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In 1363 men (mean age 84.2\u2009years), we determined D3Cr muscle mass; Fracture Risk Assessment Tool (FRAX) 10-year probability of hip and major osteoporotic (hip, humerus, vertebral, forearm) fracture; and femoral neck bone mineral density (BMD) (by dual-energy X-ray absorptiometry [DXA]). Incident fractures were centrally adjudicated by review of radiology reports over 4.6\u2009years. Correlations adjusted for weight and height were calculated between femoral neck BMD and D3Cr muscle mass. Across quartiles of D3Cr muscle mass\/weight, proportional hazards models calculated hazard ratios (HRs) for any (n\u00a0=\u00a0180); nonspine (n\u00a0=\u00a0153); major osteoporotic fracture (n\u00a0=\u00a085); and hip fracture (n\u00a0=\u00a040) after adjustment for age, femoral neck BMD, recurrent fall history, and FRAX probability. Models were then adjusted to evaluate the mediating influence of physical performance (walking speed, chair stands, and grip strength). D3Cr muscle mass was weakly correlated with femoral BMD (r\u00a0=\u00a00.10, p\u2009&amp;lt;\u20090.001). Compared to men in the highest quartile, those in the lowest quartile of D3Cr muscle mass\/weight had an increased risk of any clinical fracture (HR 1.8; 95% confidence interval [CI], 1.1\u20132.8); nonspine fracture (HR 1.8; 95% CI, 1.1\u20133.0), major osteoporotic fracture (HR 2.3; 95% CI, 1.2\u20134.6), and hip fracture (HR 5.9; 95% CI, 1.6\u201321.1). Results were attenuated after adjustment for physical performance, but associations remained borderline significant for hip and major osteoporotic fractures (p\u2009\u2265\u20090.05 to 0.10). Low D3Cr muscle mass\/weight is associated with a markedly high risk of hip and potentially other fractures in older men; this association is partially mediated by physical performance. \u00a9 2022 American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4505","type":"journal-article","created":{"date-parts":[[2022,3,6]],"date-time":"2022-03-06T23:53:46Z","timestamp":1646610826000},"page":"1213-1220","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Association Between Muscle Mass Determined by D3-Creatine Dilution and Incident Fractures in a Prospective Cohort Study of Older Men"],"prefix":"10.1093","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4938-9478","authenticated-orcid":false,"given":"Peggy M.","family":"Cawthon","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco CA 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Medicine Duke University Durham NC USA"},{"name":"Nutritional Sciences & Toxicology University of California Berkeley CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Osteoporotic Fractures in Men (MrOS) Study Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,6]]},"reference":[{"issue":"1","key":"2024012713591230300_jbmr4505-bib-0001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s002239900384","article-title":"Perspectives: some roles of mechanical usage, muscle strength, and the mechanostat in skeletal physiology, disease, and research","volume":"62","author":"Frost","year":"1998","journal-title":"Calcif Tissue 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