Hip fracture patients have more vertebral deformities than subjects in population-based studies.

The prevalence of vertebral deformity, estimated in lateral spine radiographs (Th4-L4) using quantitative morphometry, in 64 men and 132 women with hip fractures was compared with the prevalence of vertebral deformity in individuals in two population-based studies. A vertebral deformity of a specific vertebra was defined as a 3, 4, or 5 SD reduction from the normal mean of any of three ratios describing that specific vertebra. The age-adjusted prevalence of individuals with vertebral deformities was higher among the hip fracture patients than among the reference subjects in both genders, with an odds ratio of 3.6 [95% confidence interval (CI) 1.9-6.6] in men and 2.6 (95% CI 1.7-4.1) in women using deformity criterion -3 SD. Also, the number of vertebrae with deformities (-3 SD) in individuals with one deformity or more was greater among the hip fracture patients than among the reference subjects (in men mean 2.3 versus 1.8, P = 0.007; in women mean 3.3 versus 2.0, P < 0.001). Adjusted for age there were more vertebrae with deformities (-3 SD) among female than among male hip fracture patients (mean 3.3 versus 2.3, P = 0.01). We found no differences in the vertebral deformity rates when comparing patients with a per- or subtrochanteric hip fracture with patients with a cervical hip fracture. In conclusion, there is a relationship between vertebral deformities and hip fractures suggesting that a prevalent vertebral deformity could predict an increased hip fracture risk.

Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study.

The aim of this study was to evaluate whether a prevalent vertebral deformity predicts mortality and fractures in both men and women. In the city of Malmö, 598 individuals (298 men, 300 women; age 50-80 years) were selected from the city's population and were included in the Swedish part of the European Vertebral Osteoporosis Study (EVOS). At baseline the participants answered a questionnaire and lateral spine radiographs were performed. The prevalence of subjects with vertebral deformity was assessed using a morphometric method. The mortality during a 10-year follow-up period was determined through the register of the National Swedish Board of Health and Welfare. Eighty-five men and 43 women died during the study period. The subsequent fracture incidence during the follow-up period was ascertained by postal questionnaires, telephone interviews and by a survey of the archives of the Department of Radiology in the city hospital. Thirty-seven men and 69 women sustained a fracture during the study period. Data are presented as hazard ratios (HR) with 95% confidence interval (95% CI) within brackets. Prevalent vertebral deformity, defined as a reduction by more than 3 standard deviations (SD) in vertebral height ratio, predicted mortality during the forthcoming decade in both men [age-adjusted HR 2.4 (95% CI 1.6-3.9)] and women [age-adjusted HR 2.3 (95% CI 1.3-4.3)]. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. Prevalent vertebral deformity predicted an increased risk of any fracture during the forthcoming decade in both men [age-adjusted HR 2.7 (95% CI 1.4-5.3)] and women [age-adjusted HR 1.8 (95% CI 1.1-2.9)]. Prevalent vertebral deformity predicted an increased risk of any subsequent fragility fracture in women [age-adjusted HR 2.0 (95% CI 1.1-3.5)]; however, in men the increased risk was nonsignificant [age-adjusted HR 1.9 (95% CI 0.7-5.1)]. In summary, a prevalent vertebral deformity can predict both increased mortality and increased fracture incidence during the following decade in both men and women. We conclude that prevalent vertebral deformity could be used as a risk factor in both genders for mortality and future fracture.

Assessment of human body composition using dual-energy x-ray absorptiometry and bioelectrical impedance analysis.

BACKGROUND: Human body composition, particularly the content of fat tissue and its distribution, has been extensively measured in healthy, diseased, obese and elderly subjects. A variety of non-invasive methods have been applied for these studies. Bioelectrical impedance analysis (BIA) is a commonly used method, based on the conduction of electrical current in the body and the differences in the ability to conduct electricity between the fat and water components of the body. Recently, dual-energy x-ray absorptiometry (DEXA) has been introduced for bone mass, bone mineral density and body composition studies. Unlike other methods, DEXA measures three components of the body: bone mineral content, fat tissue mass, and lean tissue mass, and additionally regional fat distribution. The objective of this study was to compare body composition as assessed by DEXA and BIA methods in a sample of 100 patients. MATERIAL AND METHODS: Body composition was studied in 100 consecutive subjects, 59 women and 41 men. The lean body mass (LBM), fat body mass (FBM), and percent body fat (%BF) were measured by the DEXA and BIA techniques. RESULTS: There were highly statistically significant linear relationships between LBM, FBM and %BF assessed by DEXA and BIA in both sexes (p<0.001 for all measurements). No influence of age or BMI on the relationship between DEXA and BIA results was observed. Differences were observed between DEXA and BIA measurements of both fat and fat-free tissue. The results suggest that DEXA may underestimate the LBM and overestimate body fat compared with BIA, probably due to different assumptions about the constants. CONCLUSIONS: We conclude that both methods are suitable for body composition studies.

Vertebral deformation in urban Swedish men and women: prevalence based on 797 subjects.

Vertebral fracture-deformation, a common feature of osteoporosis, shows considerable age, sex and geographical variation. We present the prevalence in an urban population of south-west Sweden. Lateral spine radiographs of 797 men and women, age 50-86 years, were evaluated by morphomety. The age-standardized prevalence of subjects with vertebral deformation using the deformation criterion -3 SD was 39 (95%CI 34-43)% in women and 33 (95%CI 28-38)% in men. The prevalence increased with age in both sexes. After adjustment for age, women had a higher prevalence than men, odds ratio 1.4. The proportion of vertebrae with deformation ranged from 2%-11%, increasing with age. The vertebrae most commonly deformed were Th 11, Th 12 and L1.

Bone loss in relation to menopause: a prospective study during 16 years.

This prospective study evaluated bone loss in the peri- and postmenopausal period in 156 women followed from age 48 to 64 years. All women were premenopausal at the start of the study. Areal bone mineral density (g/cm(2)) was measured by single-photon absorptiometry (SPA) of the forearm at the 1 cm level (BMD 1 cm) and the 6 cm level (BMD 6 cm) every second year. Onset of menopause (MP) was determined according to the criteria of the World Health Organization (12 months of amenorrhea and elevated follicle-stimulating hormone). At the end of the study, 125 of 156 women (80%) remained. Bone mineral density (BMD) at age 48 years correlated with BMD at age 64 years within the respective region (r = 0.4-0.5, p < 0.001, respectively). There was no BMD loss in the premenopausal period. BMD loss was accelerated at menopause (MP) independent of chronological age. BMD loss was greater during the first 5 years following MP than during the following 6 years (BMD 1 cm 2.4% per year [1.0%-3.9%] vs. 0.4% per year [-0.3%-1.0%], p < 0.01). The quartile of women with late MP (>53.7 years) had greater bone loss during the first 5 years after MP than the quartile of women with early MP (<50.3 years) (p < 0.001). At age 64 years, BMD was no different when comparing the quartile of women with late MP vs. the quartile of women with early MP. Furthermore, there was no correlation between age at menopause and BMD at the age of 64. In summary, among women still menstruating at age 48 years, there was no measurable BMD loss in the premenopausal period. Independent of chronological age, BMD loss accelerated during MP. Rates of loss were highest in the early postmenopausal period. Independent of age at MP, premenopausal women with low age-specific BMD at age 48 years had an increased risk of sustaining low BMD at age 64 years also.

Changes in bone mineral, lean body mass and fat content as measured by dual energy X-ray absorptiometry: a longitudinal study.

Bone mineral density (BMD) and soft tissue composition were measured by dual energy X-ray absorptiometry (DXA) 3-4 years apart in 273 men and women aged 23-90. We found different rates of BMD loss in different skeletal regions. There were also different rates of BMD loss in different regions within the hip. Average rates of loss for male subjects 50 years of age and above for BMD total body were 0.1%/year and for femoral neck 1.5%/year, whereas lumbar spine (L2-L4) increased by 0.4%/year. Average rates of loss for female subjects 50 years of age and above for BMD total body were 0.0%/year, femoral neck 0.9%/year, and lumbar spine (L2-L4) 0.1%/year.

Bone mineral density assessed by quantitative ultrasound and dual energy X-ray absorptiometry. Normative data in Malmö, Sweden.

We measured bone mineral density (BMD) in 128 men and 143 women, aged 22-90, by dual energy X-ray absorptiometry (DEXA) and quantitative ultrasound (QUS). We found reduced bone mineral density in relation to age as measured both by DEXA and QUS. There was a correlation between 0.28 and 0.52 in men and between 0.53 and 0.77 in women when comparing DEXA and QUS measurements. When including only persons with low bone mass, the correlation was less.

Bone mineral density, muscle strength and physical activity. A population-based study of 332 subjects aged 15-42 years.

The aim of this population-based study was to find out whether differences in levels of physical activity have an influence on bone mass quantity and whether quadriceps muscle strength is a reliable determinant of bone mass. Included were 175 men and 157 women, aged 15-42 years. Bone mineral density (BMD) was measured at various sites by dual X-ray absorptiometry (DXA) and single photon absorptiometry (SPA). Muscle strength was assessed using an isokinetic muscle force meter. A questionnaire was used to estimate the level of physical activity. We found a positive correlation between physical activity and BMD for boys at the distal forearm and for girls at the trochanter (age group 15-16 years). Active men (age group 21-42 years) had up to 9% higher BMD levels at the hip than those who were less active. Quadriceps muscle torque was not an independent predictor of BMD. Our data suggest that a higher level of physical activity-within the limits of a "normal life style"-may have a positive effect on BMD in the proximal femur of young adults, which in turn may lessen the subsequent risk of fracture.

Nature and healing of tibial shaft fractures in alcohol abusers.

Alcohol abuse is associated with an increased risk of osteopenia and fractures. Previous histomorphometric studies on iliac crest bone have found decreased bone formation and increased bone resorption in alcohol abusers but it has not been established whether alcohol abuse has any effect on the anatomical location or the healing time of tibial shaft fractures. We studied, retrospectively, 199 adult male patients hospitalized for isolated tibial shaft fracture in the city of Malmö, Sweden, between 1980 and 1990. Forty-nine of the patients had earlier been registered at the Department of Alcohol Diseases and were judged to be problem drinkers. Abusers sustained their tibial shaft fractures more often by falling at ground level (P < 0.0001) or from a higher level (P = 0.009) and the fractures were more often oblique than transverse (P = 0.002) as compared with non-abusers. Healing time was impaired in abusers who had sustained a transverse fracture (P = 0.035), but no difference was observed in healing time in those with a oblique fracture. We found no difference between the abusers and the non-abusers regarding duration of hospital stay, fracture location, amount of displacement, occurrence of open fractures or the rate of complications.

Importance of participation rate in sampling of data in population based studies, with special reference to bone mass in Sweden.

OBJECTIVE: To study the effects of participation rate in sampling on "normative" bone mass data. DESIGN: This was a comparison between two randomly selected samples from the same population. The participation rates in the two samples were 61.9% and 83.6%. Measurements were made of bone mass at different skeletal sites and of muscle strength, as well as an assessment of physical activity. SETTING: Malmö, Sweden. SUBJECTS: There were 230 subjects (117 men, 113 women), aged 21 to 42 years. RESULTS: Many subjects participated in both studies (163). Those who took part only in the study with the higher participation rate (67) almost invariably had higher values for bone mass density at the sites measured (up to 7.6% for men) than participants in the study with the lower participation rate. No differences in muscle strength were recorded. CONCLUSION: A high degree of compliance is important to achieve a reliable result in determining normal values in population based studies.

Osteoarthrosis and late growth.

To examine the hypothesis that late growth of bone may occur, pelvic radiographs taken during 1990 to 1992 of patients born between 1901 and 1972 were studied. All radiographs were taken using the same equipment with constant exposure techniques. Films showing osteoarthrosis (obviously decreased joint space) or hip fracture were discarded. The remaining films of 116 women and 100 men divided into 3 age groups (18-39 years old, 40-59 years old, and > 60 years old) were measured. With a millimeter ruler and a circle template, the center and 5 radii of each femoral head, the width of the acetabulum, and the pelvic diameters, the femoral neck, and the height of the superior joint space were determined. Most of the measurements increased significantly with age, including those of the femoral head, the acetabulum, the femoral neck in women, and the pelvic diameters. The increase in superior joint space (the combined heights of the cartilage of the femoral head and acetabulum) with age was not significant, but in men between 50 and 70 years old there were cartilage measurements that were higher than in other age groups, and in women > 80 years of age there were significantly more single high values. The results are discussed against the background that growth of bone and of cartilage can hypothetically cause injuries of the cartilage.

Parathyroid localization by catheterization of large cervical and mediastinal veins to determine serum concentrations of intact parathyroid hormone.

A success rate of about 90% has been achieved after primary operations for hyperparathyroidism, compared with 60% to 80% in most series of secondary operations. The present reoperative series involved 29 patients who underwent venous catheterization with blood sampling for the determination of intact parathyroid hormone before undergoing repeat parathyroid surgery. Blood samples were taken from the internal jugular veins, innominate veins, and superior caval vein. No attempt was made to perform superselective catheterization of the small neck and mediastinal veins. The reoperations were done by four surgeons who did 1, 2, 13, and 13 of the reoperations, respectively. In all patients, distinct step-ups in parathyroid hormone concentrations were found. On average, the gradient between the highest and lowest value was about 5. Close to the location of the step-ups, diseased parathyroid tissue was found in 27 of the patients. In two cases no parathyroid tissue was found, and these patients remained hyperparathyroid postoperatively. They had been treated by the surgeon who did only two of the operations. When the step-up was observed in the left innominate vein, we could not differentiate mediastinal from low cervical adenomas. No patient developed hypoparathyroidism. To avoid this complication, autotransplantation of diseased parathyroid tissue into the abdominal subcutaneous fat was done in nine patients. No case of recurrent laryngeal nerve paralysis occurred. The introduction of reliable assays for the analysis of parathyroid hormone can make selective catheterization unnecessary when localizing remaining parathyroid glands in patients with persistent hyperparathyroidism.

Bone mineral loss after lower extremity trauma. 62 cases followed for 15-38 years.

62 former patients, who had been treated at our department for tibial shaft fracture (n 38) or knee ligament injury (n 24) 15-38 years earlier, were re-evaluated for post-traumatic osteopenia. 62 age- and sex-matched subjects without fracture served as controls. By means of a Lunar DEXA apparatus we measured the bone mineral density (BMD) in the total body, the hips and special regions of interest (ROI) in the lower extremities. We found a difference in the BMD between the injured and uninjured legs, most obvious in the femur condyle. Measurements of bone mineral loss early after the injury did not correlate with the present late measurements. The former fracture patients had at the time of follow-up the same BMD in the rest of their bodies as a whole, compared with controls. We conclude that post-traumatic osteopenia is still evident in the injured leg decades after the injury.

Predicting various fragility fractures in women by forearm bone densitometry: a follow-up study.

This is a follow-up of a previous study on the predictive power of bone mineral measurements; two more observation years have been added. A group of women (n = 1076) had their forearm bone mineral content (BMC) measured from 1970-1976. All fractures that occurred in 1975-1987 (13 years) were recorded. Four hundred sixty-nine fragility fractures occurred during the collection period. Again, it was found that BMC at the distal end of the forearm is a good predictor of future fracture before the age of 70. The measurement at the proximal site (forearm shafts), however, in contrast to our previous study, has a capacity of predicting fracture also in the age group 70-80. BMC measurements were good predictors of vertebral crush fractures and trochanteric hip fracture but lesser predictors of fractures of the distal end of the forearm. In age groups 40-70, BMC was a stronger predictor of fracture than age, and the risk associated with a 1 SD decrease of BMC 6 was 3.2 for a hip fracture as compared with those without any fragility fracture, even when adjusted for age. In addition to BMC, low body weight was a fracture predictor. Body weight 5 kg below age-adjusted mean increased the risk of a trochanteric hip fracture by 30%. The data are used in hypothetical calculations of the effects of screening.

Prevalence of Dupuytren's contracture and its correlation with degenerative changes of the hands and feet and with criteria of general health.

The prevalence of Dupuytren's contracture and its coincidence with degenerative changes in the hands and feet as well as loss of distal pulses, were studied in 574 55-year-old residents of Malmö, Sweden. Dupuytren's contracture occurred in 6% of the subjects studied, predominantly in men. Dupuytren's contracture was more common in men with degenerative changes in the feet and in men with signs of impaired arterial blood flow in the lower limbs. Men with Dupuytren's contracture had significantly less subcutaneous fat tissue, as measured by a triceps skinfold index, than men without Dupuytren's contracture. Other signs of general health, occupational work load or psychosocial factors did not interact with Dupuytren's contracture in the current study.

Bone mineral normative data in Malmö, Sweden. Comparison with reference data and hip fracture incidence in other ethnic groups.

The bone mineral mass was measured in 324 residents of the city of Malmö, Sweden, by dual energy roentgen absorptiometry (DEXA) using the Lunar DPX equipment--total body, hip, and lumbar vertebrae. The bone mineral content of the wrist was also measured with single photon absorptiometry (SPA) in 88 of the individuals. Weight, height, and vertebral height, as well as body fat, lean body mass, menarcheal age, menopausal age, and hand grip strength were determined. Measurements were compared with reference bone mineral content values from the United States, Japan, and France--also hip fracture incidence was compared. All bone mineral values decreased with age. A good correlation was found between the DEXA technique of total body bone mineral and the forearm SPA values. The bone mineral content was correlated with lean body mass and weight. The Malmö bone mineral content was on the same level as in the United States, but higher than in Japan and France. The comparatively high risk of fragility fractures in the Scandinavian countries compared with most other settings cannot be explained by low bone mass.

Bone mineral mass in hip fracture patients.

The aims of this study were to measure the bone mineral density (BMD) and some anthropometric variables in patients with hip fracture, to compare these data with those from controls, and to compare the fractured and unfractured hip. Bone mineral measurements with dual energy X-ray absorptiometry (DEXA) were undertaken in 93 consecutive hip fracture patients, 26 men and 67 women, with a mean age of 75 and 78 years, respectively, within 10 days after injury. We found lower BMD in most measurements in both men and women compared with age- and sex-matched controls. The body weight and lean body mass were also significantly lower in the male hip fracture patients; in women only weight was lower. In women there was lower BMD in spine and hip in those who had sustained trochanteric hip fractures compared with those with cervical fracture. No such difference was found in men. There was no difference in BMD in the hip when patients with stable and unstable fractures were compared. In the fractured and nonfractured hips we measured BMD in regions of interest. In women with trochanteric hip fractures the BMD was decreased in the fractured hip compared with the uninjured. No such difference was found for cervical fractures or in men.

Fracture incidence after tibial shaft fractures. A 30-year follow-up study.

Based on all patients with tibial shaft fracture (n = 767) treated in the department of orthopedics in Malmö from 1955 to 1963, a retrospective cohort study was performed in 1990. Two hundred sixty-nine of the patients were still living in Malmö or had died in the city. Since all roentgenograms were available, all other fractures that this group of patients had sustained up to 1990 were included. Data were compared with an age- and gender-matched control group with respect to location and types of fractures. The group with previous tibial shaft fractures had an increased incidence of all sorts of fractures. When comparing the risk of sustaining new fractures in the previously fractured limb with the uninjured side, only a statistically insignificant tendency toward more fractures was found. A similar tendency was observed in fractures of the upper limb. Therefore, remaining osteopenia in the injured limb after tibial shaft fracture is not associated with further fractures; rather, this group of patients were more fracture prone in general.

Bone mineral content in women: trends of change.

Altogether 426 women had their forearm bone mineral content (BMC) measured with single photon absorptiometry (SPA): one group in the early 1970s, another about 18 years later. Both groups represented purportedly healthy subjects. A third group of 328 women, measured at the same time as the second group, was from the same population but chosen by random selection (the population-based group). In the two sets of non-population-based women there was a small percentage reduction in the cortical forearm bone mass in the recent measurement as compared with the earlier measurement. This was significant only in women below 70 years of age. The forearm BMC, both cortical and trabecular, was less in all age groups of women randomly selected from the same population as the healthy control sample. This difference emphasizes the importance of selecting normative data from a population-based sample.

Coxarthrosis on the island of Gotland. Increased prevalence in a rural population.

On the island of Gotland and in the city of Malmö, the prevalence of coxarthrosis was calculated using the hip projections in colon roentgen examinations. The prevalence of coxarthrosis among the Gotland islanders was about twice that of the Malmö urbanites, and the condition became obvious earlier in life. The population of the local Gotland city of Visby did not contribute to this difference; the difference was entirely due to an increased incidence in the rural population of the island. Heavy labor in conjunction with farming is believed to be the cause of the deviation.