Vertebral fractures were diagnosed clinically. Fractures Small molecule library were adjudicated centrally by physician review of medical records and X-ray reports. Unconfirmed and pathologic fractures were not included in the analyses. The mean follow-up time for incident fractures was 6.1 years. Statistical analysis Participant baseline characteristics were compared by COPD or asthma status using chi-square tests for categorical variables and analysis of variance for continuous variables. Least squared means linear regression EVP4593 models were used to examine the association between COPD or asthma status and BMD; cross-sectional results were expressed

as mean BMD with corresponding 95% confidence intervals (CI) and longitudinal results were expressed as mean annualized percent BMD change with corresponding 95% CI. Logistic regression was used to assess the association between COPD or asthma status and osteoporosis risk; Cox proportional hazards models were used to assess the association between COPD or asthma status and fracture outcomes. Results were expressed as odds ratios and hazard ratios, respectively, with corresponding 95% CI. To control for confounding by corticosteroid use, COPD or asthma was stratified by oral or inhaled corticosteroid

use. Therefore, the predictor variable was categorized into four groups: (1) No COPD or asthma; (2) COPD or asthma, no steroids; (3) COPD or asthma, oral steroids; and (4) COPD or asthma, inhaled steroids. Known or suspected confounders of the relationship between pulmonary disease and BMD including age, BMI, ethnicity, smoking (packs per year), calcium or vitamin D supplement use, clinic site, hypertension, coronary Ruboxistaurin chemical structure artery disease, diabetes mellitus, stroke, self-reported health status, physical activity level, and alcohol were examined as potential covariates. Covariates were added to the multivariate models if the p value was <0.10 in age-adjusted analysis. Model 1 demonstrates the parsimonious model adjusting for age, BMI, clinic, and smoking; Model 2 is adjusted for all possible confounders. All

analyses were performed using SAS software, version 9.1 (SAS Institute, Cary, North Carolina, USA). Results Participant characteristics Of the 5,541 MrOS participants, 714 (13%) men were categorized as having COPD or asthma, of whom 280 were Silibinin currently prescribed an inhaled and/or oral corticosteroid. Of the 280 men, 177 (63%) were prescribed inhaled corticosteroid, 87 (31%) were prescribed oral corticosteroid, and 16 (6%) were prescribed both inhaled and oral corticosteroid. Of these 280 men, 165 (59%) were also prescribed other COPD or asthma medications like a beta agonist, anticholinergic, mast cell stabilizer, and/or leucotriene inhibitors. For the other 434 men categorized as COPD or asthma, not on steroids, 108 (25%) were prescribed a beta agonist, anticholinergic, mast cell stablizer, and/or leucotriene inhibitors. Participant characteristics are presented in Table 1.