Grip strength in men and women aged 50-79 years is associated with non-vertebral osteoporotic fracture during 15 years follow-up: The Tromsø Study 1994-1995.

In 50-79-year-olds who participated in the Tromsø Study (1994-1995), the risk of non-vertebral osteoporotic fractures during 15 years follow-up increased by 22% in men and 9% in women per 1 SD lower grip strength. The strongest association was observed in men aged 50-64 years. INTRODUCTION: We aimed to explore whether low grip strength was associated with increased risk of non-vertebral osteoporotic fracture in the population-based Tromsø Study 1994-1995. METHODS: Grip strength (bar) was measured by a Martin Vigorimeter and fractures were retrieved from the X-ray archives at the University Hospital of North Norway between 1994 and 2010. At baseline, weight and height were measured, whereas information on the other covariates were obtained through self-reported questionnaires. Cox regression was used to estimate the hazard ratio (HR) of fracture in age- and gender-specific quintiles of grip-strength, and per 1 SD lower grip strength. Similar analyses were done solely for hip fractures. Adjustments were made for age, height, body mass index (BMI), marital status, education, smoking, physical activity, use of alcohol, self-perceived health, and self-reported diseases. RESULTS: In 2891 men and 4002 women aged 50-79 years, 1099 non-vertebral osteoporotic fractures-including 393 hip fractures-were sustained during the median 15 years follow-up. Risk of non-vertebral osteoporotic fracture increased with declining grip strength: hazard ratios per SD decline was 1.22 (95% CI 1.05-1.43) in men and 1.09 (95% CI 1.01-1.18) in women. HR for fracture in lower vs. upper quintile was 1.58 (95% CI 1.02-2.45) in men and 1.28 (95% CI 1.03-1.59) in women. The association was most pronounced in men aged 50-64 years with HR = 3.39 (95% CI 1.76-6.53) in the lower compared to the upper quintile. CONCLUSIONS: The risk of non-vertebral osteoporotic fracture increased with declining grip-strength in both genders, particularly in men aged 50-64 years.

Excess mortality following hip fracture: impact of self-perceived health, smoking, and body mass index. A NOREPOS study.

Self-perceived health, smoking, and body mass index measured years before the hip fracture predicted excess post-hip fracture mortality, and even hip fracture patients with the most favorable levels of these risk factors had higher mortality than subjects who did not fracture. INTRODUCTION: This study aimed to investigate the impact of pre-fracture self-perceived health, smoking, and body mass index (BMI) on excess post-hip fracture mortality using matched peers without hip fracture as reference. METHODS: The study was based on the Cohort of Norway (CONOR) consisting of 10 regional health studies (1994-2003) and the NOREPOS hip fracture database (1994-2008). A matched cohort design was used to compare survival between hip fracture patients and subjects without fracture (matched on gender, age at participation in CONOR, and study site). Subjects aged ≥60 years were included. Hazard ratios were estimated using stratified Cox regression. Age-standardized mortality was also calculated. RESULTS: Overall, hip fracture patients (N = 3177) had a 2.26-fold (95 % CI 2.13, 2.40) increased mortality compared to matched subjects (N = 20,282). The highest excess mortality was found in hip fracture patients reporting poor health (HR 4.08, 95 % CI 3.17, 5.26) and daily smoking (HR 3.25, 95 % CI 2.89, 3.66) and in patients with BMI <18.5 (HR 3.07, 95 % CI 2.11, 4.47) prior to the fracture. However, excess mortality was also observed in hip fracture patients in all other categories of BMI, self-perceived health, and smoking. CONCLUSIONS: Information on self-perceived health, smoking, and BMI collected years before hip fracture predicted excess post-hip fracture mortality, and even hip fracture patients with the most favorable levels of these risk factors had higher mortality than the matched subjects who did not fracture. This suggests that both pre-fracture health status and factors related to the hip fracture itself might affect post-hip fracture mortality.

A combination of low serum concentrations of vitamins K1 and D is associated with increased risk of hip fractures in elderly Norwegians: a NOREPOS study.

UNLABELLED: The present study investigated the risk of incident hip fractures according to serum concentrations of vitamin K1 and 25-hydroxyvitamin D in elderly Norwegians during long-term follow-up. The results showed that the combination of low concentrations of both vitamin D and K1 provides a significant risk factor for hip fractures. INTRODUCTION: This case-cohort study aims to investigate the associations between serum vitamin K1 and hip fracture and the possible effect of 25-hydroxyvitamin D (25(OH)D) on this association. METHODS: The source cohort was 21,774 men and women aged 65 to 79 years who attended Norwegian community-based health studies during 1994-2001. Hip fractures were identified through hospital registers during median follow-up of 8.2 years. Vitamins were determined in serum obtained at baseline in all hip fracture cases (n = 1090) and in a randomly selected subcohort (n = 1318). Cox proportional hazards regression with quartiles of serum vitamin K1 as explanatory variable was performed. Analyses were further performed with the following four groups as explanatory variable: I: vitamin K1 ≥ 0.76 and 25(OH)D ≥ 50 nmol/l, II: vitamin K1 ≥ 0.76 and 25(OH)D < 50 nmol/l, III: vitamin K1 < 0.76 and 25(OH)D ≥ 50 nmol/l, and IV: vitamin K1 < 0.76 and 25(OH)D < 50 nmol/l. RESULTS: Age- and sex-adjusted analyses revealed an inverse association between quartiles of vitamin K1 and the risk of hip fracture. Further, a 50 % higher risk of hip fracture was observed in subjects with both low vitamin K1 and 25(OH)D compared with subjects with high vitamin K1 and 25(OH)D (HR 1.50, 95 % CI 1.18-1.90). The association remained statistically significant after adjusting for body mass index, smoking, triglycerides, and serum α-tocopherol. No increased risk was observed in the groups low in one vitamin only. CONCLUSION: Combination of low concentrations of vitamin K1 and 25(OH)D is associated with increased risk of hip fractures.

Hip fracture and other predictors of anti-osteoporosis drug use in Norway.

UNLABELLED: This study aims to find predictors of anti-osteoporosis drug (AOD) use. Known risk factors of osteoporosis, i.e., age, hip fracture, and corticosteroid use were found to be predictors of AOD use, in addition to a number of other drugs used. Higher socioeconomic position did not favor the use of AOD. INTRODUCTION: This study deals with studying predictors of anti-osteoporosis drug treatment in Norwegian women and men. METHODS: All Norwegian women and men≥50 years were included (n=1,407,392). Data were taken from different data sources, (1) the Norwegian Prescription Database (drug use in 2004-2005); (2) the Nationwide Census 2001 (marital status, education and resident county); (3) the National Hip Fracture Database (hip fractures 2003-2005); and (4) the National Population Register (date of death/emigration). We estimated the hazard ratios (HR) for incident treatment by Cox proportional hazard regression. RESULTS: In 2005, 10,332 women (1.5%) and 1,387 men (0.2%) were new users of anti-osteoporosis drugs (incident treatment). Age was a statistically significant predictor of incident treatment in both women and men, with HR ranging from 1.7 to 3.2 (per 10 years). A middle educational level in men strongly predicted incident treatment [HR 2.0 (CI 1.1-3.8)], but not in women after full adjustment. A previous hip fracture, increasing number of drugs used and use of corticosteroids were all predictors of incident treatment in both genders after adjustments. Corticosteroid use [HRwomen=4.0 (CI 3.8-4.2)] had a higher HR for incident treatment than hip fracture [HRwomen=2.0 (CI 1.8-2.3)]. Marital status and area of residency were not predictors of incident treatment in either gender, after adjustments. The predictors of prevalent treatment were only slightly different from incident treatment in 2005. CONCLUSIONS: Age, previous hip fracture, number of drugs used, and use of corticosteroids were positively related to treatment in both genders. In men, a middle educational level predicted treatment.

Does recalled dieting increase the risk of non-vertebral osteoporotic fractures? The Tromsø Study.

UNLABELLED: The risk of non-vertebral osteoporotic fractures increased by increasing recalled amount of weight loss when dieting in women aged ≥ 46 years and in those with BMI < 25 kg/m(2) participating in the Tromsø Study (1994/1995-2009). The increased risk was present both in women with few and several episodes of recalled dieting. INTRODUCTION: The influence of repeated dieting on bone health is uncertain. This study aims to investigate whether recalled dieting is a risk factor for non-vertebral osteoporotic fractures. METHODS: In 1994/1995 weight and height were measured in all participants aged 25-69 years in the population-based Tromsø Study. Information about socioeconomic background, diseases and lifestyle factors was collected by questionnaires-including number of recalled dieting episodes and largest amount of weight loss when dieting. The participating 20,745 women and men were followed for 15 years, fractures were registered from X-ray archives and analysed by Cox's proportional hazards models. RESULTS: Among those who recalled dieting, 975 women and 364 men suffered a non-vertebral osteoporotic fracture during follow-up. Compared to women without recalled weight loss when dieting, women who reported their largest weight loss of 11 kg or more had a hazard ratio (HR) = 1.48 (95% CI 1.13-1.94) for osteoporotic fracture, adjusted for age, marital status, body mass index, height, education, physical activity, smoking, alcohol intake, history of cardiovascular disease and psychological distress. The increased risk was statistically significant only in women aged ≥ 46 years and in those with BMI < 25 kg/m(2). Women who recalled ≥ 11 dieting episodes had HR = 1.73 (CI 1.11-2.68) for osteoporotic fracture compared to those with no recalled episodes. Dieting was not associated with risk of fractures in men, but the number of fractures was low. CONCLUSIONS: The increased risk of non-vertebral osteoporotic fractures by recalled dieting in women indicates that maintenance of a stable weight may have beneficial effects on fracture risk.

Outdoor air pollution, bone density and self-reported forearm fracture: the Oslo Health Study.

UNLABELLED: Air pollution is associated with several adverse health outcomes and increased mortality. In the Oslo Health Study, an association between long-term outdoor air pollution exposure and bone health was suggested in men aged 75/76 years, but not in younger men or in women. INTRODUCTION: Associations have been found between air pollution and a range of diseases, but few have studied whether bone health differs according to the concentration of air pollution. The aim of this study was to investigate the association between indicators of air pollution and bone health. METHODS: Self-reported forearm fracture was assessed in men and women 75/76 and 59/60 years (n = 5,976) participating in the Oslo Health Study 2000-2001. In subsamples of the participants (n = 1,039), we studied the relation between air pollution and forearm bone mineral density (BMD) measured by single X-ray absorptiometry. Exposure to air pollution (particulate matter (PM(10) and PM(2.5)) and nitrogen dioxide (NO(2))) at each participant's home address was estimated from 1992 to 2001. RESULTS: We found no associations between air pollution and self-reported forearm fractures or BMD in men aged 59/60 years or in women. In men aged 75/76 years, an increment of 10 units in PM(2.5) was associated with a reduction in distal forearm BMD of 64 mg/cm(2) (p < 0.05), and with an increased prevalence of forearm fracture after the age of 50 years among current smokers, OR = 7.4 (p < 0.05). Similar patterns of associations were suggested for PM(10) and NO(2). CONCLUSIONS: In this study, bone health was not associated with long-term exposure to air pollution in women and in men 59/60 years of age. However, a negative association was suggested in elderly men. Further studies with improved measures of air pollution are warranted.

Changes in physical activity behavior and the development of body mass index during the last 30 years in Norway.

Body mass index (BMI; kg/m(2)) has increased markedly in the last decades. We hypothesized that highly physically active persons both at work and at leisure would be resistant to weight gain. The hypothesis was tested by analyzing Norwegian cross-sectional data collected in the period 1972-2002. Participants were 214,449 men and 206,136 women (aged 20-70 years). During the last 30 years in men and the last 15 years in women, a systematic larger BMI increase per year was observed in the sedentary [regression coefficients (SE) in men 0.060 (0.004) kg/m(2) and women 0.137 (0.012) kg/m(2)] compared with highly physically active groups [regression coefficients (SE) in men 0.036 (0.00 4) kg/m(2), and in women -0.001 (0.039) kg/m(2)]. Analyses were robust to adjustments for age, smoking and education. There was a larger absolute net increase in the prevalence of obesity among the sedentary compared with persons performing light, moderate or heavy physical activity (PA) at leisure. PA level in women both at work and in leisure was not associated with weight gain during the last decades. This association was less evident among men. Men and women who were lightly, moderately or highly active at leisure were less likely to be obese compared with those who were sedentary.

Outdoor air pollution and bone mineral density in elderly men - the Oslo Health Study.

UNLABELLED: The association between bone mineral density (BMD) and outdoor air pollution has not previously been explored. In this study including 590 elderly men, total body BMD was inversely associated with indicators of air pollution. Further studies to address any relation between air pollution and BMD and bone fracture are warranted. INTRODUCTION: The relation between air pollution and bone mineral density (BMD) is unknown. Based on higher fracture rates and more osteoporosis in urban compared to rural populations, this exploratory study aimed at investigating the association between indicators of air pollution and BMD. METHODS: In an osteoporosis sub-study of the population-based Oslo Health Study (2000-2001) BMD of total body and total hip (mg/cm(2)) was measured by DXA in 590 men 75-76 years old. Exposure to air pollution (particulate matter (PM(10) and PM(2.5)) and nitrogen dioxide (NO(2))) at each participant's home address was estimated from 1992 to 2001. RESULTS: Air pollution was inversely associated with total body BMD, whereas no significant association was found for total hip BMD. The adjusted odds ratio (OR) [95% confidence interval] for low total body BMD (Z-score

Risk factors associated with body mass index increase in men at 28 years follow-up.

BACKGROUND: Several studies have reported a general increase in body mass index (BMI). AIM: To identify factors influencing BMI changes at 28 years follow-up. DESIGN: Prospective screening study. METHODS: The cohort of the Oslo I study of 1972/73 had another screening in 2000 (Oslo II). We present data for these men, and men from Oslo I who participated in five similar studies during 1996-2001. In all, 7157 men aged 20-49 years at first screening attended two health screenings, and complete data were available for 7104. BMI change from 1972/73 to 2000 was the dependent variable in multiple regression analyses. RESULTS: The percentage with obesity (BMI > or = 30) increased overall from 2.5% to 13.5%. The overall mean (SD) BMI increased from 24.2 (2.6) kg/m2 to 26.2 (3.4) kg/m2. The increase was largest (3.9 (2.5) kg/m2) among men aged 20-24 in 1972/73 and least (1.6 (2.5) kg/m2) in those aged 45-49 years. No age trend was observed for those with BMI > or = 30.0 kg/m2 in 1972/3. On multiple regression analysis, increasing triglycerides, systolic blood pressure, age and non-fasting glucose, decreasing physical activity and not smoking were all significantly related to increasing BMI. Having stopped smoking was also related to increased BMI. Daily smoking in both 1972/73 and 2000, and daily smoking in 2000 but not in 1972/73, were inversely related to increased BMI. DISCUSSION: There was a substantial increase in BMI, with the largest increase in the younger men, except in those who were already obese at first screening. Overall, obesity increased by 11% in the study period and was associated with multiple life-style factors.

Mental distress and risk of hip fracture. Do broken hearts lead to broken bones?

OBJECTIVE: Mental distress may entail increased risk of hip fracture, but it is uncertain whether the effect consists solely of an indirect effect through use of medication, or whether it is also mediated through other mechanism. The purpose of this study was to examine the association between mental distress and risk of hip fracture in women, adjusted for medication (that is, use of tranquillisers/sedatives or hypnotics). DESIGN: A three year follow up of hip fracture was conducted on 18,612 women, consisting of 92.5% of all women aged 50 years or older in a Norwegian county. Three hundred and twenty nine suffered a hip fracture. A mental distress index was based on questions about life dissatisfaction, nervousness, loneliness, sleep disorders, troubled and uneasy feelings, depression and impairment attributable to psychological complaints. Relative risk with 95% confidence intervals (CI) of hip fracture with respect to mental distress were controlled for medication, age, body mass index (BMI), smoking, physical inactivity, and physical illness by means of Cox regression. RESULTS: The 10% of women with the highest mental distress had more than twofold increased risk of hip fracture compared with the 10% of women with the lowest mental distress, after adjustment for age and medication. The relative risk was 1.95 (95% CI 1.2, 3.3) after additional control for BMI, smoking, physical inactivity, and physical illness. The relative risk of hip fracture for daily users of medication compared with never users was 2.1 (95% CI 1.6, 2.9). After adjusting for mental distress it was 1.5 (95% CI 1.0, 2.2). CONCLUSIONS: Risk of hip fracture was positively related to mental distress, also after adjustment for medication use. The effect of tranquillisers/sedatives or hypnotics on hip fracture risk may be overestimated in studies with no adjustments for mental distress.

The Tromsø Study: physical activity and the incidence of fractures in a middle-aged population.

We have studied the relation of occupational and recreational physical activity to fractures at different locations. All men born between 1925 and 1959 and all women born between 1930 and 1959 in the city of Tromsø were invited to participate in surveys in 1979-1980 and 1986-1987 (The Tromsø Study). Of 16,676 invited persons, 12,270 (73.6%) attended both surveys. All nonvertebral fractures (n = 1435) sustained from 1988 to 1995 were registered in the only hospital in the area. Average age in the middle of the follow-up period (December 31, 1991) was 47.3 years among men and 4501 years among women, ranging from 32 to 66 years. Fracture incidence increased with age at all locations among women, but it decreased with or was independent of age among men. Low-energetic fractures constituted 74.4% of all fractures among women and 55.2% among men. When stratifying by fracture location, the most physically active persons among those 45 years or older suffered fewer fractures in the weight-bearing skeleton (relative risk [RR] 0.6, confidence interval [CI] 0.4-0.9, age-adjusted), but not in the non-weight-bearing skeleton (RR 1.0, CI 0.7-1.2, age-adjusted) compared with sedentary persons. The relative-risk of a low-energetic fracture in the weight-bearing skeleton among the most physically active middle-aged was 0.3 (CI 0.1-0.7) among men and 0.9 (CI 0.4-1.8) among women compared with the sedentary when adjusted for age, body mass index, body height, tobacco smoking, and alcohol and milk consumption. It seems that the beneficial effect on the skeleton of weight-bearing activity is reflected also in the incidence of fractures at different sites.

[Who gives up smoking? Results from the health surveys in Finnmark in 1977/78 and 1987/88]. / Hvem stumper røyken? Resultater fra helseundersøkelsene i Finnmark i 1977/78 og 1987/88.

In order to develop effective smoking cessation programmes, it is important to understand why people stop smoking. This study is based on data from two population-based health surveys carried out in the northernmost county of Norway in 1977-78 and 1987-88. 6,254 men and 6,404 women smokers participated in the survey. For both surveys questionnaires were used to collect information on smoking habits, sociodemographic variables, various diseases, symptoms, health related behaviours, and social network. Ten years later 19.3% of the men and 16.0% of the women had stopped smoking. The primary factors for giving up were: a short history of smoking, older age, having non-smoking family and friends, and acquiring a smoking related disease during the period. Health promoting behaviours, such as low consumption of coffee, alcohol, butter and margarine, also increased the chances of giving up smoking. Developing smoking related symptoms, such as a morning cough, or coughing up mucus in the mornings, predicted continuous smoking. Future health promotion programmes should be targeted at young smokers and persons with smoking related diseases; and efforts should probably be directed towards lifestyle with the aim of modifying general attitudes to health.

[Knowledge about the attitude to mental disorders. An interview study prior to last autumn's TV-action]. / Kunnskaper om og holdninger til psykiske lidelser. Intervjuundersøkelse foran høstens TV-aksjon.

In June 1992 a random sample of 1,191 Norwegians were interviewed about their knowledge concerning mental disorders and psychiatric research, and their attitudes in this connection. The study shows that people tend to underestimate the prevalence of mental illness, and they are less willing to talk freely about a mental disorder in the family than about cancer. People have a relatively good understanding of the aetiology of mental disorders. They are less willing, however, to support psychiatric research financially compared with cancer research.

Self-reported change in health behaviour after a mass media-based health education campaign.

A comprehensive short-term fund-raising campaign, was launched in 1987 by a health charity organization in cooperation with the only Norwegian TV-channel covering the whole country. The campaign which was extensively announced on TV and other media and which involved large proportions of the population, finished up with a six hour TV-show on the fund-raising day. Because a considerable amount of information on prevention of heart disease was presented in connection with the campaign, it is presently evaluated as a nationwide health education campaign. Twenty-two per cent of the population reported changes in one or more habits in connection with the campaign (one third of them took more exercise, while one quarter reduced/quit their smoking). Health behaviour change among family/friends, reported new knowledge of health and worry created by the campaign, were the factors most clearly associated with self-reported behaviour change. The paper discusses the magnitude of the effects of the campaign in relation to the study design, and the importance of social environment and fear arousal on health behaviour.