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| 2. |
- Michaëlsson, Karl, et al.
(författare)
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Impact of hip fracture on mortality : a cohort study in hip fracture discordant identical twins
- 2014
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Ingår i: Journal of Bone and Mineral Research. - : Wiley-Blackwell. - 0884-0431 .- 1523-4681. ; 29:2, s. 424-431
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Tidskriftsartikel (refereegranskat)abstract
- Several studies have shown a long-lasting higher mortality after hip fracture but the reasons of the excess risk is not well understood. We aimed to determine whether there exists a higher mortality after hip fracture when controlling for genetic constitution, shared environment, comorbidity and lifestyle by use of a nation-wide cohort study in hip fracture discordant monozygotic twins. All 286 identical Swedish twin pairs discordant for hip fracture (1972-2010) were identified. Comorbidity and lifestyle information was retrieved by registers and questionnaire information. We used intrapair Cox regression to compute multivariable-adjusted hazard ratios (HRs) for death. During follow-up, 143 twins with a hip fracture died (50%) compared to 101 twins (35%) without a hip fracture. Through the first year after hip fracture, the rate of death increased four-fold in women (HR 3.71; 95% confidence interval (CI) 1.32-10.40) and seven-fold in men (HR 6.67; 95% CI 1.47-30.13). The increased rate in women only persisted during the first year after hip fracture (HR after 1 year 0.99; 95% CI 0.66-1.50), whereas the corresponding HR in men was 2.58 (95% CI 1.02-6.62). The higher risk in men after the hip fracture event was successively attenuated during follow-up. After 5 years, the hazard ratio in men with a hip fracture was 1.19 (95% CI 0.29-4.90). On average, the hip fracture contributed to 0.9 years of life lost in women (95% CI 0.06-1.7) and 2.7 years in men (95% CI 1.7-3.7). The potential years of life lost associated with the hip fracture was especially pronounced in older men (>75 years), with an average loss of 47% (95% CI 31-61) of the expected remaining lifetime. We conclude that both women and men display a higher mortality after hip fracture independent of genes, comorbidity and lifestyle.
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| 3. |
- Nordström, Anna, et al.
(författare)
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Bone loss and fracture risk after reduced physical activity.
- 2005
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Ingår i: Journal of Bone and Mineral Research. - 0884-0431 .- 1523-4681. ; 20:2, s. 202-207
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Tidskriftsartikel (refereegranskat)abstract
- Former male young athletes partially lost benefits in BMD (g/cm2) with cessation of exercise, but, despite this, had a higher BMD 4 years after cessation of career than a control group. A higher BMD might contribute to the lower incidence of fragility fractures found in former older athletes > or =60 years of age compared with a control group. INTRODUCTION: Physical activity increases peak bone mass and may prevent osteoporosis if a residual high BMD is retained into old age. MATERIALS AND METHODS: BMD was measured by DXA in 97 male young athletes 21.0 +/- 4.5 years of age (SD) and 48 controls 22.4 +/- 6.3 years of age, with measurements repeated 5 years later, when 55 of the athletes had retired from sports. In a second, older cohort, fracture incidence was recorded in 400 former older athletes and 800 controls > or =60 years of age. RESULTS: At baseline, the young athletes had higher BMD than controls in total body (mean difference, 0.08 g/cm2), spine (mean difference, 0.10 g/cm2), femoral neck (mean difference, 0.13 g/cm2), and arms (mean difference, 0.05 g/cm2; all p < 0.001). During the follow-up period, the young athletes who retired lost more BMD than the still active athletes at the femoral neck (mean difference, 0.07 g/cm2; p = 0.001) and gained less BMD at the total body (mean difference, 0.03 g/cm2; p = 0.004). Nevertheless, BMD was still higher in the retired young athletes (mean difference, 0.06-0.08 g/cm2) than in the controls in the total body, femoral neck, and arms (all p < 0.05). In the older cohort, there were fewer former athletes > or =60 of age than controls with fragility fractures (2.0% versus 4.2%; p < 0.05) and distal radius fractures (0.75% versus 2.5%; p < 0.05). CONCLUSIONS: Although exercise-induced BMD benefits are reduced after retirement from sports, former male older athletes have fewer fractures than matched controls.
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| 4. |
- Nordström, Anna, et al.
(författare)
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Rapid loss of bone mineral density of the femoral neck after cessation of ice hockey training: a 6-year longitudinal study in males.
- 2003
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Ingår i: Journal of Bone and Mineral Research. - : Wiley. - 0884-0431 .- 1523-4681. ; 18:11, s. 1964-1969
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the effect of training and reduced training on BMD in young ice hockey players during 6 years of follow-up. We found BMD gains in the femoral neck in the ice hockey group compared with controls. However, these gains were lost with reduced activity after cessation of career. INTRODUCTION: It has been suggested that increasing bone mass by intense physical activity during childhood and adolescence may decrease the risk of osteoporosis later in life. MATERIALS AND METHODS: In this longitudinal study, 43 ice hockey players (16.7 +/- 0.6 years) and 25 control subjects (16.8 +/- 0.3 years) were studied at baseline and after a mean period of 30 and 70 months. The groups did not differ in weight or height. Bone mineral density (BMD; g/cm2) was measured for total body, femoral neck, and spine using DXA. Volumetric BMD (vBMD; mg/cm3) of the femoral neck was estimated. RESULTS: The ice hockey players were found to have gained significantly more femoral neck BMD than controls (0.07 versus 0.03 g/cm2, p = 0.04) and to have gained femoral neck vBMD, whereas the controls did not (16 versus 0 mg/cm3, p = 0.049) between baseline and the first follow-up. At the first follow-up, the ice hockey players were found to have significantly higher BMD at the femoral neck and total body versus controls (p < 0.05). Between the first and second follow-ups, 21 ice hockey players stopped their active sports career. During this time period, these subjects lost significantly more femoral neck BMD (0.10 versus 0.02 g/cm2, p < 0.001) and femoral neck vBMD (38 versus 4 mg/cm3, p < 0.001) compared with the 22 ice hockey players who continued training. The former ice hockey players also lost significantly more neck vBMD (38 versus 14 mg/cm3, p = 0.009) compared with the controls during the same period. At the second follow-up, only the 22 ice hockey players who had continued their training were found to have significantly higher BMD at the femoral neck (p = 0.01), total body (p = 0.04), and spine (p = 0.02) compared with the controls. The former athletes were found to have intermediate BMD at all sites. CONCLUSION: In summary, we have demonstrated fast BMD loss at the femoral neck after decreased physical activity in young men. We conclude that ice hockey training during childhood and adolescence may not prevent the development of osteoporosis of the femoral neck later in life if the activity is not maintained.
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| 5. |
- Nordström, Peter, et al.
(författare)
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Bone Specific Drugs and Osteonecrosis of Sites Other than the Jaw : A Nationwide Cohort Study
- 2020
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Ingår i: Journal of Bone and Mineral Research. - : John Wiley & Sons. - 0884-0431 .- 1523-4681. ; 35:9, s. 1703-1710
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Tidskriftsartikel (refereegranskat)abstract
- Bone specific drugs (BSDs) increase the risk of osteonecrosis of the jaw, but whether they increase the risk of osteonecrosis at other sites is not known. Two studies, a cohort study and a case-control study, were conducted using registry data on everyone who was residing in Sweden on December 31, 2005, and who was 50 years of age or older at the time (N = 3,523,912). In the cohort study, individuals prescribed a BSD during 2006-2017 (n = 217 387) were 1:1 matched with nonusers on birth year, sex, hip fracture status and Swedish or foreign origin. In the case-control study, individuals diagnosed with osteonecrosis during 2006-2017 (n = 12 614) were 1:1 matched with individuals without a diagnosis of osteonecrosis on birth year, sex, and Swedish or foreign background. In the cohort study, osteonecrosis was diagnosed in 983 BSD users and 214 nonusers (adjusted hazard ratio [aHR], 4.02; 95% CI, 3.32-4.87), during a mean treatment time of 2.8 years. A similar association was observed in a subcohort where all indivuals diagnosed with cancer (HR, 4.82, 95% CI, 2.52-9.22). The greatest difference in incidence between BSD users and nonusers was observed in patients with a femoral neck fracture that was not treated with total hip arthroplasty or hemiarthroplasty (Incidence rate difference, 77.8 cases per 10,000 person-years, p < 0.05). The risk of osteonecrosis was higher in users of denosumab (HR, 1.93; 95% CI, 1.33-2.79) and users of zoledronic acid (HR, 1.95; 95% CI, 1.31-2.91) than in users of other BSDs. The increased risk of osteonecrosis decreased after the end of therapy (p < 0.001 for time trend). The results were confirmed in the case-control study. In summary, use of BSDs, especially more potent BSDs, is associated with increased risk of osteonecrosis of sites other than the jaw. This increased risk decreases after the final dose of BSD.
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| 6. |
- Nordström, Peter, et al.
(författare)
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Cognitive Function in Young Men and the Later Risk of Fractures
- 2012
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Ingår i: Journal of Bone and Mineral Research. - : Wiley. - 1523-4681 .- 0884-0431. ; 27:11, s. 2291-2297
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Tidskriftsartikel (refereegranskat)abstract
- Dementia has been associated with an increased risk of fractures. These associations may be explained by an impaired cognitive function, as well as comorbid illness and toxic reaction from drugs. To investigate whether cognitive function in young, healthy individuals already affects the risk of fractures, overall cognitive function scores were calculated from four cognitive tests accomplished during a national conscriptions test in 960,956 men with a mean age of 18 years. Incident fractures were searched in national registers. During a median follow-up of 30 years (range 0 to 41 years), 65,313 men had one fracture and 2589 men had a hip fracture. Compared with men with no fracture, overall cognitive function at baseline was 3.5% lower for men sustaining one fracture and 5.5% lower for men sustaining a hip fracture (p<0.001 for both). When comparing the lowest and the highest decile, low overall cognitive function scores increased the risk one fracture (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.50-1.61) and a hip fracture (HR 2.12, 95% CI 1.77-2.55), after adjustment for confounders. A higher education (university level versus elementary school) was associated with a decreased risk of a fracture (HR 0.67, 95% CI 0.65-0.69) and a hip fracture (HR 0.51, 95% CI 0.45-0.57). The effects of education and cognitive function were reduced when also adjusting for total income and disability pension. In summary, low cognitive function and education in young men were associated with the later risk of especially hip fractures. These associations may partly be mediated by socioeconomic factors. (C) 2012 American Society for Bone and Mineral Research.
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| 7. |
- Nordström, Peter, et al.
(författare)
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High physical fitness in young adulthood reduces the risk of fractures later in life in men : a nationwide cohort study
- 2013
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Ingår i: Journal of Bone and Mineral Research. - : Wiley-Blackwell. - 0884-0431 .- 1523-4681. ; 28:5, s. 1061-1067
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Tidskriftsartikel (refereegranskat)abstract
- A few studies indicate that self reported physical activity is associated with the risk of fractures in middle-aged and elderly men. We investigated whether objectively measured physical fitness in young adulthood was associated with the risk of low-energy fractures later in life in men. Aerobic capacity and isometric muscle strength were measured in 435445 Swedish men that conscripted for military service from 1969-1978. Incident fractures were searched in national registers. During a median follow-up period of 35 years (range, 11-41 years), 8 030 subjects sustained at least one fracture, increasing the risk of death 1.8 times (95% CI = 1.6-2.0) during follow up. When comparing men in the lowest and highest decile of physical fitness, the risk of a fracture was 1.8 times higher (95% CI = 1.6-2.1) and that of hip fracture was 2.7 times higher (95% CI = 1.6-4.7). The risk of fracture was also 1.4-1.5 times higher when comparing the extreme deciles of muscle strength (p < 0.001 for all). In a subcohort of 1009 twin pairs, up to 22% of the variation in physical fitness and 27-39% of the variation in muscle strength was attributable to environmental factors unique to one twin, e.g. physical activity. In conclusion, low aerobic capacity and muscle strength in young adulthood are associated with an increased risk of low-energy fractures later in life, while a low-energy fracture is associated with an increased risk of death already in middle-aged men.
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| 8. |
- Nordström, Peter, et al.
(författare)
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Type of physical activity, muscle strength, and pubertal stage as determinants of bone mineral density and bone area in adolescent boys.
- 1998
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Ingår i: Journal of Bone and Mineral Research. - : Wiley. - 0884-0431 .- 1523-4681. ; 13:7, s. 1141-8
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Tidskriftsartikel (refereegranskat)abstract
- The present study was conducted to evaluate the influence of different types of weight-bearing physical activity, muscle strength, and puberty on bone mineral density (BMD, g/cm2) and bone area in adolescent boys. Three different groups were investigated. The first group consisted of 12 adolescent badminton players (age 17.0 +/- 0.8 years) training for 5.2 +/- 1.9 h/week. The second group consisted of 28 ice hockey players (age 16.9 +/- 0.3 years) training for 8.5 +/- 2.2 h/week. The third group consisted of 24 controls (age 16.8 +/- 0.3 years) training for 1.4 +/- 1.4h/week. The groups were matched for age, height, and pubertal stage. BMD, bone mineral content (BMC, g), and the bone area of the total body, lumbar spine, hip, femur and tibia diaphyses, distal femur, proximal tibia, and humerus were measured using dual-energy X-absorptiometry. When adjusting for the difference in body weight between the groups, the badminton players were found to have significantly higher BMD (p < 0.05) of the trochanter and distal femur compared with the ice hockey players despite a significantly lower weekly average training. The badminton players had higher BMD compared with the control with the control group at all weight-bearing BMD sites, except at the diaphyses of the femur and tibia and lumbar spine. The independent predictors of bone density were estimated by adjusting BMC for the bone area in a multivariate analysis among all subjects (n = 64). Accordingly, the bone density of all sites except the spine was significantly related to muscle strength and height, and the bone density of the total body, neck, trochanter, distal femur, and proximal tibia was significantly related to type of physical activity (beta = 0.09-0.33, p < 0.05). The bone area values at different sites were strongly related to muscle strength and height and less strongly related to the type of physical activity and pubertal stage. In conclusion, it seems that during late puberty in adolescent boys the type of weight-bearing physical activity is an important determinant of bone density, while the bone area is largely determined by parameters related to body size. The higher BMD at weight-bearing sites in badminton players compared with ice hockey players, despite significantly less average weekly training, indicates that physical activity including jumps in unusual directions has a great osteogenic potential.
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