| 1. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Secular trends in cardiovascular risk factors with a 36-year perspective: observations from 38- and 50-year-olds in the Population Study of women in Gothenburg
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 26:3, s. 140-6
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Tidskriftsartikel (refereegranskat)abstract
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Sweden. cecilia.bjorkelund@allmed.gu.se OBJECTIVES: To study secular trends in cardiovascular risk factors in four different cohorts of women examined in 1968-1969, 1980-1981, 1992-1993 and 2004-2005. DESIGN: Comparison of four representative cohorts of 38- and 50-year-old women over a period of 36 years. SETTING: Gothenburg, Sweden with approximately 450,000 inhabitants. SUBJECTS: Four representative samples of 38- and 50-year-old women were invited to free health examinations (participation rate 59-90%, n =1901). MAIN OUTCOME MEASURES: Body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), leisure time exercise, use of antihypertensive medication, smoking, levels of haemoglobin, b-glucose, s-cholesterol, s-triglycerides and HDL-cholesterol. RESULTS: There was no significant difference in mean BMI from 1968-1969 versus 2004-2005. Mean leisure time exercise was significantly higher in later born cohorts; in 1968, around 15% were physically active compared with 40% in 2004. SBP and DBP, mean s-cholesterol and s-triglyceride levels were significantly lower in both 38- and 50-year-old cohorts in 2004-2005 versus 1968-1969. HDL-cholesterol (not measured until 1992-1993), showed a significantly higher mean level in 2004-2005. Reduction of risk factors was apparent in women with a high as well as low level of physical activity. Smoking declined most in women with high levels of physical activity. CONCLUSIONS: Several cardiovascular risk factors related to lifestyle have improved in middle-aged women from the 1960s until today. Most of the positive trends are observed in women with both low and high physical activity.
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| 2. |
- Blomstrand, Ann, et al.
(författare)
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Forty-four-year longitudinal study of stroke incidence and risk factors - the Prospective Population Study of Women in Gothenburg
- 2022
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 40:1, s. 139-147
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess stroke incidence over 44 years and association with risk factors. To study total stroke incidence at 60-82 years of age and risk factors. Design Prospective population study. Setting Gothenburg, Sweden, with similar to 450,000 inhabitants. Subjects A representative sample of a general population of women (1462 in total) in 5 age strata aged 38-60 years in 1968-1969 (the Population Study of Women in Gothenburg, PSWG) were followed up to the ages of 82-104 years in 2012. Further, analysis was also performed for the age interval 60-82 years. Main outcome measures Incidence of total stroke (TS), ischaemic (IS), haemorrhagic (HS), non-specified (NS) and fatal (FS) strokes and association with baseline classic risk factors (such as hypertension, atrial fibrillation, low physical activity, diabetes, high waist-hip-ratio, hyperlipidaemia, smoking), low education, mental stress, pre-eclampsia and oral health as expressed by loss of teeth and bone score. Blood pressure in levels 1-3 according to modern guidelines. Associations with atrial fibrillation, diabetes and myocardial infarction shown in survival analyses. The five cohorts contributed to risk time data concerning associations with TS in the 60-82 age interval from the examination performed when they were 60. Results Three hundred and thirty-seven (23%) women had a first-ever stroke, 64 (19%) fatal. TS was associated with physical inactivity, high triglycerides and low education in multivariable analysis. The main sub-type IS was associated with systolic blood pressure, physical inactivity and low education. Pre-eclampsia showed association with IS only in the univariable analysis. FS was associated with systolic blood pressure and smoking. During 60-82 years of age, having <20 teeth (HR 1.74, CI 1.25-2.42), diabetes (HR 2.28 CI 1.09-4.76), WHR (HR 1.29 per 0.1 units CI 1.01-1.63), systolic blood pressure (HR 1.11 per 10 units CI 1.04-1.18) and smoking (HR 1.57, CI 1.14-2.16), were associated with TS in the combined five cohorts. Conclusions Several classic risk factors showed independent associations with stroke. Vulnerability factors as low education and oral health, reflected by loss of teeth, also showed association with stroke. All these factors are possible to target in primary care preventive interventions.
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| 3. |
- Jonasson, Grethe, 1945, et al.
(författare)
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A prospective study of mandibular trabecular bone to predict fracture incidence in women: A low-cost screening tool in the dental clinic
- 2011
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Ingår i: Bone. - : Elsevier BV. - 8756-3282. ; 49:4, s. 873-879
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Tidskriftsartikel (refereegranskat)abstract
- Bone structure is the key to the understanding of fracture risk. The hypothesis tested in this prospective study is that dense mandibular trabeculation predicts low fracture risk, whereas sparse trabeculation is predictive of high fracture risk. Out of 731 women from the Prospective Population Study of Women in Gothenburg with dental examinations at baseline 1968, 222 had their first fracture in the follow-up period until 2006. Mandibular trabeculation was defined as dense, mixed dense plus sparse, and sparse based on panoramic radiographs from 1968 and/or 1980. Time to fracture was ascertained and used as the dependent variable in three Cox proportional hazards regression analyses. The first analysis covered 12 years of follow-up with self-reported endpoints; the second covered 26 years of follow-up with hospital verified endpoints; and the third combined the two follow-up periods, totaling 38 years. Mandibular trabeculation was the main independent variable predicting incident fractures, with age, physical activity, alcohol consumption and body mass index as covariates. The Kaplan–Meier curve indicated a graded association between trabecular density and fracture risk. During the whole period covered, the hazard ratio of future fracture for sparse trabeculation compared to mixed trabeculation was 2.9 (95% CI: 2.2–3.8, p < 0.0001), and for dense versus mixed trabeculation was 0.21 (95% CI: 0.1–0.4, p < 0.0001). The trabecular pattern was a highly significant predictor of future fracture risk. Our findings imply that dentists, using ordinary dental radiographs, can identify women at high risk for future fractures at 38–54 years of age, often long before the first fracture occurs.
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| 4. |
- Jonasson, Grethe, 1945, et al.
(författare)
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Evaluation of clinical and radiographic indices as predictors of osteoporotic fractures: a 10-year longitudinal study.
- 2018
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier BV. - 2212-4411 .- 2212-4403. ; 125:5, s. 487-494
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to evaluate 2 radiographic and 3 clinical indices as predictors of future osteoporotic fractures.In a prospective, longitudinal study with a 10-year fracture follow-up, the 2 radiographic indices mandibular cortical erosion (normal, mild/moderate erosion, and severe erosion of the inferior cortex) and cortex thickness were assessed using panoramic radiographs of 411 women, age 62 to 78 years. The clinical indices were the fracture assessment tool FRAX, the osteoporosis index of risk (OSIRIS), and the osteoporosis self-assessment tool (OST).The relative risks (RRs) for future fracture were significant for FRAX greater than 15%, 4.1 (95% confidence interval [CI] 2.4-7.2), and for severely eroded cortices, 1.7 (95% CI 1.1-2.8). Cortical thickness less than 3 mm, OSIRIS, and OST were not significant fracture predictors (RR 1.1, 1.4, and 1.5, respectively). For the 5 tested fracture predictors, Fisher's exact test gave the following P values for differences between fracture and nonfracture groups: FRAX <.001, cortical erosion 0.023, OST 0.078, OSIRIS 0.206, and cortical thickness 0.678. The area under the curve was 0.69 for FRAX less than 15%, 0.58 for cortical erosion, and 0.52 for cortical thickness. Adding OSIRIS and OST did not change the area under the curve significantly.FRAX and severely eroded cortices predicted fracture but cortical thickness, OSIRIS, and OST did not.
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| 5. |
- Jonasson, Grethe, 1945, et al.
(författare)
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Mandibular bone changes in 24 years and skeletal fracture prediction.
- 2013
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Ingår i: Clinical Oral Investigations. - : Springer Science and Business Media LLC. - 1432-6981 .- 1436-3771. ; 17:2, s. 565-572
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The objectives of the investigation were to describe changes in mandibular bone structure with aging and to compare the usefulness of cortical and trabecular bone for fracture prediction. MATERIALS AND METHODS: From 1968 to 1993, 1,003 women were examined. With the help of panoramic radiographs, cortex thickness was measured and cortex was categorized as: normal, moderately, or severely eroded. The trabeculation was assessed as sparse, mixed, or dense. RESULTS: Visually, the mandibular compact and trabecular bone transformed gradually during the 24 years. The compact bone became more porous, the intertrabecular spaces increased, and the radiographic image of the trabeculae seemed less mineralized. Cortex thickness increased up to the age of 50 and decreased significantly thereafter. At all examinations, the sparse trabeculation group had more fractures (71-78 %) than the non-sparse group (27-31 %), whereas the severely eroded compact group showed more fractures than the less eroded groups only in 1992/1993, 24 years later. Sparse trabecular pattern was associated with future fractures both in perimenopausal and older women (relative risk (RR), 1.47-4.37) and cortical erosion in older women (RR, 1.35-1.55). RR for future fracture associated with a severely eroded cortex increased to 4.98 for cohort 1930 in 1992/1993. RR for future fracture associated with sparse trabeculation increased to 11.43 for cohort 1922 in 1992/1993. CONCLUSION: Dental radiographs contain enough information to identify women most at risk of future fracture. CLINICAL RELEVANCE: When observing sparse mandibular trabeculation, dentists can identify 40-69 % of women at risk for future fractures, depending on participant age at examination.
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| 6. |
- Sundh, Valter, 1950, et al.
(författare)
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FRAX and mandibular sparse trabeculation as fracture predictors: a longitudinal study from 1980 to 2002.
- 2017
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Ingår i: European journal of oral sciences. - : Wiley. - 1600-0722 .- 0909-8836. ; 125:2, s. 135-140
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Tidskriftsartikel (refereegranskat)abstract
- The fracture assessment tool (FRAX) is widely used for predicting fractures, but better methods are needed. The aim of this study was to determine whether visual assessments of mandibular trabecular bone could improve FRAX predictions. Three age-cohorts of women were examined twice - 499 women in 1980/1981 and 412 women in 1992/1993; 397 participated in both examinations. Information on 10-yr fracture events was available, and bone trabeculation was assessed in radiographs as 'dense', 'mixed', or 'sparse'. Fracture assessment tool values, without bone mineral density (BMD), were calculated twice. Both sparse trabeculation and FRAX >15% were associated with a twofold higher risk for future fracture in the younger group and with a three- to fourfold higher risk for future fracture in the older group. For those with both FRAX >15% and sparse trabeculation, the relative risk (RR) for a fracture in the next 10 yr was 5.9 (95% CI: 3.5-9.8) in the younger group and 22.7 (95% CI: 5.6-92) in the older group. If either FRAX >15% or sparse trabeculation was present, the RR was 2.6 (95% CI: 1.7-4.1) in the younger group and 15.7 (95% CI: 3.9-6.4) in the older group. We concluded that FRAX >15%, without BMD measurements, was an effective fracture predictor, and mandibular sparse trabeculation had a substantial additive effect. Together, FRAX plus mandibular sparse trabeculation predicts major osteoporotic fractures to approximately the same extent as does FRAX with BMD measurements.
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