respectively. Low muscle strength ORs of all the CAF110 tertile groups were not significant. In the longitudinal analysis, 292 and 289 women were assessed for incidents of low muscle mass and strength, respectively. Of those, 34 (11.6%) and 20 (6.9%) women exhibited low muscle mass and strength, respectively. For incident low muscle mass, the crude OR of the CAF110 ≥ the median value group was marginally higher than that of the CAF110 < median value group (median [interquartile range]: 1.98 [0.94–4.17] (P = 0.072). After adjusting for age and baseline muscle mass, the OR was 2.22 [0.97–5.06] (P = 0.058). All low muscle strength ORs of the median categories of CAF110 were not significant. Conclusions CAF110 was not associated with low muscle strength. However, CAF110 may be a potential marker for the incidence of low muscle mass.

A variety of easy-to-use commercial bioelectrical impedance appliances are available. The aim of this study was to examine the usefulness of a commercially available body composition meter using bioelectrical impedance analysis (BIA) by comparing its measurement results with those obtained from dual-energy X-ray absorptiometry (DXA). The participants were 443 children aged from 10 to 14 years (226 boys and 217 girls). Fat mass, fat-free mass, lean body mass, percentage of body fat, and bone mineral contents were evaluated for all participants using BIA and DXA. The agreement in the anthropometric data obtained from both devices was analyzed using correlation analysis, intraclass correlation coefficient (ICC), Lin’s concordance correlation coefficient (CCC), Bland–Altman plots, and ordinary least products regression analysis. Equivalence between both devices was tested by two one-sided t -test. All measured indicators showed strong linear correlations between the two measurement systems (r, 0.853–1.000). Fat mass, fat-free mass, and lean body mass showed absolute concordance (ICC, 0.902–0.972; Lin’s CCC, 0.902–0.972). BIA overestimated bone mineral content (62.7–66.5%) and underestimated percentage of body fat (− 8.9 to − 0.8%), lean body mass (− 3.5 to − 1.8%), and body mass (− 0.8 to − 0.5%). For fat mass and fat-free mass, the overestimate or underestimate varied according to the sex and statistical analysis test. Bland–Altman analysis and ordinary least products analysis showed fixed bias and proportional bias in all indicators. Results according to quartiles of body mass index showed poor agreement for fat mass and percentage of body fat in both boys and girls in the lowest body mass index quartile. The present results revealed strong linear correlations between BIA and DXA, which confirmed the validity of the present single-frequency BIA-derived parameters. Our results suggest that BIA cannot provide the exact same values as DXA for some body composition parameters, but that performance is sufficient for longitudinal use within an individual for daily health management and monitoring.

Background In Japan, height and weight measurements, taken for all children at birth and 1.5- and 3-year health checks, are recorded in the Mother and Child Health (MCH) Handbook, as required by the law. The present population-based retrospective cohort study aimed to evaluate the diagnostic performance of height and weight records in the Handbook for predicting excessive adiposity in adolescents. Methods The source population consisted of 8th grade students (800 students aged 14 years) registered at two public junior high schools. Of these, we excluded students who were born at a gestational age < 37 weeks or > 42 weeks. The present analyses included 435 participants who provided complete information. Body mass index (BMI) was calculated using height and weight records. Body fat mass at 14 years of age was measured by dual-energy X-ray absorptiometry (DXA). Diagnostic performance of BMI calculated from the MCH Handbook records to discriminate between the presence and absence of excessive adiposity at 14 years of age was evaluated using receiver operating characteristic (ROC) curve analysis. The area under the ROC curve (AUC) was used to quantify the diagnostic accuracy of BMI. Results With regard to the prediction of excessive fat at 14 years of age, AUCs and 95% confidence intervals for BMI at 1.5 and 3 years of age were greater than 0.5. Meanwhile, the AUC of BMI at birth was not significantly greater than 0.5. Conclusion The present study findings indicate that BMI values calculated using MCH Handbook data have potential ability to distinguish between the presence and absence of excessive fat at 14 years of age.

Background: Several studies have examined the association between physical performance and fracture in women, but few such studies have targeted elderly men. This study aimed to determine whether the combined results of several physical performance tests can predict the subsequent incidence of fractures in elderly men after adjusting for confounding factors. Methods: Of the 2174 elderly men who participated in this study, 2012 completed the baseline study visit, including physical performance tests (walking speed, hand grip strength, and one-leg standing) and measurement of bone mineral density by dual-energy X-ray absorptiometry. Follow-up study visits were conducted five and ten years later, during which incident fractures were identified by detailed interviews. We excluded 140 men with diseases or who took medications known to affect bone metabolism at baseline, 185 with missing values for predictors and potential confounding factors, and one who did not participate in any of the follow-up study visits. The remaining 1686 men were analyzed. Each physical performance test was analyzed by quartiles. Poor performance was defined as belonging to the worst quartile of performance. The association between physical performance and fracture was assessed using Cox proportional hazards models. Results: We identified 175 clinical fractures (osteoporotic fracture: 77, major osteoporotic fracture: 48) in 1686 men during a mean follow-up period of 8.4 years. After adjusting for potential confounding factors including bone mineral density, men who performed poorly on all three physical performance tests had a 3.7-fold higher risk of osteoporotic fracture and a 6.6-fold higher risk of major osteoporotic fracture than men who did not perform poorly on any of the tests. Conclusions: Japanese elderly men who performed poorly on all three physical performance tests had a significantly higher risk of incident osteoporotic fracture independently of bone mineral density. The combined results of several physical performance tests may be useful for predicting incident fractures in elderly men.