3 (95% CI 1.1 to 4.9) times that of males, while the odds of them reporting posterior upper leg pain were 2.7 (95% CI 1.1 to 6.2) times that of males. The odds of females reporting pain were not more than males at the other five sites. The odds of females having 12-month ankle pain were 1.7 (95% CI 1.0 to 3.1) times that of males (Table 2). The odds of them reporting 12-month foot pain

were buy MLN8237 2.0 (95% CI 1.0 to 4.1) times that of males, while the odds of them reporting posterior upper leg pain were 2.1 (95% CI 1.0 to 4.4) times that of males. The odds of females reporting pain at 12 months were not more than males at the other five sites. The odds of those 50 years or older reporting current lower limb pain were 4.1 (95% CI 2.8 to 6.1) times that of their younger counterparts (Table 3). The odds of those 50 years or older reporting current pain were more than the younger participants for all sites

except the foot and the anterior upper leg. In particular, the odds of participants 50 years or older reporting current knee pain were 3.4 (95% CI 2.2 to 5.2) times, and current posterior leg pain were 3.2 (95% CI 1.6 to 6.2) times that of the younger participants. The odds of those 50 years or older reporting 12-month lower limb pain were 4.0 (95% CI 2.7 to 6.0) times that of their younger counterparts (Table 3). The odds of those 50 years Epacadostat or older reporting 12-month pain were more than the younger participants for all sites except the foot and the anterior upper leg. In particular, the odds of participants 50 years or older reporting 12-month knee pain were 3.0 (95% CI 2.0 to 4.5) times that of the younger participants. The observation walks revealed a homogenous population living an extremely arduous lifestyle. Adults were observed undertaking activities that involve bending of the hips, knees, and

ankles, often in a weighted position. Sustained squatting was observed during activities such as toileting, clothes washing and socialising (Figure 1). We noted both men and women lifting and carrying heavy loads (eg, rocks, crops, and children), often over long distances and up and down steep terrain. Footwear was commonly poor in quality and often consisted of rubber boots or canvas shoes with little cushioning Thalidomide or arch support. We saw adults and children with moderate to severe bowing of the legs. We did not observe any obesity in the 19 villages visited. The point prevalence of musculoskeletal lower limb pain in this rural Tibetan population was 40% (95% CI 34 to 46), which is higher than that in some low-income countries (Minh Hoa et al 2003, Veerapen et al 2007, Zeng et al 2005). The knee was by far the most common site of pain, followed by the ankle and the hip. Furthermore, the prevalence of current knee pain in those over 50 years was 41% (95% CI 30 to 52) even though we observed no obesity in this population.