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  • 1.
    Banefelt, J.
    et al.
    Quantify Res, Stockholm, Sweden.
    Akesson, K. E.
    Lund Univ, Dept Clin Sci Malmo, Clin & Mol Osteoporosis Res, Malmo, Sweden;Skane Univ Hosp, Dept Orthopaed, Malmo, Sweden.
    Spangeus, A.
    Linkoping Univ, Linkoping Univ Hosp, Linkoping, Sweden.
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Karlsson, L.
    Quantify Res, Stockholm, Sweden.
    Strom, O.
    Quantify Res, Stockholm, Sweden;Karolinska Inst, Stockholm, Sweden.
    Ortsater, G.
    Quantify Res, Stockholm, Sweden.
    Libanati, C.
    UCB Biopharma Sprl, Allee Rech 60, B-1070 Brussels, Belgium.
    Toth, E.
    UCB Biopharma Sprl, Allee Rech 60, B-1070 Brussels, Belgium.
    Risk of imminent fracture following a previous fracture in a Swedish database study2019Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 30, nr 3, s. 601-609Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The SummaryThis study examined the imminent risk of a future fracture within 1 and 2years following a first fracture in women aged 50years and older and assessed independent factors associated with risk of subsequent fractures. The study highlights the need to intervene rapidly after a fracture to prevent further fractures.IntroductionThis study aims to determine the imminent risk of subsequent fractures within 1 and 2years following a first fracture and to assess independent factors associated with subsequent fractures.MethodsRetrospective, observational cohort study of women aged 50years with a fragility fracture was identified from Swedish national registers. Clinical/demographic characteristics at the time of index fracture and cumulative fracture incidences up to 12 and 24months following index fracture were calculated. Risk factors for subsequent fracture were identified using multivariate regression analysis.ResultsTwo hundred forty-two thousand one hundred eight women (mean [SD] age 74 [12.5] years) were included. The cumulative subsequent fracture incidence at 12months was 7.1% (95% confidence interval [CI], 6.9-7.2) and at 24months was 12.0% (95% CI, 11.8-12.1). The rate of subsequent fractures was highest in the first month (similar to 15 fractures per 1000 patient-years) and remained steady between 4 and 24months (similar to 5 fractures/1000 patient-years). Higher age was an independent risk factor for imminent subsequent fractures (at 24months, sub-distribution hazard ratio [HR], 3.07; p<0.001 for women 80-89years [reference 50-59years]). Index vertebral fracture was a strong independent risk factor for subsequent fracture (sub-distribution HR, 2.72 versus hip fracture; p<0.001 over 12months; HR, 2.23; p<0.001 over 24months).ConclusionsOur findings highlight the need to intervene rapidly after any fragility fracture in postmenopausal women. The occurrence of a fragility fracture provides healthcare systems with a unique opportunity to intervene to reduce the increased risk of subsequent fractures.

  • 2.
    Banefelt, J.
    et al.
    Quantify Res, Stockholm, Sweden..
    Akesson, K.
    Lund Univ, Dept Orthopaed, Skane Univ Hosp, Malmo, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Spangeus, A.
    Linkoping Univ, Dept Endocrinol, Dept Med & Hlth Sci, Linkoping, Sweden..
    Karlsson, L.
    Quantify Res, Stockholm, Sweden..
    Strom, O.
    Quantify Res, Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Ortsater, G.
    Quantify Res, Stockholm, Sweden..
    Libanati, C.
    UCB Pharma, Brussels, Belgium..
    Toth, E.
    UCB Pharma, Brussels, Belgium..
    Short-Term Fracture (Fx) Incidence And Risk Factors Following Fracture In A Swedish Database Study2017Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 28, s. S365-S365Artikkel i tidsskrift (Annet vitenskapelig)
  • 3. Benetou, V
    et al.
    Orfanos, P
    Feskanich, D
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Pettersson-Kymmer, U
    Ahmed, L A
    Peasey, A
    Wolk, A
    Brenner, H
    Bobak, M
    Wilsgaard, T
    Schöttker, B
    Saum, K-U
    Bellavia, A
    Grodstein, F
    Klinaki, E
    Valanou, E
    Papatesta, E-M
    Boffetta, P
    Trichopoulou, A
    Education, marital status, and risk of hip fractures in older men and women: the CHANCES project2015Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 26, nr 6, s. 1733-1746Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk.

    INTRODUCTION: The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA.

    METHODS: A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regression adjusting for several factors. Summary estimates were derived using random effects models.

    RESULTS: Individuals with higher education, compared to those with low education, had lower hip fracture risk [hazard ratio (HR) = 0.84, 95 % confidence interval (CI) 0.72-0.95]. Respective HRs were 0.97 (95 % CI 0.82-1.13) for men and 0.75 (95 % CI 0.65-0.85) for women. Overall, individuals living alone, especially those aged 60-69 years, compared to those being married/cohabiting, tended to have a higher hip fracture risk (HR = 1.12, 95 % CI 1.02-1.22). There was no suggestion for heterogeneity across cohorts (P heterogeneity > 0.05).

    CONCLUSIONS: The combined data from >150,000 individuals 60 years and older suggest that higher education may contribute to lower hip fracture risk. Furthermore, this risk may be higher among individuals living alone, especially among the age group 60-69 years, when compared to those being married/cohabiting.

  • 4.
    Benetou, V.
    et al.
    Univ Athens, WHO Collaborating Ctr Nutr & Hlth, Unit Nutr Epidemiol & Nutr Publ Hlth, Dept Hyg Epidemiol & Med Stat,Sch Med, 75 Mikras Asias St, Athens 11527, Greece.
    Orfanos, P.
    Hellen Hlth Fdn, Athens, Greece;Univ Athens, WHO Collaborating Ctr Nutr & Hlth, Unit Nutr Epidemiol & Nutr Publ Hlth, Dept Hyg Epidemiol & Med Stat,Sch Med, 75 Mikras Asias St, Athens 11527, Greece.
    Feskanich, D.
    Harvard Med Sch, Boston, MA USA;Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Pettersson-Kymmer, U.
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden;Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Eriksson, S.
    Umea Univ, Dept Community Med, Umea, Sweden.
    Grodstein, F.
    Harvard Med Sch, Boston, MA USA;Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA.
    Wolk, Alicja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Karolinska Inst, Inst Environm Med, Div Nutr Epidemiol, Stockholm, Sweden.
    Jankovic, N.
    Wageningen Univ, Div Human Nutr, Wageningen, Netherlands;Univ Duisburg Essen, Inst Med Informat Biometry & Epidemiol, Ctr Clin Epidemiol, Fac Med, Essen, Germany.
    de Groot, L. C. P. G. M.
    Wageningen Univ, Div Human Nutr, Wageningen, Netherlands.
    Boffetta, P.
    Icahn Sch Med Mt Sinai, Inst Translat Epidemiol, New York, NY 10029 USA;Icahn Sch Med Mt Sinai, Tisch Canc Inst, New York, NY 10029 USA.
    Trichopoulou, A.
    Hellen Hlth Fdn, Athens, Greece.
    Mediterranean diet and hip fracture incidence among older adults: the CHANCES project2018Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, nr 7, s. 1591-1599Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk. Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults. A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis. A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92-0.99, p(heterogeneity) = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87-0.99) and high (HR 0.94; 95% CI 0.87-1.01) adherence to the score compared with those with low adherence. In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.

  • 5.
    Borgström, F.
    et al.
    Quantify Res, Stockholm, Sweden..
    Olafsson, G.
    Quantify Res, Stockholm, Sweden..
    Jonsson, E.
    Quantify Res, Stockholm, Sweden..
    Ström, O.
    Quantify Res, Stockholm, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Akesson, K.
    Skane Univ Hosp, Dept Orthoped, Lund, Sweden.;Lund Univ, Clin Sci Malmo, Lund, Sweden..
    Spangeus, A.
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Kanis, J. A.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    A Simulation Model For The Treatment Pathway Of Osteoporosis2016Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, s. S60-S60Artikkel i tidsskrift (Annet vitenskapelig)
  • 6.
    Byberg, Liisa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Milk and other dairy foods and risk of hip fracture in men and women: Comments on Feskanich et al.2018Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, nr 5, s. 1221-1222Artikkel i tidsskrift (Fagfellevurdert)
  • 7.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism. Univ Uppsala Hosp, Dept Geriatr Med, Uppsala, Sweden..
    Sarcopenia And Osteoporosis - The Hazardous Duo2016Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, s. S569-S570Artikkel i tidsskrift (Annet vitenskapelig)
  • 8.
    Ekman, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Petren-Mallmin, M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi.
    Ljunghall, Sverker
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Mallmin, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    DXA of the hip and heel ultrasound but not densitometry of the fingers can discriminate female hip fracture patients from controls: a comparison between four different methods2001Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 12, nr 3, s. 185-191Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Dual-energy X-ray absorptiometry (DXA) of the proximal femur and in more recent years quantitative ultrasound (QUS) of the heel are the most established methods for assessing hip fracture risk. Measurement of the fingers offers a new approach. We performed DXA of the proximal femur, QUS of the heel and fingers, and radiographic absorptiometry (RA) of the fingers in 87 non-institutionalized women, 65-85 years of age, with a first hip fracture and compared them with 195 randomly selected age-matched controls. Bone mineral density (BMD) of the femoral neck and heel Stiffness Index were significantly lower among cases than among controls (by 15% and 17%, respectively; p < 0.0001), whereas no significant differences were found for finger measurements. When applying the WHO criterion of osteoporosis, 62-98% of the patients were classified as osteoporotic, compared with 19-85% of the controls, depending on method and site. The risks of hip fracture, estimated as odds ratios for every 1 SD reduction in femoral neck BMD, heel Stiffness Index, finger QUS and finger RA, were: 3.6 (95% CI 2.4-5.5), 3.4 (95% CI 2.2-5.0), 1.0 (95% CI 0.7-1.3) and 1.2 (95% CI 0.8-1.6), respectively. Compared with women with normal BMD of the femoral neck, those classified as osteopenic had an odds ratio of hip fracture of 14 (95% CI 2-110), whereas those classified as osteoporotic had an odds ratio of 63 (95% CI 8-501). We conclude that hip DXA and heel QUS have similar capacities to discriminate the risk of a first hip fracture, whereas QUS and RA of the phalanges seem inferior techniques for differentiating female hip fracture patients from controls.

  • 9. Fahrleitner-Pammer, A.
    et al.
    Langdahl, B. L.
    Marin, F.
    Jakob, F.
    Karras, D.
    Barrett, A.
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Walsh, J. B.
    Rajzbaum, G.
    Barker, C.
    Lems, W. F.
    Fracture rate and back pain during and after discontinuation of teriparatide: 36-month data from the European Forsteo Observational Study (EFOS)2011Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 22, nr 10, s. 2709-2719Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Summary: In this observational study in postmenopausal women with severe osteoporosis, the incidence of fractures was decreased during 18 months of teriparatide treatment with no evidence of further change in the subsequent 18-month post-teriparatide period when most patients took other osteoporosis medications. Fracture reduction was accompanied by reductions in back pain.

    Introduction: To describe fracture outcomes and back pain in postmenopausal women with severe osteoporosis during 18 months of teriparatide treatment and 18 months post-teriparatide in normal clinical practice.

    Methods: The European Forsteo Observational Study (EFOS) was a prospective, multinational, observational study. Data on incident clinical fractures and back pain (100 mm Visual Analogue Scale [VAS] and questionnaire) were collected. Fracture data were summarised in 6-month intervals and analysed using logistic regression with repeated measures. Changes from baseline in back pain VAS were analysed using a repeated measures model.

    Results: A total of 208 (13.2%) of 1,576 patients sustained 258 fractures during 36 months of follow-up: 34% were clinical vertebral fractures and 66% non-vertebral fractures. The adjusted odds of fracture were reduced during teriparatide treatment and there was no evidence of further change in the 18-month post-teriparatide period, during which 63.3% patients took bisphosphonates. A 74% decrease in the adjusted odds of fracture in the 30- to < 36-month period compared with the first 6-month period was observed (p < 0.001). Back pain decreased during teriparatide treatment and this decrease was sustained after teriparatide discontinuation. Adjusted mean back pain VAS decreased by 26.3 mm after 36 months (p < 0.001) from baseline mean of 57.8 mm.

    Conclusions: In a real-life clinical setting, the risk of fracture decreased during teriparatide treatment, with no evidence of further change after teriparatide was discontinued. The changes in back pain seen during treatment were maintained for at least 18 months after teriparatide discontinuation. These results should be interpreted in the context of the design of an observational study.

  • 10. Farahmand, Bahman Y.
    et al.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Ahlbom, Anders
    Ljunghall, Sverker
    Baron, John A.
    Survival after hip fracture2005Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 16, nr 12, s. 1583-90Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Although it is known that overall mortality is increased after hip fracture, the influence of hip fracture risk factors on the subsequent mortality and cause of death has not been well studied. The objective of this study was to establish the survival after hip fracture in women and to assess the impact of comorbidity on mortality. We identified a complete population-based set of 2,245 incident hip fracture cases and 4,035 randomly selected population-based controls among women 50-81 years old in Sweden and followed these subjects for an average of 5 years through the Swedish National Inpatient and Cause-of-Death Registers. Information on factors related to hip fracture was obtained through linkage to hospital discharge data and through a mailed questionnaire. We studied excess mortality of hip fracture patients compared to controls using survival curves and proportional hazard regression models. During follow-up, 896 hip fracture patients (40%) and 516 (13%) controls died. The relative risk (RR) of death, adjusted for age and previous hospitalization for serious disease, was 2.3 (95% CI 2.0-2.5). Although the highest mortality risks were in the 1st 6 months post-fracture, RRs for fractures versus controls were increased for at least 6 years. Increased mortality was apparent both in those with evidence of comorbidity and those without. Hip fracture patients have a substantially increased risk of death that persists for at least 6 years post-fracture. The relative excess mortality is independent of comorbidity and known hip fracture risk factors.

  • 11. Farahmand, Bahman Y.
    et al.
    Persson, Per-Gunnar
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Baron, John A.
    Parker, M.G.
    Ljunghall, Sverker
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Socioeconomic status, marital status and hip fracture risk: a population-based case-control study2000Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 11, nr 9, s. 803-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Socioeconomic status and social support have been identified as important determinants of several diseases and overall mortality, but these factors have not been adequately examined in relation to hip fracture risk. The aim of this study was to determine the relationship of socioeconomic status and marital status to hip fracture risk. We used data from a population-based case-control study in postmenopausal women aged 50-81 years during 1993-1995 who resided in six counties in Sweden. The analysis was based on 1327 incident cases of hip fracture and 3262 randomly selected controls. Socioeconomic and marital status were obtained by record linkage with census data in 1960, 1970, 1980 and 1990. Information on other possible risk factors for hip fracture was collected by a mailed questionnaire. Women who were gainfully employed in 1990 had an odds ratio (OR) of 0.74 [95% confidence interval (CI) 0.56-0.96] compared with those not gainfully employed; those in the highest tertile of household income had an OR of 0.74 (95% CI 0.60-0.90) compared with those in the lowest tertile of income. Women who lived in a one-family house had an OR of 0.85 (95% CI 0.72-0.99) compared with those living in an apartment. Divorced, widowed or unmarried women had a higher risk of hip fracture than married or cohabiting women; the OR was 1.40 (95% CI 1.06-1.85). Married women who were both gainfully employed and were living in a one-family house had a substantially decreased risk of hip fracture compared with unemployed women living without a partner in an apartment (OR 0.39; 95% CI 0.22-0.71). Occupational affiliation among women ever employed, and educational level, were not associated with hip fracture risk. We conclude that employment, household income, type of housing and marital status seem to be risk indicators of hip fracture risk independent of known osteoporotic risk factors.

  • 12. Felsenberg, Dieter
    et al.
    Beller, Gisela
    Fiore, Carmelo
    Lyritis, George
    Kindmark, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Metabola bensjukdomar.
    Boerst, Hendrikje
    Bock, Oliver
    Hartard, Manfred
    Runge, Martin
    Brandi, Maria Luisa
    Sergi, Giuseppe
    Bergström, Ingrid
    Beneficial effects of strontium ranelate compared to alendronate on bone mass and strength parameters at the tibia in postmenopausal osteoporotic women: A 2-year study2012Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 23, nr S2, s. S113-S114Artikkel i tidsskrift (Annet vitenskapelig)
  • 13.
    Feudjo Tepie, M.
    et al.
    Amgen Ltd, Uxbridge, Middx, England..
    Banefelt, J.
    Quantify Res, Stockholm, Sweden..
    Ström, O.
    Quantify Res, Stockholm, Sweden..
    Ortsater, G.
    Quantify Res, Stockholm, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Åkesson, K.
    Skane Univ Hosp, Dept Orthoped, Lund, Sweden.;Lund Univ, Clin Sci Malmo, Lund, Sweden..
    Sprafka, J. M.
    Amgen Inc, Thousand Oaks, CA 91320 USA..
    Wagman, R. B.
    Amgen Inc, Thousand Oaks, CA 91320 USA..
    Denosumab (DMAB) Freedom Extension Pseudo Control Study: A Retrospective Cohort Study Of Comorbidities In Swedish Women With Postmenopausal Osteoporosis (PMO)2016Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, s. S154-S154Artikkel i tidsskrift (Annet vitenskapelig)
  • 14. Glynn, A. Wicklund
    et al.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Lind, Monica
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Biologiska sektionen, Institutionen för evolutionsbiologi.
    Wolk, Alicja
    Aune, M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Atuma, S.
    Darnerud, P.O.
    Mallmin, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Organochlorines and bone mineral density in Swedish men from the general population2000Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 11, nr 12, s. 1036-1042Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Persistent organochlorines (POCs), such as polychlorinated biphenyls (PCBs) and DDT, are present at relatively high concentrations in food and show estrogenic, anti-estrogenic or anti-androgenic activity in biological test systems. Because bone mineral density (BMD) in men is influenced by sex hormones, we looked for associations between BMD and serum concentrations of POCs in 115 men (mean age 63 years, range 40-75 years) from the general Swedish population. Ten PCB congeners, five DDT isomers, hexachlorobenzene, three hexachlorocyclohexane isomers, trans-nonachlor and oxychlordane were analyzed by gas chromatography. Quantitative bone measurements were performed by dual-energy X-ray absorptiometry at three sites: whole body, the L2-L4 region of the lumbar spine, and the neck region of the proximal femur, as well as by quantitative ultrasound on the left os calcis (broadband ultrasound attenuation (BUA) and speed of sound (SOS)). After adjustment for confounding factors in linear regression analyses we found no strong association between serum concentrations of single POCs and the five BMD and ultrasound variables. When POCs were grouped according to hormonal activity (estrogenic, anti-estrogenic, anti-androgenic) and the study subjects were divided into organochlorine concentration quartiles, a weak association was indicated between increased serum concentrations of p,p'-DDE (antiandrogenic) and decreased BMD, BUA and SOS. This may suggest that p,p'-DDE could cause negative effects on bone density, but the findings might also be due to chance since multiple comparisons were made in the statistical analysis. Overall our results do not suggest that the studied POCs caused major effects on bone density in our study group.

  • 15.
    Grundberg, E
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Lau, E
    Lorentzson, M
    Karlsson, M
    Holmberg, A
    Groop, L
    Mellström, D
    Orwoll, E
    Mallmin, H
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Ohlsson, C
    Ljunggren, O
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Åkesson, K
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Large-scale association study between two coding LRP5 gene polymorphisms and bone phenotypes and fractures in men2007Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 19, nr 6, s. 829-837Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Summary  Herein we investigated the association between polymorphisms in the LRP5 gene and bone phenotypes and fractures in three large male cohorts based on the rationale that mutations in LRP5 cause severe bone phenotypes. Results showed an association of the Val667Met SNP with spine BMD in 3,800 young and elderly men. Introduction  The low-density lipoprotein receptor-related protein 5 (LRP5)-Wnt signalling system is of importance for regulating osteoblastic activity, which became clear after findings that inactivating mutations in LRP5 cause osteoporosis. The overall aim of this study was to investigate the association between polymorphisms in the LRP5 gene and bone mineral density (BMD) in three large cohorts of young and elderly men. Methods  The cohorts used were MrOS Sweden (n = 3014, aged 69–81 years) and MrOs Hong Kong (n = 2000, aged  > 65 years) and the Swedish GOOD study (n = 1068, aged 18–20 years). The polymorphisms Val667Met and Ala1330Val were genotyped using a TaqMan assay. Results  When combining the data from the Swedish cohorts in a meta-analysis (n = 3,800), men carrying the 667Met-allele had 3% lower BMD at lumbar spine compared with non-carriers (p < 0.05). The Val667Met SNP was not polymorphic in the Hong Kong population and thus were not included. There were no associations between the Ala1330Val SNP and bone phenotypes in the study populations. No associations between the LRP5 polymorphisms and self-reported fractures were seen in MrOs Sweden. Conclusions  Results from these three large cohorts indicate that the Val667Met polymorphism but not the Ala1330Val contributes to the observed variability in BMD in the Swedish populations.

  • 16.
    Hallström, Helena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Wolk, Alicja
    Glynn, A.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women2006Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 17, nr 7, s. 1055-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Consumption of coffee and tea, and total intake of caffeine has been claimed to be associated with osteoporotic fracture risk. However, results of earlier studies lack consistency. METHODS: We examined this relation in a cohort of 31,527 Swedish women aged 40-76 years at baseline in 1988. The consumption of coffee, caffeinated tea and the intake of caffeine were estimated from a self-administered food frequency questionnaire (FFQ). Multivariate-adjusted hazards ratios (HRs) of fractures with 95% confidence intervals (95% CIs) were estimated by Cox proportional hazards models. RESULTS: During a mean follow-up of 10.3 years, we observed 3,279 cases with osteoporotic fractures. The highest (>330 mg/day) compared with the lowest (<200 mg/day) quintile of caffeine intake was associated with a modestly increased risk of fracture: HR 1.20 (95% CI: 1.07-1.35). A high coffee consumption significantly increased the risk of fracture (p for trend 0.002), whereas tea drinking was not associated with risk. The increased risk of fracture with both a high caffeine intake and coffee consumption was confined to women with a low calcium intake (<700 mg/day): HR 1.33 (95% CI: 1.07-1.65) with > or =4 cups (600 ml)/day of coffee compared to <1 cup (150 ml)/day. The same comparison but risk estimated for women with a high propensity for fractures (> or =2 fracture types) revealed a HR of 1.88 (95% CI: 1.17-3.00). CONCLUSIONS: In conclusion, our results indicate that a daily intake of 330 mg of caffeine, equivalent to 4 cups (600 ml) of coffee, or more may be associated with a modestly increased risk of osteoporotic fractures, especially in women with a low intake of calcium.

  • 17.
    Harvey, N. C.
    et al.
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton SO16 6YD, Hants, England.;Univ Southampton, NIHR Southampton Biomed Res Ctr, Tremona Rd, Southampton, Hants, England.;Univ Hosp Southampton NHS Fdn Trust, Tremona Rd, Southampton, Hants, England..
    Johansson, H.
    Univ Gothenburg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden.;Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England..
    Oden, A.
    Univ Gothenburg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden.;Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England..
    Karlsson, M. K.
    Lund Univ, Dept Clin Sci Malmo, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden.;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden..
    Rosengren, B. E.
    Lund Univ, Dept Clin Sci Malmo, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden.;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Cooper, C.
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton SO16 6YD, Hants, England.;Univ Southampton, NIHR Southampton Biomed Res Ctr, Tremona Rd, Southampton, Hants, England.;Univ Hosp Southampton NHS Fdn Trust, Tremona Rd, Southampton, Hants, England.;Univ Oxford, NIHR Musculoskeletal Biomed Res Unit, Oxford, England..
    McCloskey, E.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England..
    Kanis, J. A.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England..
    Ohlsson, C.
    Univ Gothenburg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden..
    Mellstrom, D.
    Univ Gothenburg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden..
    FRAX predicts incident falls in elderly men: findings from MrOs Sweden2016Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, nr 1, s. 267-274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A Summary Falls and fractures share several common risk factors. Although past falls is not included as an input variable in the FRAX calculator, we demonstrate that FRAX probability predicts risk of incident falls in the MrOs Sweden cohort. Introduction Although not included in the FRAXA (R) algorithm, it is possible that increased falls risk is partly dependent on other risk factors that are incorporated into FRAX. The aim of the present study was to determine whether fracture probability generated by FRAX might also predict risk of incident falls and the extent that a falls history would add value to FRAX. Methods We studied the relationship between FRAX probabilities and risk of falls in 1836 elderly men recruited to the MrOS study, a population-based prospective cohort of men from Sweden. Baseline data included falls history, clinical risk factors, bone mineral density (BMD) at femoral neck, and calculated FRAX probabilities. Incident falls were captured during an average of 1.8 years of follow-up. An extension of Poisson regression was used to investigate the relationship between FRAX, other risk variables, and the time-to-event hazard function of falls. All associations were adjusted for age and time since baseline. Results At enrolment, 15.5 % of the men had fallen during the preceding 12 months (past falls) and 39 % experienced one or more falls during follow-up (incident falls). The risk of incident falls increased with increasing FRAX probabilities at baseline (hazard ratio (HR) per standard deviation (SD), 1.16; 95 % confidence interval (95%CI), 1.06 to 1.26). The association between incident falls and FRAX probability remained after adjustment for past falls (HR per SD, 1.12; 95%CI, 1.03 to 1.22). High compared with low baseline FRAX score (>15 vs <15 % probability of major osteoporotic fracture) was strongly predictive of increased falls risk (HR, 1.64; 95%CI, 1.36 to 1.97) and remained stable with time. Whereas past falls were a significant predictor of incident falls (HR, 2.75; 95%CI, 2.32 to 3.25), even after adjustment for FRAX, the hazard ratio decreased markedly with increasing follow-up time. Conclusions Although falls are not included as an input variable, FRAX captures a component of risk for future falls and outperforms falls history with an extended follow-up time.

  • 18.
    Harvey, N. C.
    et al.
    Univ Southampton, Southampton Gen Hosp, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England..
    Johansson, H.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Oden, A.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Karlsson, M. K.
    Lund Univ, Skane Univ Hosp, Clin & Mol Osteoporosis Res Unit, Dept Orthoped & Clin Sci, Malmo, Sweden..
    Rosengren, B.
    Lund Univ, Skane Univ Hosp, Clin & Mol Osteoporosis Res Unit, Dept Orthoped & Clin Sci, Malmo, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Cooper, C.
    Univ Southampton, Southampton Gen Hosp, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England..
    McCloskey, E. V.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Kanis, J. A.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Ohlsson, C.
    Univ Gothenburg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden..
    Mellstrom, D.
    Univ Gothenburg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden..
    The Predictive Value Of Past Falls For Incident Falls Decreases, But That Of Frax Remains Stable, With Increasing Follow-Up Time: Findings From MROS Sweden2015Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 26, s. S143-S143Artikkel i tidsskrift (Annet vitenskapelig)
  • 19.
    Harvey, N. C.
    et al.
    Univ Oxford, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, Botnar Res Ctr, Oxford, England..
    Oden, A.
    Univ Sheffield, Ctr Metab Bone Dis, Med Sch, Sheffield, S Yorkshire, England..
    Orwoll, E.
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA..
    Lapidus, J.
    Oregon Hlth & Sci Univ, Dept Publ Hlth & Prevent Med, Div Biostat, Portland, OR 97201 USA..
    Kwok, T.
    Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Sch Publ Hlth, Hong Kong, Hong Kong, Peoples R China..
    Karlsson, M.
    Lund Univ, Dept Orthopaed & Clin Sci, Skane Univ Hosp, Malmo, Sweden..
    Rosengren, B.
    Lund Univ, Clin & Mol Osteoporosis Res Unit, Dept Clin Sci Malmo, Malmo, Sweden.;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Cooper, C.
    Univ Oxford, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, Botnar Res Ctr, Oxford, England..
    Kanis, J. A.
    Univ Sheffield, Ctr Metab Bone Dis, Med Sch, Sheffield, S Yorkshire, England..
    Ohlsson, C.
    Univ Gothenburg, Gothenburg, Sweden..
    Mellstrom, D.
    Univ Gothenberg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden..
    Johansson, H.
    Univ Sheffield, Ctr Metab Bone Dis, Med Sch, Sheffield, S Yorkshire, England..
    McCloskey, E. V.
    Univ Sheffield, Ctr Metab Bone Dis, Med Sch, Sheffield, S Yorkshire, England..
    Mobility Related Risk Factors Predict Incident Fractures Independently Of Frax: The Osteoporotic Fractures In Men (MROS) Study2017Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 28, s. S61-S61Artikkel i tidsskrift (Annet vitenskapelig)
  • 20.
    Harvey, N. C.
    et al.
    Univ Oxford, Musculoskeletal Epidemiol, Botnar Res Ctr, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, Oxford, England..
    Oden, A.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Orwoll, E.
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA..
    Lapidus, J.
    Oregon Hlth & Sci Univ, Dept Publ Hlth & Prevent Med, Div Biostat, Portland, OR 97201 USA..
    Kwok, T.
    Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Sch Publ Hlth, Hong Kong, Hong Kong, Peoples R China..
    Karlsson, M.
    Lund Univ, Dept Orthopaed & Clin Sci, Skane Univ Hosp, Malmo, Sweden..
    Rosengren, B.
    Lund Univ, Clin & Mol Osteoporosis Res Unit, Dept Clin Sci Malmo, Malmo, Sweden.;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Cooper, C.
    Univ Oxford, Musculoskeletal Epidemiol, Botnar Res Ctr, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, Oxford, England..
    McCloskey, E.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Kanis, J. A.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Ohlsson, C.
    Univ Gothenburg, Gothenburg, Sweden..
    Mellstrom, D.
    Univ Gothenberg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden..
    Johansson, H.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    PRIOR FALLS PREDICT INCIDENT FRACTURES INDEPENDENTLY OF FRAX: The Osteoporotic Fractures In Men (MROS) Study2017Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 28, s. S259-S259Artikkel i tidsskrift (Annet vitenskapelig)
  • 21.
    Harvey, N. C.
    et al.
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England.
    Oden, A.
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res CBAR, Gothenburg, Sweden.
    Orwoll, E.
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA.
    Lapidus, J.
    Oregon Hlth & Sci Univ, Div Biostat, Dept Publ Hlth & Prevent Med, Portland, OR 97201 USA.
    Kwok, T.
    Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China;Chinese Univ Hong Kong, Sch Publ Hlth, Hong Kong, Hong Kong, Peoples R China.
    Karlsson, M.
    Lund Univ, Dept Clin Sci Malmo, Lund, Sweden.
    Rosengren, B.
    Lund Univ, Dept Clin Sci Malmo, Lund, Sweden.
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Coopers, C.
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England.
    Cawthon, P. M.
    Univ Calif San Fransisco, Dept Epidemiol & Biostat, San Francisco, CA USA.
    Kanis, J. A.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England.
    Ohlsson, C.
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res CBAR, Gothenburg, Sweden.
    Mellstrom, D.
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res CBAR, Gothenburg, Sweden.
    Johansson, H.
    Catholic Univ Australia, Inst Hlth & Aging, Melbourne, Vic, Australia.
    McCloskey, E. V.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England.
    Physical Performance Or Function, But Not Appendicular Lean Mass, Predict Incident Fractures Independently Of FRAX Probability And BMD: Results From The Osteoporotic Fractures In Men (MROS) Cohort2018Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, s. S69-S70Artikkel i tidsskrift (Annet vitenskapelig)
  • 22.
    Hellström, Hans-Olov
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Mjöberg, Bengt
    Mallmin, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    The aluminum content of bone increases with age, but is not higher in hip fracture cases with and without dementia compered to controls2005Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 16, nr 12, s. 1982-1988Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aluminum is considered a potentially toxic metal, and aluminum poisoning may lead to three types of disorders: aluminum-induced bone disease, microcytic anemia and encephalopathy. This is well known in patients with chronic renal failure, but since healthy subjects with normal renal function retain 4% of the aluminum consumed, they are also at risk of long-term low-grade aluminum intoxication. Included in this study were a total of 172 patients (age range 16-98 years) with the aim of examining whether aluminum accumulates in bone with increasing age. Additionally, we aimed to investigate whether the aluminum content of bone differs between controls and hip fracture cases with and without dementia, in particular in those with Alzheimer's disease. During operations for all cases, bone biopsies were taken with an aluminum-free instrument from the trabecular bone. The samples were measured for their content of aluminum using an inductively coupled mass spectrometer. We found an exponential increase in aluminum content of bone with age. The average aluminum values, adjusted for age, were similar in men and women (P=0.46). No significant differences in sex- and age-adjusted mean aluminum values between the controls and the hip fracture cases with (P=0.72) and without (P=0.33) dementia could be detected. The average aluminum concentration among cases with Alzheimer's disease was also similar to the values of hip fracture patients with other types of dementia (P=0.47). Odds ratios of hip fracture for each quartile of aluminum content in bone were also estimated to detect non-linear effects, but we did not find any statistically significant association remaining after age and sex adjustment. Thus, our results indicate that we accumulate aluminum in bone over our life span, but this does not seem to be of major pathogenetic significance for the occurrence of hip fracture or dementia.

  • 23. Holvik, K
    et al.
    Gjesdal, C G
    Tell, G S
    Grimnes, G
    Schei, B
    Apalset, E M
    Samuelsen, S O
    Blomhoff, R
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Meyer, H E
    Low serum concentrations of alpha-tocopherol are associated with increased risk of hip fracture: A NOREPOS study2014Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 25, nr 11, s. 2545-2554Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We investigated the risk of hip fracture according to circulating alpha-tocopherol, a plant-derived substance with antioxidant properties, in community-dwelling older Norwegians. We found a linear increasing risk of hip fracture with lower serum alpha-tocopherol concentrations, with a 51 % higher risk in the lowest compared to the highest quartile.

    INTRODUCTION:

    Oxidative stress is a suggested contributing cause of osteoporosis and fractures. Vitamin E (α-tocopherol) has potent antioxidant properties in humans. The relationship between circulating α-tocopherol and fracture risk is not established. The aim of this study was to investigate the association between serum α-tocopherol concentrations and risk of hip fracture during up to 11 years of follow-up.

    METHODS:

    We performed a case-cohort analysis among 21,774 men and women aged 65-79 years who participated in four community-based health studies in Norway 1994-2001. Serum α-tocopherol concentrations at baseline were determined in 1,168 men and women who subsequently suffered hip fractures (median follow-up 8.2 years) and in a random sample (n = 1,434) from the same cohort. Cox proportional hazard regression adapted for gender-stratified case-cohort data was performed.

    RESULTS:

    Median (25, 75 percentile) serum α-tocopherol was 30.0 (22.6, 38.3) μmol/L, and it showed a linear inverse association with hip fracture: hazard ratio (HR) 1.11 (95 % confidence interval (CI) 1.04-1.20) per 10-μmol/L decrease in serum α-tocopherol, adjusted for gender and study center. The lowest compared to the highest quartile conferred an HR of 1.51 (95 % CI 1.17-1.95), adjusted for gender and study center. Adjustment for smoking, month of blood sample, BMI, education, physical inactivity, self-rated health, and serum 25-hydroxyvitamin D (25(OH)D) yielded similar results. Taking serum total cholesterol concentration into account attenuated the association somewhat: HR of hip fracture was 1.37 (95 % CI 1.05-1.77) in first versus fourth quartile of serum α-tocopherol/total cholesterol ratio.

    CONCLUSIONS:

    Low serum concentrations of α-tocopherol were associated with increased risk of hip fracture in older Norwegians.

  • 24. Jia, T
    et al.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Lindholm, B
    Larsson, T E
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Carrero, J J
    Dietary acid load, kidney function, osteoporosis, and risk of fractures in elderly men and women2015Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 26, nr 2, s. 563-570Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Because kidney dysfunction reduces the ability to excrete dietary acid excess, we hypothesized that underlying kidney function may have confounded the mixed studies linking dietary acid load with the risk of osteoporosis and fractures in the community. In a relatively large survey of elderly men and women, we report that dietary acid load did neither associate with DEXA-estimated bone mineral density nor with fracture risk. Underlying kidney function did not modify these null findings. Our results do not support the dietary acid-base hypothesis of bone loss.

    INTRODUCTION:

    Impaired renal function reduces the ability to excrete dietary acid excess. We here investigate the association between dietary acid load and bone mineral density (BMD), osteoporosis, and fracture risk by renal function status.

    METHODS:

    An observational study was conducted in 861 community-dwelling 70-year-old men and women (49 % men) with complete dietary data from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS). The exposure was dietary acid load as estimated from 7-day food records by the net endogenous acid production (NEAP) and potential renal acid load (PRAL) algorithms. Renal function assessed by cystatin C estimated glomerular filtration rate was reduced in 21 % of the individuals. Study outcomes were BMD and osteoporosis state (assessed by DEXA) and time to fracture (median follow-up of 9.2 years).

    RESULTS:

    In cross-section, dietary acid load had no significant associations with BMD or with the diagnosis of osteoporosis. During follow-up, 131 fractures were validated. Neither NEAP (adjusted hazard ratios (HR) (95 % confidence interval (CI)), 1.01 (0.85-1.21), per 1 SD increment) nor PRAL (adjusted HR (95 % CI), 1.07 (0.88-1.30), per 1 SD increment) associated with fracture risk. Further multivariate adjustment for kidney function or stratification by the presence of kidney disease did not modify these null associations.

    CONCLUSIONS:

    The hypothesis that dietary acid load associates with reduced BMD or increased fracture risk was not supported by this study in community-dwelling elderly individuals. Renal function did not influence on this null finding.

  • 25.
    Johansson, H.
    et al.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Harvey, N. C.
    Univ Southampton, Southampton Gen Hosp, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England..
    Oden, A.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Karlsson, M. K.
    Lund Univ, Skane Univ Hosp, Dept Orthoped & Clin Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden..
    Rosengren, B.
    Lund Univ, Skane Univ Hosp, Dept Orthoped & Clin Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Cooper, C.
    Univ Southampton, Southampton Gen Hosp, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England..
    McCloskey, E. V.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Kanis, J. A.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Ohlsson, C.
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden..
    Mellstrom, D.
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden..
    Waning Long-Term Predictive Value Of Falls History For Incident Fracture: MROS Sweden2015Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 26, s. S42-S42Artikkel i tidsskrift (Annet vitenskapelig)
  • 26. Johansson, H.
    et al.
    Oden, A.
    Kanis, J.
    McCloskey, E.
    Lorentzon, M.
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Karlsson, M. K.
    Thorsby, P. M.
    Tivesten, A.
    Barrett-Connor, E.
    Ohlsson, C.
    Mellstrom, D.
    Low serum vitamin D is associated with increased mortality in elderly men: MrOS Sweden2012Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 23, nr 3, s. 991-999Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In elderly man, low serum 25-hydroxyvitamin D (25(OH)D) was associated with a substantial excess risk of death compared to 25(OH)D values greater than 50-70 nmol/l, but the association attenuated with time. The aim of the present study was to determine whether poor vitamin D status was associated with an increase in the risk of death in elderly men. We studied the relationship between serum 25(OH)D and the risk of death in 2,878 elderly men drawn from the population and recruited to the MrOS study in Sweden. Baseline data included general health and lifestyle measures and serum 25(OH)D measured by competitive RIA. Men were followed for up to 8.2 years (average 6.0 years). Mortality adjusted for comorbidities decreased by 5% for each SD increase in 25(OH)D overall (gradient of risk 1.05; 95% confidence interval 0.96-1.14). The predictive value of 25(OH)D for death was greatest below a threshold value of 50-70 nmol/l, was greatest at approximately 3 years after baseline and thereafter decreased with time. Low serum 25(OH)D is associated with a substantial excess risk of death compared to 25(OH)D values greater than 50-70 nmol/l, but the association attenuates with time. These findings, if causally related, have important implications for intervention in elderly men.

  • 27.
    Johansson, H.
    et al.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Oden, A.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Karlsson, M.
    Lund Univ, Skane Univ Hosp, Dept Orthopaed & Clin Sci, Malmo, Sweden..
    Lorentzon, M.
    Sahlgrens Acad, Inst Med, Dept Internal Med & Clin Nutr, Geriatr Med, Molndal, Sweden..
    Kanis, J. A.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Rosengren, B.
    Lund Univ, Dept Clin Sci Malmo, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden.;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden..
    Mellström, D.
    Sahlgrens Acad, Inst Med, Dept Internal Med & Clin Nutr, Geriatr Med, Molndal, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    OhIsson, C.
    Univ Gothenburg, Gothenburg, Sweden..
    Harvey, N. C.
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England..
    McCloskey, E.
    Univ Sheffield, Sch Med, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Femoral Neck BMD Is Still The Preferred Site In The Assessment Of Hip Fracture In Elderly Men (10-Year Follow-Up Of MROS Sweden)2016Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 27, s. S58-S59Artikkel i tidsskrift (Annet vitenskapelig)
  • 28. Johansson, H.
    et al.
    Oden, A.
    Lerner, U. H.
    Jutberger, H.
    Lorentzon, M.
    Barrett-Connor, E.
    Karlsson, M. K.
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Metabola bensjukdomar.
    Smith, U.
    McCloskey, E.
    Kanis, J. A.
    Ohlsson, C.
    Mellström, D.
    High serum adiponectin predicts incident fractures in elderly men: MrOS Sweden2012Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 23, nr 2, s. S306-S307Artikkel i tidsskrift (Annet vitenskapelig)
  • 29. Johansson, H.
    et al.
    Odén, A.
    Kanis, J.
    McCloskey, E.
    Lorentzon, M.
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Karlsson, M. K.
    Orwoll, E.
    Tivesten, Å.
    Ohlsson, C.
    Mellström, D.
    Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden2011Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 22, nr 5, s. 1411-1418Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We studied the nature of the relationship between bone mineral density (BMD) and the risk of death among elderly men. BMD was associated with mortality risk and was independent of adjustments for other co-morbidities. A piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020). Low BMD was associated with a substantial excess risk of death, whilst a higher than average BMD had little impact on mortality. Previous studies have demonstrated an association between low BMD and an increased risk of death among men and women. The aim of the present study was to examine the pattern of the risk in men and its relation to co-morbidities. We studied the nature of the relationship between BMD and death among 3,014 elderly men drawn from the population and recruited to the MrOS study in Sweden. Baseline data included general health questionnaires, life style questionnaires and BMD measured using DXA. Men were followed for up to 6.5 years (average 4.5 years). Poisson regression was used to investigate the relationship between BMD, co-morbidities and the hazard function of death. During follow-up, 382 men died (all-cause mortality). Low BMD at all measured skeletal sites was associated with increased mortality. In multivariate analyses, the relationship between BMD and mortality was non-linear, and a piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020). Low BMD is associated with a substantial excess risk of death compared to an average BMD, whereas a higher than average BMD has a more modest effect on mortality. These findings, if confirmed elsewhere, have implications for the constructing of probability-based fracture risk assessment tools.

  • 30. Johansson, Helena
    et al.
    Oden, Anders
    Karlsson, Magnus
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Mccloskey, Eugene
    Kanis, John A.
    Ohlsson, Claes
    Mellstrom, Dan
    Adiponectin and 10-year probability of fracture in elderly men: MR OS Sweden2013Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 24, nr Suppl. 1, s. S47-S47Artikkel i tidsskrift (Annet vitenskapelig)
  • 31.
    Jonsson, E.
    et al.
    Quantify Res, Stockholm, Sweden..
    Hansson-Hedblom, A.
    Quantify Res, Stockholm, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Akesson, K.
    Lund Univ, Dept Clin Sci, Clin & Mol Osteoporosis Unit, Malmo, Sweden..
    Spangeus, A.
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Borgstrom, F.
    Quantify Res, Stockholm, Sweden.;Karolinska Inst, Stockholm, Sweden..
    Kanis, J. A.
    Catholic Univ Australian, Melbourne, Vic, Australia.;Univ Sheffield, Sheffield, S Yorkshire, England..
    Cost-Effectiveness Of Complying With Treatment Guidelines In Sweden2017Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 28, s. S440-S440Artikkel i tidsskrift (Annet vitenskapelig)
  • 32.
    Jonsson, E.
    et al.
    Quantify Res, Hantverkargatan 8, SE-11221 Stockholm, Sweden..
    Hansson-Hedblom, A.
    Quantify Res, Hantverkargatan 8, SE-11221 Stockholm, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Akesson, K.
    Lund Univ, Dept Clin Sci, Clin & Mol Osteoporosis Unit, Malmo, Sweden..
    Spangeus, A.
    Linkoping Univ, Dept Endocrinol Med & Hlth, Linkoping, Sweden..
    Kanis, J. A.
    Univ Sheffield, Sheffield, S Yorkshire, England.;Catholic Univ Australia, Melbourne, Vic, Australia..
    Borgstrom, F.
    Quantify Res, Hantverkargatan 8, SE-11221 Stockholm, Sweden.;Karolinska Inst, LIME MMC, Stockholm, Sweden..
    A health economic simulation model for the clinical management of osteoporosis2018Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, nr 3, s. 545-555Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective was to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice. Results showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings.

    Introduction

    The purpose of this study is to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice.

    Methods

    The analysis was carried out using a model that simulates the individual patients considered for pharmacological treatment during 1 year and their projected osteoporosis treatment pathway, quality-adjusted life years (QALYs) and costs over their remaining lifetime. All patients regardless of treatment or no treatment were simulated. Information on current management of osteoporosis in terms of patient characteristics and treatment patterns were derived from a Swedish osteoporosis research database based on national registers and patient records. Current (standard) clinical management was compared with alternative scenarios mirroring Swedish treatment guidelines.

    Results

    The national burden in terms of lost QALYs was estimated at 14,993 QALYs and the total economic cost at €776M. Scenario analyses showed that 382–3864 QALYs could be gained at a cost/QALY ranging from cost-saving to €31368, depending on the scenario. The margin of investment, i.e. the maximum amount that could be invested in the healthcare system to achieve these improvements up to the limit of the willingness to pay/QALY, was estimated at €199M on a population level (€3,634/patient).

    Conclusions

    The analysis showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings. From a cost-effectiveness perspective, there is also considerable room for investment to achieve these improvements in the management of osteoporosis.

  • 33.
    Kanis, J. A.
    et al.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Oden, A.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Harvey, N. C.
    Univ Southampton, Southampton Gen Hosp, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England..
    Leslie, W. D.
    Univ Manitoba, Med & Radiol, Winnipeg, MB, Canada..
    Hans, D.
    Univ Lausanne Hosp, Ctr Bone Dis, Lausanne, Switzerland..
    Johansson, H.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    Barkmann, R.
    Klin Diagnost Radiol, Sekt Biomed Bildgebung, Kiel, Germany..
    Boutroy, S.
    Univ Lyon, Hosp Civils Lyon, Hop E Herriot, INSERM UMR 1033, Lyon, France..
    Brown, J. P.
    CHU Quebec, Res Ctr, Quebec City, PQ, Canada.;Univ Laval, Quebec City, PQ, Canada..
    Chapurlat, R. D.
    INSERM Unit 433, Lyon, France..
    Elders, P.
    Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands..
    Fujita, Y.
    Kinki Univ, Fac Med, Dept Publ Hlth, Osaska Sayama, Japan..
    Glueer, C. C.
    Univ Kiel, Diagnost Radiol, Biomed Imaging, Kiel, Germany..
    Goltzman, D.
    Royal Victoria Hosp, Dept Med, Montreal, PQ H3A 1A1, Canada.;Royal Victoria Hosp, Dept Physiol, Montreal, PQ H3A 1A1, Canada.;McGill Univ, Montreal, PQ, Canada..
    Iki, M.
    Kinki Univ, Dept Publ Hlth, Fac Med, Osaka, Japan..
    Karlsson, M. K.
    Lund Univ, Clin & Mol Osteoporosis Res Unit, Dept Orthoped & Clin Sci, Skane Univ Hosp, Malmo, Sweden..
    Kindmark, Andreas
    Univ Uppsala Hosp, Dept Med Sci, Uppsala, Sweden..
    Kurtunatani, N.
    Nara Med Univ, Dept Community Hlth & Epidemiol, Sch Med, Kashihara, Nara 634, Japan..
    Kwok, A.
    Chinese Univ Hong Kong, Jockey Club, Ctr Osteoporosis Care & Control, Hong Kong, Hong Kong, Peoples R China..
    Leung, J.
    Chinese Univ Hong Kong, Jockey Club, Ctr Osteoporosis Care & Control, Hong Kong, Hong Kong, Peoples R China..
    Lippuner, K.
    Univ Hosp Bern, CH-3010 Bern, Switzerland..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Lorentzon, M.
    Univ Gothenburg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden..
    Mellstrom, D.
    Univ Gothenburg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden..
    Merlijn, T.
    Oei, L.
    Deakin Univ, Epi Ctr Healthy Ageing, Sch Med, Geelong, Vic 3217, Australia..
    Ohlsson, C.
    Univ Gothenburg, CBAR, Sahlgrenska Acad, Gothenburg, Sweden..
    Pasco, J. A.
    Deakin Univ, Epi Ctr Healthy Ageing, Sch Med, Geelong, Vic 3217, Australia..
    Rivadeneira, F.
    Erasmus Univ, Dept Internal Med, Med Ctr, Rotterdam, Netherlands.;Erasmus Univ, Dept Epidemiol, Med Ctr, Rotterdam, Netherlands..
    Rosengren, B.
    Lund Univ, Clin & Mol Osteoporosis Res Unit, Dept Orthoped & Clin Sci, Skane Univ Hosp, Malmo, Sweden..
    Sornay-Rendu, E.
    Szulc, P.
    Tamaki, J.
    Osaka Med Coll, Dept Hyg & Publ Hlth, Takatsuki, Osaka 569, Japan..
    McCloskey, E. V.
    Univ Sheffield, Ctr Metab Bone Dis, Sheffield, S Yorkshire, England..
    A Meta-Analysis Of Trabecular Bone Score In Fracture Risk Prediction And Its Interaction With Frax2015Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 26, s. S46-S46Artikkel i tidsskrift (Annet vitenskapelig)
  • 34.
    Karlsson, L.
    et al.
    Quantify Res, SE-11221 Stockholm, Sweden..
    Lundkvist, Jonas
    Psachoulia, E.
    Amgen Europe GmbH, Zug, Switzerland..
    Intorcia, M.
    Amgen Europe GmbH, Zug, Switzerland..
    Strom, O.
    Quantify Res, SE-11221 Stockholm, Sweden.;Karolinska Inst, MMC, Dept Learning Informat Management & Eth LIME, Stockholm, Sweden..
    Persistence with denosumab and persistence with oral bisphosphonates for the treatment of postmenopausal osteoporosis: a retrospective, observational study, and a meta-analysis2015Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 26, nr 10, s. 2401-2411Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Summary The objectives of this study were to estimate persistence with denosumab and put these results in context by conducting a review of persistence with oral bisphosphonates. Persistence with denosumab was found to be higher than with oral bosphosphonates. Purpose This study had two objectives: to analyse persistence in Swedish women initiating denosumab for treatment of postmenopausal osteoporosis (PMO) and to put these findings in context by conducting a literature review and meta-analysis of persistence data for oral bisphosphonates. Methods The study used the Swedish Prescribed Drug Register and included women aged at least 50 years initiating denosumab between May 2010 and July 2012. One injection of denosumab was defined as 6-month persistence. Women were considered persistent for another 6 months if they filled their next prescription within 6 months + 56 days and survival analysis applied to the data. A literature search was conducted in PubMed to identify retrospective studies of persistence with oral bisphosphonates and pooled persistence estimates were calculated using a random-effects model. Results The study identified 2,315 women who were incident denosumab users. Mean age was 74 years and 61 % had been previously treated for PMO. At 12 and 24 months, persistence with denosumab was 83 % (95 % CI, 81-84 %) and 62 % (95 % CI, 60-65 %), respectively. The literature search identified 40 articles for inclusion in the meta-analysis. At 12 and 24 months, persistence with oral bisphosphonates ranged from 10 % to 78 % and from 16 % to 46 %, with pooled estimates of 45 % and 30 %, respectively. Conclusion These data from the Swedish Prescribed Drug Register and literature review suggest that persistence was higher with denosumab than with oral bisphosphonates.

  • 35.
    Kettenberger, U.
    et al.
    Ecole Polytech Fed Lausanne, Lab Biomech Orthoped, Lausanne, Switzerland..
    Ston, J.
    Ecole Polytech Fed Lausanne, Lab Biomech Orthoped, Lausanne, Switzerland..
    Thein, E.
    Univ Hosp Lausanne CHUV, Orthopaed & Traumatol Dept, Lausanne, Switzerland..
    Procter, Philip
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Tillämpad materialvetenskap.
    Pioletti, D. P.
    Ecole Polytech Fed Lausanne, Lab Biomech Orthoped, Lausanne, Switzerland..
    Influence Of Locally Delivered Zoledronate On Peri-Implant Bone Resorption And Formation2015Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 26, s. S155-S156Artikkel i tidsskrift (Annet vitenskapelig)
  • 36.
    Kristjansdottir, H.
    et al.
    Sahlgrens Univ Hosp, Sect Hematol & Coagulat, Gothenburg, Sweden..
    Lewerin, C.
    Sahlgrens Univ Hosp, Sect Hematol & Coagulat, Gothenburg, Sweden..
    Lerner, U.
    Univ Gothenburg, Dept Internal Med, Ctr Bone & Arthrit Res, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Clin Nutr, Gothenburg, Sweden..
    Waern, E.
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Geriatr Med, Gothenburg, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Johansson, H.
    Australian Catholic Univ, Inst Hlth & Aging, Melbourne, Vic, Australia..
    Sundh, D.
    Sahlgrens Acad, Geriatr Med, Dept Internal Med, Gothenburg, Sweden.;Sahlgrens Acad, Inst Med, Clin Nutr, Gothenburg, Sweden..
    Karlsson, M.
    Skane Univ Hosp, Lund Univ, Dept Orthopaed & Clin Sci, Malmo, Sweden..
    Cummings, S.
    Calif Pacific Med Ctr, San Francisco Coordinating Ctr, San Francisco, CA USA..
    Zetterberg, H.
    Univ Gothenburg, Dept Psychiat & Neurochem, Gothenburg, Sweden..
    Lorentzon, M.
    Sahlgrens Acad, Dept Internal Med, Geriatr Med, Molndal, Sweden.;Sahlgrens Acad, Inst Med, Clin Nutr, Molndal, Sweden..
    Ohlsson, C.
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden..
    Mellstrom, D.
    Sahlgrens Acad, Dept Internal Med, Geriatr Med, Molndal, Sweden.;Sahlgrens Acad, Inst Med, Clin Nutr, Molndal, Sweden..
    Both High And Low Serum Serotonin Levels Predict Incident Non-Vertebral Fractures2017Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 28, s. S181-S182Artikkel i tidsskrift (Annet vitenskapelig)
  • 37.
    Leavy, Breiffni
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Åberg, Anna Cristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Melhus, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Mallmin, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    When and where do hip fractures occur?: A population-based study2013Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 24, nr 9, s. 2387-2396Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    SUMMARY

    We investigated the effects of socio-demographic and health factors on timing and location of hip fracture among 484 subjects. Time of fracture varied between community dwellers and residential care facility dwellers, and in relation to subjects' psychotropic drug status. Indoor hip fracture incidence increased on snow-covered days.

    INTRODUCTION

    This paper aims to describe the timing and whereabouts of hip fracture cases in a population-based setting and to relate these factors with residential and health status, seasonal variation, and snow-covered ground.

    METHODS

    We consecutively included 484 incident hip fracture events (age ≥50 years) admitted to a Swedish orthopedic department during a 1-year period. Data concerning socio-demographic details, fall location, time of fracture, comorbidity, and medications were collected from in-patient medical records and through patient or caregiver interviews.

    RESULTS

    The expected peak in fracture occurrence during daytime was observed among community dwellers but not among subjects living in residential care. Hip fracture was twice as likely to occur during nighttime hours among psychotropic drug users (adjusted odds ratio (Adj. OR), 2.20; 95 % confidence interval (CI), 1.12-4.30) compared to those not receiving these medications. Subjects without dementia, taking psychotropic drugs, were also more likely to fracture during nighttime hours (Adj. OR, 2.91; 95 % CI, 1.40-6.0). We observed an increase in indoor hip fracture incidence on snow-covered days among community dwellers (incidence rate ratio, 1.34; 95 % CI, 1.02-1.74). We observed only a weak seasonal trend in hip fracture incidence, based on month, among community dwellers who fractured indoors.

    CONCLUSIONS

    Special attention and possibly fall-preventive efforts should be directed not only toward those living in residential care facilities but also toward community-dwelling subjects taking psychotropic drugs since these groups have a higher incidence of nighttime hip fracture. Further research aiming to explain the seasonal variation of indoor fracture incidence among community dwellers is warranted.

  • 38. Lewerin, C.
    et al.
    Nilsson-Ehle, H.
    Jacobsson, S.
    Johansson, H.
    Sundh, V.
    Karlsson, M. K.
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Lorentzon, M.
    Kanis, J. A.
    Lerner, U. H.
    Cummings, S. R.
    Ohlsson, C.
    Mellström, D.
    Low holotranscobalamin and cobalamins predict incident fractures in elderly men: the MrOS Sweden2014Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 25, nr 1, s. 131-140Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Summary

    In a population-based study on cobalamin status and incident fractures in elderly men (n  = 790) with an average follow-up of 5.9 years, we found that low levels of metabolically active and total cobalamins predict incident fractures, independently of body mass index (BMI), bone mineral density (BMD), plasma total homocysteine (tHcy), and cystatin C.

    Introduction

    Cobalamin deficiency in elderlies may affect bone metabolism. This study aims to determine whether serum cobalamins or holotranscobalamin (holoTC; the metabolic active cobalamin) predict incident fractures in old men.

    Methods

    Men participating in the Gothenburg part of the population-based Osteoporotic Fractures in Men (MrOS) Sweden cohort and without ongoing vitamin B medication were included in the present study (n = 790; age range, 70–81 years).

    Results

    During an average follow-up of 5.9 years, 110 men sustained X-ray-verified fractures including 45 men with clinical vertebral fractures. The risk of fracture (adjusted for age, smoking, BMI, BMD, falls, prevalent fracture, tHcy, cystatin C, 25-OH-vitamin D, intake of calcium, and physical activity (fully adjusted)), increased per each standard deviation decrease in cobalamins (hazard ratio (HR), 1.38; 95 % confidence intervals (CI), 1.11–1.72) and holoTC (HR, 1.26; 95 % CI, 1.03–1.54), respectively. Men in the lowest quartile of cobalamins and holoTC (fully adjusted) had an increased risk of all fracture (cobalamins, HR = 1.67 (95 % CI, 1.06–2.62); holoTC, HR = 1.74 (95 % CI, 1.12–2.69)) compared with quartiles 2–4. No associations between folate or tHcy and incident fractures were seen.

    Conclusions

    We present novel data showing that low levels of holoTC and cobalamins predicting incident fracture in elderly men. This association remained after adjustment for BMI, BMD, tHcy, and cystatin C. However, any causal relationship between low cobalamin status and fractures should be explored in a prospective treatment study.

  • 39.
    Marsell, Richard
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Mirza, M. A.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Mallmin, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Karlsson, M.
    Mellström, D.
    Orwoll, E.
    Ohlsson, C.
    Jonsson, Kenneth B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Larsson, T. E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Relation between fibroblast growth factor-23, body weight and bone mineral density in elderly men2009Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 20, nr 7, s. 1167-1173Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We evaluated the relation between serum FGF23 and bone mineral density (BMD) in a community-based cohort of elderly men. There was a weak correlation between FGF23 and BMD, which was primarily dependent on body weight.

    INTRODUCTION: FGF23 is a hormonal factor produced in bone and regulates serum levels of phosphate (Pi) and vitamin D. FGF23 over-expression is associated with skeletal abnormalities, including rickets/osteomalacia. The relation between FGF23 and Bone Mineral Density (BMD) in the community remains unexplored.

    METHODS: We employed a large, population-based cohort of 3014 Swedish men aged 69-80 years, without known renal disease. BMD was measured with dual X-ray absorptiometry (DXA) in the hip and lumbar spine. Serum intact FGF23 was analyzed with a two-site monoclonal ELISA.

    RESULTS: There was a weak but significant correlation between FGF23 and BMD in femoral neck (r = 0.04, p < 0.05), femoral trochanter (r = 0.05, p = 0.004), total hip (r = 0.06, p = 0.0015) and lumbar spine (r = 0.07, p = 0.0004). The correlations remained significant when adjusting for biochemical covariates (Pi, calcium, PTH, 25(OH)D and renal function). However, the association became insignificant in all regions when adjusting for established confounding variables including age, height, weight and smoking. Further analysis confirmed a significant correlation between FGF23 and body weight (r = 0.13, p < 0.0001).

    CONCLUSIONS: The weak correlation between FGF23 and BMD in elderly male subjects is mainly due to an association between FGF23 and body weight. Therefore, FGF23 may not play a significant role in the hormonal regulation of BMD.

  • 40.
    Melhus, Håkan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Risérus, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Warensjö, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Wernroth, Mona-Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Jensevik, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Berglund, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Vessby, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    A high activity index of stearoyl-CoA desaturase is associated with increased risk of fracture in men2008Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 19, nr 7, s. 929-934Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The activity index of stearoyl-CoA desaturase (SCD), a key enzyme in lipogenesis, was associated with increased risk of fracture in a longitudinal population-based cohort of men. This indicates that elevated levels of endogenous lipogenesis increase the risk of fracture and suggest a role for saturated fat in the pathogenesis of osteoporosis. INTRODUCTION: Osteoblasts and marrow adipocytes are derived from a common mesenchymal progenitor, and experimental studies have indicated that increased adipogenesis can occur at the expense of osteoblasts, leading to bone loss. Stearoyl-CoA desaturase (SCD) converts saturated to monounsaturated fatty acids and is a key enzyme in lipogenesis. METHODS: Analysis was performed in a population-based, longitudinal cohort study of men (n = 2009). A product-to-precursor index (palmitoleic acid/palmitic acid) was used to estimate SCD activity in fasting serum analyzed in samples obtained at enrollment at age 50 years. Fractures were documented in 422 men during 35 years of follow-up. Cox regression analysis was used to determine the risk of fracture according to SCD activity index. RESULTS: The risk of fracture was highest among men with the highest levels of SCD activity index. Multivariable analysis of the risk of fracture in the highest quintile as compared to the lowest one showed that the rate ratio was 1.71 (95% CI 1.26-2.33) for any fracture, with an estimated population attributable risk of 15%. The risk was further increased within the highest quintile. CONCLUSIONS: Our results indicate that elevated levels of endogenous lipogenesis increase the risk of fracture and suggest a role for saturated fat in the pathogenesis of osteoporosis.

  • 41.
    Mellstrom, D.
    et al.
    Sahlgrens Acad, Inst Med, Dept Internal Med & Clin Nutr, Geriatr Med, Molndal, Sweden..
    Ohlsson, C.
    Univ Gothenburg, Sahlgrenska Acad, CBAR, Gothenburg, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Lorentzon, M.
    Sahlgrens Acad, Inst Med, Dept Internal Med & Clin Nutr, Geriatr Med, Molndal, Sweden..
    Nilsson, A. G.
    Sahlgrens Acad, Inst Med, Dept Internal Med & Clin Nutr, Geriatr Med, Molndal, Sweden..
    Lewerin, C.
    Sahlgrens Univ Hosp, Sect Hematol & Coagulat, Gothenburg, Sweden..
    Smith, U.
    Inst Med, Gothenburg, Sweden..
    Karlsson, M.
    Lund Univ, Skane Univ Hosp, Dept Orthopaed & Clin Sci, Malmo, Sweden..
    Increased Risk For Incident Hip Fracture In Men With Type 2 Diabetes2017Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 28, s. S529-S530Artikkel i tidsskrift (Annet vitenskapelig)
  • 42.
    Mellström, D. M.
    et al.
    Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Geriatr Med, Gothenburg, Sweden.
    Bokrantz, T. B.
    Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Lorentzon, M. L.
    Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Geriatr Med, Gothenburg, Sweden.
    Karlsson, M. K.
    Lund Univ, Dept Clin Sci Malmo, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden;Skane Univ Hosp, Dept Orthoped, Malmo, Sweden.
    Ljunggren, L.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Manhem, K. M.
    Univ Gothenburg, Inst Med, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Ohlsson, C. O.
    Univ Gothenburg, Inst Med, Dept Med & Clin Nutr, Gothenburg, Sweden.
    Peripheral Arterial Disease Predicts Hip Fracture In Men.MR OS Sweden Study2018Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, s. S243-S244Artikkel i tidsskrift (Annet vitenskapelig)
  • 43.
    Michaëlsson, Karl
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Baron, J.A.
    Johnell, O.
    Persson, I.
    Ljunghall, Sverker
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Variation in the Efficacy of Hormone Replacement Therapy in the Prevention of Hip Fracture1998Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 8, nr 6, s. 540-546Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Use of postmenopausal hormone replacement therapy (HRT) has been associated with a reduced risk of osteoporotic fractures. However, it is uncertain whether this risk reduction is modified by other risk factors for hip fracture. In a population-based case-control study in Sweden, we investigated the association between HRT and hip fracture risk within categories of age, body measures and lifestyle factors in postmenopausal women, 50-81 years of age. Mailed questionnaires and telephone interviews were used to collect data. Of those eligible, 1328 incident cases with hip fracture (82.5%) and 3312 randomly selected controls (81.6%) answered the questionnaire. Ever use of HRT in women less than 75 years old was associated with an odds ratio (OR) of 0.66 (95% confidence interval: 95% CI 0.50-0.87) for hip fracture compared with OR 0.40 (95% CI 0.21-0.77) in women 75 years or older. We found a significant interaction between HRT and both weight and physical activity (p < 0.05). The protective effect of HRT was particularly pronounced in lean women: compared with never HRT users, ever users weighing under 60 kg had an OR of 0.44 (95% CI 0.30-0.66) whereas women weighing more than 70 kg had an OR of 0.91 (95% CI 0.53-1.56). Women with low recent leisure physical activity (less than 1 h/week) similarly benefited more from HRT for hip fracture prevention than women with a higher degree of recreational physical activity. The observed interactions with weight and physical activity suggest that HRT has the best protective effect against hip fracture among high-risk women.

  • 44.
    Michaëlsson, Karl
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Bergström, R.
    Holmberg, Lars
    Mallmin, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Wolk, Alicja
    Ljunghall, Sverker
    A high dietary calcium intake is needed for a positive effect on bone density in Swedish postmenopausal women1997Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 7, nr 2, s. 155-161Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The importance of dietary calcium for bone health is unclear, partly since most investigations have dealt only with a fairly narrow range of calcium intake. In the present population-based observational study with longitudinal dietary assessment, we investigated women with a mean age of 60 years and with a consistently high (range 1417-2417, mean 1645 mg, n = 40), intermediate (800-1200, mean 1006 mg, n = 35) or low (400-550, mean 465 mg, n = 40) estimated daily consumption of calcium. Measurements of bone mineral density (BMD) of the lumbar spine, femoral neck and total body were performed by dual-energy X-ray absorptiometry, as well as ultrasound of the heel. In a multivariate analysis, with adjustment for energy intake the risk factors for osteoporosis (age, body mass index, physical activity, menopausal age, use of estrogens, smoking and former athletic activity), the group with the highest calcium intake had higher values for BMD than the others at all measured sites. The average mean difference compared with the low and the intermediate calcium group was 11% for the femoral neck, 8-11% for the lumbar spine and 5-6% for total body BMDs. In univariate analyses and multivariate models which did not include energy intake, the differences between the groups were less pronounced. The women in the intermediate calcium group had approximately the same mean BMD values as those in the low calcium group. These findings support the view that only a high calcium intake (3% highest percentiles in the studied population) protects against osteoporosis in Swedish postmenopausal women.

  • 45.
    Michaëlsson, Karl
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Bergström, R.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Statistiska institutionen.
    Mallmin, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Wolk, Alicja
    Ljunghall, Sverker
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Screening for osteopenia and osteoporosis: selection by body composition1996Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 6, nr 2, s. 120-126Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There is a great need for simple means of identifying persons at low risk of developing osteoporosis, in order to exclude them from screening with bone mineral measurements, since this procedure is too expensive and time-consuming for general use in the unselected population. We have determined the relationships between body measure (weight, height, body mass index, lean tissue mass, fat mass, waist-to-hip ratio) and bone mineral density (BMD) in 175 women of ages 28-74 years in a cross-sectional study in a county in central Sweden. Dual-energy X-ray absorptiometry was performed at three sites: total body, L2-4 region of lumbar spine, and neck region of the proximal femur. Using multiple linear regression models, the relationship between the dependent variable, BMD, and each of the body measures was determined, with adjustment for confounding factors. Weight alone, in a multivariate model, explained 28%, 21% and 15% of the variance in BMD of total body, at the lumbar spine and at the femoral neck according to these models. The WHO definition of osteopenia was used to dichotomize BMD, which made it possible, in multivariate logistic regression models, to estimate the risk of osteopenia with different body measures categorized into tertiles. Weight of over 71 kg was associated with a very low risk of being osteopenic compared with women weighing less than 64 kg, with odds ratios (OR) of 0.01 (95% confidence interval (CI) 0.00-0.09), 0.06 (CI 0.02-0.22) and 0.13 (CI 0.04-0.42) for osteopenia of total body, lumbar spine and femoral neck, respectively. Furthermore a sensitivity/specificity analysis revealed that, in this population, a woman weighing over 70 kg is not likely to have osteoporosis. Test specifics of a weight under 70 kg for osteoporosis (BMD less than 2.5 SD compared with normal young women) of femoral neck among the postmenopausal women showed a sensitivity of 0.94, a specificity of 0.36, positive predictive value (PPV) of 0.21, and negative predictive value (NPV) of 0.97. Thus, exclusion of the 33% of women with the highest weight meant only that 3% of osteoporotic cases were missed. The corresponding figures for lumbar spine were sensitivity 0.89, specificity 0.38, PPV 0.33, and NPV 0.91. All women who were defined as being osteoporotic of total body weighed under 62 kg. When the intention was to identify those with osteopenia of total body among the postmenopausal women we attained a sensitivity of 0.92 and a NPV of 0.91 for a weight under 70 kg, whereas we found that weight could not be used as an exclusion criterion for osteopenia of femoral neck and lumbar spine. Our data thus indicate that weight could be used to exclude women from a screening program for postmenopausal osteoporosis.

  • 46.
    Michaëlsson, Karl
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Interpretation of milk research results2018Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, nr 3, s. 773-775Artikkel i tidsskrift (Annet vitenskapelig)
  • 47.
    Michaëlsson, Karl
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Schilcher, J
    Aspenberg, P
    Comment on Compston: pathophysiology of atypical femoral fractures and osteonecrosis of the jaw2012Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 23, nr 12, s. 2901-2902Artikkel i tidsskrift (Fagfellevurdert)
  • 48.
    Michaëlsson, Karl
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Weiderpass, E.
    Farahmand, Bahman Y.
    Baron, John A.
    Persson, P-G
    Ziden, L.
    Zetterberg, C.
    Ljunghall, Sverker
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Differences in Risk Factor Patterns Between Cervical and Trochanteric Hip Fractures1999Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 10, nr 6, s. 487-494Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The two types of hip fracture--cervical and trochanteric femoral fractures--are generally considered together in etiologic studies. However, women with a trochanteric fracture may be more osteoporotic than those with cervical hip fractures, and have higher post-fracture mortality. To explore differences in risk factor patterns between the two types of hip fracture we used data from a large population-based case-control study in Swedish women, 50-81 years of age. Data were collected by questionnaire, to which more than 80% of subjects responded. Of the cases included, 811 had had a cervical fracture and 483 a trochanteric fracture during the study period; these cases were compared with 3312 randomly selected controls. Height and hormonal factors appeared to affect the risk of the two types of hip fracture differently. For every 5 cm of current height, women with a cervical fracture had an adjusted odds ratio (OR) of 1.23 (95% CI 1.15-1.32) compared with an OR of 1.06 (95% CI 0.97-1.15) for women with trochanteric fractures. Later menopausal age was protective for trochanteric fractures (OR 0.95, 95% CI 0. 91-0.99 per 2 years) but no such association was found for cervical fractures. Compared with never smokers, current smokers had an OR of 1.48 (95% CI 1.12-1.95) for trochanteric fractures and 1.22 (95% CI 0.98-1.52) for cervical fractures. Current hormone replacement therapy was similarly protective for both fracture types, but former use substantially reduced risk only for trochanteric fractures: OR 0. 55 (95% CI 0.33-0.92) compared with 1.00 (95% CI 0.71-1.39) for cervical fractures. These risk factor patterns suggest etiologic differences between the fracture types which have to be considered when planning preventive interventions.

  • 49. Nilsson, M.
    et al.
    Ohlsson, C.
    Eriksson, A. L.
    Frandin, K.
    Karlsson, M.
    Ljunggren, O.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Mellstrom, D.
    Lorentzon, M.
    Competitive physical activity early in life is associated with bone mineral density in elderly Swedish men2008Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 19, nr 11, s. 1557-1566Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In this population-based study of 75-year-old men (n = 498), we investigated the association between physical activity (PA) early in life and present bone mineral density (BMD). We demonstrate that a high frequency of competitive sports early in life is associated with BMD at several bone sites, indicating that increases in BMD following PA are preserved longer than previously believed. Introduction Physical activity (PA) increases bone mineral density (BMD) during growth. It is unclear if the positive effects remain at old age. In this study, we aimed to determine if PA early in life was associated with BMD in elderly men. Methods In this population-based study, 498 men, 75.2 +/- .3 (mean +/- SD) years old, were included. BMD was assessed using DXA. Data concerning lifetime PA, including both competitive (CS) and recreational sports (RS), and occupational physical load (OPL), were collected at interview. Results Subjects in the highest frequency group of CS in the early period (10-35 years), had higher BMD at the total body (4.2%, p < 0.01), total hip (7.0%, p < 0.01), trochanter (8.7%, p < 0.01), and lumbar spine (7.9%, p < 0.01), than subjects not involved in CS. A stepwise linear regression model showed that frequency of CS in the early period independently positively predicted present BMD at the total body (beta=0.12, p < 0.01), total hip (beta=0.11, p < 0.01), trochanter (beta=0.12, p < 0.01), and lumbar spine (beta=0.11, p=0.01). Conclusions We demonstrate that PA in CS early in life is associated with BMD in 75-year-old Swedish men, indicating that increases in BMD following PA are preserved longer than previously believed.

  • 50.
    Sennerby, Ulf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Farahmand, B.
    Ahlbom, A.
    Ljunghall, Sverker
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniskt forskningscentrum (UCR).
    Cardiovascular diseases and future risk of hip fracture in women2007Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 18, nr 10, s. 1355-1362Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    SUMMARY: We used a population-based case-control study in women and linkage to the Swedish in-patient register to examine if there is an increased risk of hip fracture after a cardiovascular disease. There was a substantially increased risk of hip fracture after a diagnosis of a cardiovascular disease. INTRODUCTION: Recent data have indicated that cardiovascular diseases (CVDs) might have a relationship to osteoporosis, which may explain the increased risk of mortality after hip fracture. It is uncertain, however, whether there is an increased risk of fracture after any cardiovascular disease and in subgroups of CVDs. The objective of this study was to determine whether there are associations between CVD and future hip fracture risk. Knowledge of the risk pattern would lead to better understanding of common pathologic pathways of osteoporosis and CVD. METHODS: We conducted a population-based case-control study of 1,327 incident hip fracture cases and 3,170 randomly selected population controls among women 50-81 years old in Sweden. Information on cardiovascular and other diseases before the fracture was obtained by linkage to the Swedish National Inpatient Register. Odds ratios (OR) and 95% confidence intervals (CI) where calculated by unconditional logistic regression. RESULTS: Before study entry, CVDs were diagnosed more than twice as commonly among fracture cases (25%) as among controls (12%). Also, after adjustment for variables including several chronic diseases, we found a doubled risk of hip fracture after a CVD event (OR 2.38; 95% CI 1.92-2.94). There was a gradient increase in risk of hip fracture with increasing number of hospitalizations for CVD and highest fracture risk occurred the first year after the CVD event. Hypertension, heart failure, and cerebrovascular lesions remained independent risk factors, with 2- to 3-fold increases in odds ratios, even after mutual adjustments for other CVDs. CONCLUSION: There was a substantially increased risk of hip fracture in women after a diagnosis of a CVD, a finding compatible with the concept of common pathologic pathways for osteoporotic fractures and CVD.

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