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Ribom, Eva L
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Publications (10 of 21) Show all publications
Cronholm, F., Rosengren, B. E., Nilsson, J.-Å., Ohlsson, C., Mellström, D., Ribom, E. L. & Karlsson, M. K. (2019). The fracture predictive ability of a musculoskeletal composite score in old men - data from the MrOs Sweden study. BMC Geriatrics, 19, Article ID 90.
Open this publication in new window or tab >>The fracture predictive ability of a musculoskeletal composite score in old men - data from the MrOs Sweden study
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2019 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 90Article in journal (Refereed) Published
Abstract [en]

Background: Detection of high-risk individuals for fractures are needed. This study assessed whether level of physical activity (PA) and a musculoskeletal composite score could be used as fracture predictive tools, and if the score could predict fractures better than areal bone mineral density (aBMD).

Methods: MrOs Sweden is a prospective population-based observational study that at baseline included 3014 men aged 69-81years. We assessed femoral neck bone mineral content (BMC), bone area, aBMD and total body lean mass by dual energy X-ray absorptiometry, calcaneal speed of sound by quantitative ultrasound and hand grip strength by a handheld dynamometer. PA was assessed by the Physical Activity Scale for the Elderly (PASE) questionnaire. We followed the participants until the date of first fracture, death or relocation (median 9.6years). A musculoskeletal composite score was calculated as mean Z-score of the five measured traits. A Cox proportional hazards model was used to analyze the association between the musculoskeletal traits, the composite score and incident fractures (yes/no) during the follow-up period. Data are presented as hazard ratios (HR) with 95% confidence intervals (95% CI) for fracture for a+1 standard deviation (SD) change (+1 Z-score) in the various musculoskeletal traits as well as the composite score. We used a linear regression model to estimate the association between level of PA, measured as PASE-score and the different musculoskeletal traits as well as the composite score.

Results: A+1 SD higher composite score was associated with an incident fracture HR of 0.61 (0.54, 0.69), however not being superior to aBMD in fracture prediction. A+1 SD higher PASE-score was associated with both a higher composite score and lower fracture incidence (HR 0.83 (0.76, 0.90)).

Conclusions: The composite score was similar to femoral neck aBMD in predicting fractures, and also low PA predicted fractures. This highlights the need of randomized controlled trials to evaluate if PA could be used as a fracture preventive strategy.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Bone mass, Osteoporosis, Physical activity, Older, Men
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-381584 (URN)10.1186/s12877-019-1106-2 (DOI)000462214300001 ()30902044 (PubMedID)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Björk, A., Ribom, E., Johansson, G., Scragg, R., Mellstrom, D., Grundberg, E., . . . Kindmark, A. (2019). Variations in the vitamin D receptor gene are not associated with measures of muscle strength, physical performance, or falls in elderly men: Data from MrOS Sweden. Journal of Steroid Biochemistry and Molecular Biology, 187, 160-165
Open this publication in new window or tab >>Variations in the vitamin D receptor gene are not associated with measures of muscle strength, physical performance, or falls in elderly men: Data from MrOS Sweden
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2019 (English)In: Journal of Steroid Biochemistry and Molecular Biology, ISSN 0960-0760, E-ISSN 1879-1220, Vol. 187, p. 160-165Article in journal (Refereed) Published
Abstract [en]

The vitamin D receptor (VDR) has been proposed as a candidate gene for several musculoskeletal phenotypes. However, previous results on the associations between genetic variants of the VDR with muscle strength and falls have been contradictory. The MrOS Sweden survey, a prospective population-based cohort study of 3014 elderly men (mean age 75 years, range 69-81) offered the opportunity to further investigate these associations. At baseline, data were collected on muscle strength and also the prevalence of falls during the previous 12 months. Genetic association analysis was performed for 7 Single Nucleotide Polymorphisms (SNPs), covering the genetic region surrounding the VDR gene in 2924 men with available samples of DNA. Genetic variations in the VDR were not associated with five different measurements of muscle strength or physical performance (hand grip strength right and left, 6 m walking test (easy and narrow) and timed-stands test). However, one of the 7 SNPs of the gene for the VDR receptor, rs7136534, was associated with prevalence of falls (33.6% of the AA, 14.6% of the AG and 16.5% of the GG allele). In conclusion, VDR genetic variants are not related to muscle strength or physical performance in elderly Swedish men. The role of the rs7136534 SNP for the occurrence of falls is not clear.

Keywords
Vitamin D receptor gene, Polymorphisms, Muscle strength, Physical performance, Falls
National Category
Geriatrics Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-379342 (URN)10.1016/j.jsbmb.2018.11.014 (DOI)000459952100021 ()30476589 (PubMedID)
Funder
Swedish Research Council, 2016-01001Knut and Alice Wallenberg Foundation, KAW 2015.0317Torsten Söderbergs stiftelseNovo Nordisk
Available from: 2019-03-15 Created: 2019-03-15 Last updated: 2019-03-15Bibliographically approved
Harvey, N., Oden, A., Orwoll, E., Kwok, T., Karlsson, M., Rosengren, B., . . . Mccloskey, E. (2018). Definitions of sarcopenia as predictors of fracture risk independent of FRAX, falls and BMD: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) Study. Paper presented at Annual Meeting of the American-Society-for-Bone-and-Mineral-Research, SEP 28-OCT 01, 2018, Montreal, CANADA. Journal of Bone and Mineral Research, 33, 13-14
Open this publication in new window or tab >>Definitions of sarcopenia as predictors of fracture risk independent of FRAX, falls and BMD: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) Study
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2018 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, p. 13-14Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2018
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-372519 (URN)000450475400041 ()
Conference
Annual Meeting of the American-Society-for-Bone-and-Mineral-Research, SEP 28-OCT 01, 2018, Montreal, CANADA
Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-08Bibliographically approved
Harvey, N. C., Oden, A., Orwoll, E., Lapidus, J., Kwok, T., Karlsson, M. K., . . . McCloskey, E. (2018). Measures of Physical Performance and Muscle Strength as Predictors of Fracture Risk Independent of FRAX, Falls, and aBMD: A Meta-Analysis Of The Osteoporotic Fractures In Men (MrOS) Study. Journal of Bone and Mineral Research, 33(12), 2150-2157
Open this publication in new window or tab >>Measures of Physical Performance and Muscle Strength as Predictors of Fracture Risk Independent of FRAX, Falls, and aBMD: A Meta-Analysis Of The Osteoporotic Fractures In Men (MrOS) Study
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2018 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, no 12, p. 2150-2157Article in journal (Refereed) Published
Abstract [en]

Measures of muscle mass, strength, and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX (fracture risk assessment tool) probability. In the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, United States), we investigated whether measures of physical performance/appendicular lean mass (ALM) by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck aBMD, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the relationship between time for five chair stands, walking speed over a 6 m distance, grip strength, ALM adjusted for body size (ALM/height(2)), FRAX probability (major osteoporotic fracture [MOF]) with or without femoral neck aBMD, available in a subset of n = 7531), and incident MOF (hip, clinical vertebral, wrist, or proximal humerus). Associations were adjusted for age and time since baseline, and are reported as hazard ratios (HRs) for first incident fracture per SD increment in predictor using meta-analysis. 5660 men in the United States (mean age 73.5 years), 2764 men in Sweden (75.4 years), and 1987 men in Hong Kong (72.4 years) were studied. Mean follow-up time was 8.7 to 10.9 years. Greater time for five chair stands was associated with greater risk of MOF (HR 1.26; 95% CI, 1.19 to 1.34), whereas greater walking speed (HR 0.85; 95% CI, 0.79 to 0.90), grip strength (HR 0.77; 95% CI, 0.72 to 0.82), and ALM/height(2) (HR 0.85; 95% CI, 0.80 to 0.90) were associated with lower risk of incident MOF. Associations remained largely similar after adjustment for FRAX, but associations between ALM/height(2) and MOF were weakened (HR 0.92; 95% CI, 0.85 to 0.99). Inclusion of femoral neck aBMD markedly attenuated the association between ALM/height(2) and MOF (HR 1.02; 95% CI, 0.96 to 1.10). Measures of physical performance predicted incident fractures independently of FRAX probability. Whilst the predictive value of ALM/height(2) was substantially reduced by inclusion of aBMD requires further study, these findings support the consideration of physical performance in fracture risk assessment.

Keywords
Osteoporosis, Epidemiology, Frax, Falls, Fracture, Interaction
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-372697 (URN)10.1002/jbmr.3556 (DOI)000452301800008 ()30011086 (PubMedID)
Funder
Swedish Research Council
Available from: 2019-01-09 Created: 2019-01-09 Last updated: 2019-01-09Bibliographically approved
Vandenput, L., Nethander, M., Karlsson, M., Rosengren, B., Ribom, E. L., Mellstrom, D. & Ohlsson, C. (2018). Serum DHEA and its Sulfate Are Associated with Incident Fall Risk in Older Men - the MrOS Sweden Study. Paper presented at Annual Meeting of the American-Society-for-Bone-and-Mineral-Research, SEP 28-OCT 01, 2018, Montreal, CANADA. Journal of Bone and Mineral Research, 33, 310-310
Open this publication in new window or tab >>Serum DHEA and its Sulfate Are Associated with Incident Fall Risk in Older Men - the MrOS Sweden Study
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2018 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, p. 310-310Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2018
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-372520 (URN)000450475401505 ()
Conference
Annual Meeting of the American-Society-for-Bone-and-Mineral-Research, SEP 28-OCT 01, 2018, Montreal, CANADA
Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-08Bibliographically approved
Ohlsson, C., Nethander, M., Karlsson, M. K., Rosengren, B. E., Ribom, E. L., Mellstrom, D. & Vandenput, L. (2018). Serum DHEA and Its Sulfate Are Associated With Incident Fall Risk in Older Men: The MrOS Sweden Study. Journal of Bone and Mineral Research, 33(7), 1227-1232
Open this publication in new window or tab >>Serum DHEA and Its Sulfate Are Associated With Incident Fall Risk in Older Men: The MrOS Sweden Study
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2018 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, no 7, p. 1227-1232Article in journal (Refereed) Published
Abstract [en]

The adrenal-derived hormones dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are the most abundant circulating hormones and their levels decline substantially with age. Many of the actions of DHEAS are considered to be mediated through metabolism into androgens and estrogens in peripheral target tissues. The predictive value of serum DHEA and DHEAS for the likelihood of falling is unknown. The aim of this study was, therefore, to assess the associations between baseline DHEA and DHEAS levels and incident fall risk in a large cohort of older men. Serum DHEA and DHEAS levels were analyzed with mass spectrometry in the population-based Osteoporotic Fractures in Men study in Sweden (n=2516, age 69 to 81 years). Falls were ascertained every 4 months by mailed questionnaires. Associations between steroid hormones and falls were estimated by generalized estimating equations. During a mean follow-up of 2.7 years, 968 (38.5%) participants experienced a fall. High serum levels of both DHEA (odds ratio [OR] per SD increase 0.85; 95% CI, 0.78 to 0.92) and DHEAS (OR 0.88, 95% CI, 0.81 to 0.95) were associated with a lower incident fall risk in models adjusted for age, BMI, and prevalent falls. Further adjustment for serum sex steroids or age-related comorbidities only marginally attenuated the associations between DHEA or DHEAS and the likelihood of falling. Moreover, the point estimates for DHEA and DHEAS were only slightly reduced after adjustment for lean mass and/or grip strength. Also, the addition of the narrow walk test did not substantially alter the associations between serum DHEA or DHEAS and fall risk. Finally, the association with incident fall risk remained significant for DHEA but not for DHEAS after simultaneous adjustment for lean mass, grip strength, and the narrow walk test. This suggests that the associations between DHEA and DHEAS and falls are only partially mediated via muscle mass, muscle strength, and/or balance. In conclusion, older men with high DHEA or DHEAS levels have a lesser likelihood of a fall.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
SEX STEROIDS, DHEAS, FALLS, GENERAL POPULATION STUDIES, MEN
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-360427 (URN)10.1002/jbmr.3418 (DOI)000437284400005 ()29528519 (PubMedID)
Funder
Swedish Research CouncilSwedish Foundation for Strategic Research Knut and Alice Wallenberg Foundation
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2018-09-19Bibliographically approved
Ribom, E. L., Kindmark, A. & Ljunggren, Ö. (2015). Hyperkyphosis and back pain are not associated with prevalent vertebral fractures in women with osteoporosis. Physiotherapy Theory and Practice, 31(3), 182-185
Open this publication in new window or tab >>Hyperkyphosis and back pain are not associated with prevalent vertebral fractures in women with osteoporosis
2015 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 31, no 3, p. 182-185Article in journal (Refereed) Published
Abstract [en]

Vertebral fractures (VFs) are the clinical consequence of spinal osteoporosis and may be associated with back pain and aggravated kyphosis. However, the relative importance of VFs as an underlying cause of kyphosis and chronic back pain is not known. The aim of this study was to investigate the relationship between prevalent VFs and the size of kyphosis, and back pain in osteoporotic women. Thirty-six women, aged 74.6 +/- 8.3 years, were consecutively recruited from the osteoporosis unit at Uppsala University Hospital. The patients had 1-9 radiographic verified VFs. Tragus wall distance (TWD) and numeric rating scale were used to measure kyphosis and pain. All patients had a hyperkyphosis (TWD >= 10 cm). Notably, there were no associations between numbers or location of VFs versus size of kyphosis (rho = 0.15, p = 0.4; rho = -0.27, p = 0.12) or severity of back pain (rho = -0.08, p = 0.66; rho = 0.16, p = 0.35). Furthermore, no association was evident between kyphosis and back pain (rho = -0.02, p = 0.89). There was, however, an association between size of kyphosis and age (R = 0.44, p = 0.008). In conclusion, these data suggest that prevalent VFs are not significantly associated with kyphosis or chronic back pain, in patients with manifest spinal osteoporosis.

Keywords
Backpain, kyphosis, osteoporosis, vertebral fracture
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:uu:diva-252725 (URN)10.3109/09593985.2014.989295 (DOI)000352858300005 ()25495768 (PubMedID)
Available from: 2015-05-12 Created: 2015-05-11 Last updated: 2017-12-04Bibliographically approved
Karlsson, M. K., Ribom, E. L., Nilsson, J.-Å., Karlsson, C., Cöster, M., Vonschewelov, T., . . . Rosengren, B. E. (2014). International and ethnic variability of falls in older men. Scandinavian Journal of Public Health, 42(2), 194-200
Open this publication in new window or tab >>International and ethnic variability of falls in older men
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2014 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 2, p. 194-200Article in journal (Refereed) Published
Abstract [en]

Aims: Fallers and especially recurrent fallers are at high risk for injuries. The aim of this study was to evaluate fall epidemiology in older men with special attention to the influence of age, ethnicity and country of residence. Methods: 10,998 men aged 65 years or above recruited in Hong Kong, the United States (US) and Sweden were evaluated in a cross-sectional retrospective study design. Self-reported falls and fractures for the preceding 12 months were registered through questionnaires. Group comparisons were done by chi-square test or logistic regression. Results: The proportion of fallers among the total population was 16.5% in ages 65-69, 24.8% in ages 80-84 and 43.2% in ages above 90 (P <0.001). The corresponding proportions of recurrent fallers in the same age groups were 6.3%, 10.1% and 18.2%, respectively (P <0.001), and fallers with fractures 1.0%, 2.3% and 9.1%, respectively (P <0.001). The proportion of fallers was highest in the US, intermediate in Sweden and lowest in Hong Kong (in most age groups P <0.05). The proportion of fallers among white men in the US was higher than in white men in Sweden (all comparable age groups P <0.01) but there were no differences in the proportion of fallers in US men with different ethnicity. Conclusions: The proportion of fallers in older men is different in different countries, and data in this study corroborate with the view that society of residence influences fall prevalence more than ethnicity.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-218245 (URN)10.1177/1403494813510789 (DOI)000331371600011 ()24259542 (PubMedID)
Available from: 2014-02-10 Created: 2014-02-10 Last updated: 2017-12-06Bibliographically approved
Rosengren, B. E., Ribom, E. L., Nilsson, J.-Å., Mallmin, H., Ljunggren, Ö., Ohlsson, C., . . . Karlsson, M. K. (2012). Inferior physical performance test results of 10,998 men in the MrOS Study is associated with high fracture risk. Age and Ageing, 41(3), 339-344
Open this publication in new window or tab >>Inferior physical performance test results of 10,998 men in the MrOS Study is associated with high fracture risk
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2012 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 41, no 3, p. 339-344Article in journal (Refereed) Published
Abstract [en]

Background: most fractures are preceded by falls.

Objective: the aim of this study was to determine whether tests of physical performance are associated with fractures.

Subjects: a total of 10,998 men aged 65 years or above were recruited.

Methods: questionnaires evaluated falls sustained 12 months before administration of the grip strength test, the timed stand test, the six-metre walk test and the twenty-centimetre narrow walk test. Means with 95% confidence interval (95% CI) are reported. P < 0.05 is a statistically significant difference.

Results: fallers with a fracture performed worse than non-fallers on all tests (all P < 0.001). Fallers with a fracture performed worse than fallers with no fractures both on the right-hand-grip strength test and on the six-metre walk test (P < 0.001). A score below -2 standard deviations in the right-hand-grip strength test was associated with an odds ratio of 3.9 (95% CI: 2.1-7.4) for having had a fall with a fracture compared with having had no fall and with an odds ratio of 2.6 (95% CI: 1.3-5.2) for having had a fall with a fracture compared with having had a fall with no fracture.

Conclusion: the right-hand-grip strength test and the six-metre walk test performed by old men help discriminate fallers with a fracture from both fallers with no fracture and non-fallers.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-168374 (URN)10.1093/ageing/afs010 (DOI)000303335000011 ()22314696 (PubMedID)
Available from: 2012-02-09 Created: 2012-02-09 Last updated: 2018-06-04Bibliographically approved
Karlsson, M. K., Ribom, E., Nilsson, J.-Å., Ljunggren, Ö., Ohlsson, C., Mellström, D., . . . Rosengren, B. E. (2012). Inferior physical performance tests in 10,998 men in the MrOS study is associated with recurrent falls. Age and Ageing, 41(6), 740-746
Open this publication in new window or tab >>Inferior physical performance tests in 10,998 men in the MrOS study is associated with recurrent falls
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2012 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 41, no 6, p. 740-746Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

recurrent fallers are at especially high risk for injuries.

OBJECTIVE:

to study whether tests of physical performance are associated with recurrent falls. SUBJECTS: a total of 10,998 men aged 65 years or above.

METHODS:

questionnaires evaluated falls sustained 12 months preceding testing of grip strength, timed stand, 6-m walk and 20-cm narrow walk test. Means with 95% confidence interval (95% CI) are reported. P < 0.01 is a statistically significant difference.

RESULTS:

in comparison to both occasional fallers and non-fallers, recurrent fallers performed more poorly on all the physical ability tests (all P < 0.001). A score below -2 standard deviations (SDs) in the right-hand grip strength test was associated with an odds ratio of 2.4 (95% CI 1.7, 3.4) for having had recurrent falls compared with having had no fall and of 2.0 (95% CI 1.3, 3.4) for having had recurrent falls compared with having had an occasional fall.

CONCLUSION:

low performance in physical ability tests are in elderly men associated with recurrent falls.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-181722 (URN)10.1093/ageing/afs104 (DOI)000310153100009 ()22923607 (PubMedID)
Available from: 2012-09-27 Created: 2012-09-27 Last updated: 2017-12-07Bibliographically approved
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