{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T21:55:33Z","timestamp":1777931733201,"version":"3.51.4"},"reference-count":38,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T00:00:00Z","timestamp":1724371200000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003009","name":"Science and Technology Development Fund","doi-asserted-by":"publisher","award":["XZ202102YD0026C"],"award-info":[{"award-number":["XZ202102YD0026C"]}],"id":[{"id":"10.13039\/501100003009","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,7,29]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Osteoporotic fractures are a leading cause of disability and contribute significantly to medical care costs worldwide. Variations in bone mineral density and the risk of osteoporosis are notably influenced by altitude. This study aims to longitudinally examine individuals with osteoporosis and low bone mass at three different altitudes (low, high and very high) to understand the effects of high-altitude environments on bone density.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This multicentre, prospective cohort study will involve 893 participants divided into three groups based on altitude: low (500\u20131500 m), high (2500\u20134500 m) and very high (4500\u20135500 m). Participants will undergo comprehensive diagnostic assessments, including demographic data collection, structured questionnaires, medical examinations and clinical laboratory tests. Follow-up visits will occur annually for a minimum of 5 years. The primary outcome will be changes in bone mineral density values. Secondary outcomes will include the incidence of osteoporosis and osteoporotic fractures. Cox proportional hazard models will be used to calculate the risk associated with osteoporotic events and related fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study has been approved by the Institutional Review Board of the Hospital of Chengdu Office of People\u2019s Government of Tibetan Autonomous Region (No: 2024-70). The acquired insights will be disseminated via academic forums, scholarly articles and stakeholder engagement sessions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registrationnumber<\/jats:title>\n                    <jats:p>ChiCTR2300078872.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-087142","type":"journal-article","created":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T04:52:46Z","timestamp":1724475166000},"page":"e087142","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of altitude on the development of low bone mineral density and osteoporosis in individuals aged 50 years and older: protocol for a multicentre prospective cohort 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Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiyou","family":"Shi","sequence":"additional","affiliation":[{"name":"Tibet University, Lhasa, Tibet, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Zhong","sequence":"additional","affiliation":[{"name":"Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suying","family":"Zhu","sequence":"additional","affiliation":[{"name":"Tibet University, Lhasa, Tibet, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ciren","family":"Wangmu","sequence":"additional","affiliation":[{"name":"Department of Emergency, Shigatse People's Hospital, Lhasa, Tibet, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunhong","family":"Wu","sequence":"additional","affiliation":[{"name":"Hospital of Chengdu Office of People's 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