Secular reduction of excess mortality in hip fracture patients >85 years.

BACKGROUND: More than 20% of the hip fracture patients die within the first year after the incident. Few data are available on the trends in mortality following a hip fracture. The present aim was to study changes in excess mortality after hip fracture from 1978/79 up to 1996/97. METHODS: Data on 5180 hip fracture patients aged ≥ 50 years, identified in three earlier, well validated, incidence studies from Oslo were used. The studies took place in the two years periods 1978-79 and 1989-89 and in a one year period from 1st of May 1996 to 30th of April 1997. The study was designed as a historic cohort study. Exposure was sustaining a hip fracture in the registration periods. Outcome was death of all causes. Age- and sex-specific one year-mortality rates were provided by Statistics Norway. Standardized mortality ratios (SMR) were calculated for the three cohorts for each sex and age-group, for the 0-6 months, 6-12 months, 0-1 year, 1-5 years and 5-10 years intervals after fracture. To assess the duration of the excess mortality in hip fracture patients, time-framed Kaplan-Meier curves for consecutive 5-years intervals were conducted for the hip fracture patients and the corresponding background population. Only patients still alive at the start of the time interval were included. One sample log rank tests were used to test for statistical significance. RESULTS: The one-year SMR ranged from 3.64 (2.82 - 4.61) to 4.53 (3.67 - 5.54) in men and from 2.78 (2.39 - 3.19) to 3.60 (3.19 - 4.05) in women. In the 0-6 months interval a reduction in SMR from 1978/79 to 1996/97 was observed in women aged ≥85 years. The duration of excess mortality ranged from two years in men ≥85 years to more than ten years in men and women aged 65-84 years. CONCLUSION: Excess mortality among hip fracture patients remains high. Over the decades, a reduced excess mortality was mainly seen in the oldest patients, suggesting that specific efforts intending to improve prevention and treatment of osteoporosis and osteoporotic fractures in the youngest elderly are required.

Influence of socioeconomic factors on the adherence of alendronate treatment in incident users in Norway.

PURPOSE: To examine whether socioeconomic factors influence adherence to alendronate drug treatment among incident users in Norway during 2005-2009. METHODS: The study included 7610 incident alendronate users in 2005 (40-79 years), followed until 31 December 2009. Mean age was 66.6 years, and 86.7% of the patients were women. Data were drawn from the Norwegian Prescription Database and linked to marital status, education and income. Adherence was measured by the medication possession ratio (MPR). MPR was defined as the number of dispensed defined daily doses divided by the number of days each patient was included in the study. A patient was adherent if MPR ≥ 80%. ORs with 95%CI were estimated using logistic regression. RESULTS: Among all patients, 45.5% was adherent throughout 4.2 years. A slightly higher proportion of women than men were adherent. Adjusted for all covariates, women aged 70-79 years had an OR of 1.27 (95%CI 1.10-1.45) for adherence compared with those 40-59 years. In women, high household income predicted adherence of alendronate use. In men, a middle educational level compared with a low level, predicted adherence (adjusted OR = 1.47 (95%CI 1.10-1.96)). After adjustments, previous marriage reduced the odds of being adherent compared with present marriage, in both men and women. CONCLUSIONS: In women, the most important factors for being adherent were high age and high income. In men, a middle educational level predicted adherence. Previous marriage reduced the odds of being adherent in both women and men.

Prescription of anti-osteoporosis drugs during 2004-2007-a nationwide register study in Norway.

PURPOSE: To assess 1-year prevalence, incidence rates and minimum refill of anti-osteoporosis drug use in Norway by age, gender and place of residence during 2004-2007. METHODS: Data from patients aged > or = 40 years receiving anti-osteoporosis drugs (AOD) were retrieved from the Norwegian Prescription Database (NorPD). AOD were defined as bisphosphonates (alendronate with or without cholecalciferol, risedronate, ibandronate and etidronate with or without calcium), raloxifene, teriparatide and nasal calcitonin. The NorPD covers the total Norwegian population in ambulatory care. Key measurements were 1-year prevalence, incidence rate and minimum refill. RESULTS: Among Norwegian women and men > or = 40 years, 4.3 and 0.45% respectively used AOD in 2004. In 2007, the prevalence of AOD use had slightly increased to 4.6% in women and to 0.52% in men. In 2007, 90% of users were women. The use of alendronate, representing 88% of all AOD use in 2007, increased from 2004 to 2007 while the use of other bisphosphonates decreased. The counties with highest overall bisphosphonate use were the counties with the historically lowest incidence of osteoporotic fractures. The incidence rate of overall bisphosphonate use decreased from 2005 to 2007. Among those patients who were dispensed a bisphosphonate in 2005, 72% refilled at least one prescription both in 2006 and 2007. CONCLUSION: There was an increasing prevalence and a decreasing incidence of AOD use over this limited time period. There was substantial geographical variation in the prevalence of anti-osteoporosis drugs. We also observed a high minimum refill rate.

A population-based study of demographical variables and ability to perform activities of daily living in adults with osteogenesis imperfecta.

PURPOSES: To describe demographical variables, and to study functional ability to perform activities of daily life in adults with osteogenesis imperfecta (OI). METHODS: Population-based study. Ninety-seven patients aged 25 years and older, 41 men and 56 women, were included. For the demographical variables, comparison was made to a matched control-group (475 persons) from the Norwegian general population. Structured interviews concerning social conditions, employment and educational issues and clinical examination were performed. The Sunnaas Activities of Daily Living (ADL) Index was used to assess the ability to perform ADL. RESULTS: The prevalence of clinical manifestations according to Sillence was in accordance with other studies. Demographical variables showed that most adults with OI are married and have children. They had a higher educational level than the control group, but the employment rate was significantly lower. However, the rate of employed men was similar in both groups. Adult persons with OI achieved a high score when tested for ADL. CONCLUSIONS: Adults with OI are well educated compared with the general population, and most of them are employed. High scores when tested for ADL indicate that most of them are able to live their lives independently, even though there are some differences according to the severity of the disorder.

Weight change over three decades and the risk of osteoporosis in men: the Norwegian Epidemiological Osteoporosis Studies (NOREPOS).

The purpose of this study was to assess the effect of weight in middle-aged men and subsequent weight change on the risk of osteoporosis three decades later. The authors utilized data from 1,476 Norwegian men participating in two health screenings in Oslo (1972-1973 and 2000-2001) and Tromsø (1974-1975 and 2001). Height and weight were measured at baseline and follow-up. Total hip bone mineral density (BMD) was assessed at follow-up by dual energy x-ray absorptiometry. Baseline body mass index (BMI) was positively related to BMD three decades later. Subsequent weight change was also strongly related to BMD, and the proportion of persons with osteoporosis decreased from 15.1% among those who lost >or=10% of their body weight to 0.6% among those who gained >or=10% of their body weight. Excluding participants with medical conditions did not change the association between weight change and BMD. Taking both BMI and weight change into account, the prevalence of osteoporosis in the lowest quarter of baseline BMI was 31% (95% confidence interval: 24, 37) in persons losing >or=5% of their weight and 4% (95% confidence interval: 1, 7) in persons gaining >or=5% of their weight. In this cohort of middle-aged men, low baseline BMI and weight loss during the following three decades were both strongly and negatively related to total hip BMD.

In vivo and in vitro comparison of densitometers in the NOREPOS study.

The purpose of this study was to assess the agreement of in vivo hip scans on 3 densitometers (1 GE Lunar DPX-IQ and 2 GE Lunar Prodigy scanners) and to evaluate whether the European Spine Phantom (ESP) was able to reproduce the in vivo variability. Sixteen subjects had 3 repeated scans (with repositioning) on each densitometer, and the ESP was measured on each densitometer at least 40 times. Mean differences between hip scans on the Prodigy scanners were small and insignificant, and the in vivo results were not significantly different from the in vitro results. Bland and Altman plots showed no systematic differences between the Prodigy scanners over the range of bone mineral density (BMD). On the other hand, differences between Prodigy and DPX-IQ changed systematically over the range of BMD. The ESP did not fully reproduce the in vivo difference between Prodigy and DPX-IQ. In conclusion, the ESP is a valid substitute when assessing agreement between Prodigy scanners. However, when assessing agreement between different types of scanners, substitution of in vivo with in vitro measurements should be made with caution.

The Oslo Health Study: Is bone mineral density higher in affluent areas?

BACKGROUND: Based on previously reported differences in fracture incidence in the socioeconomic less affluent Oslo East compared to the more privileged West, our aim was to study bone mineral density (BMD) in the same socioeconomic areas in Oslo. We also wanted to study whether possible associations were explained by socio-demographic factors, level of education or lifestyle factors. METHODS: Distal forearm BMD was measured in random samples of the participants in The Oslo Health Study by single energy x-ray absorptiometry (SXA). 578 men and 702 women born in Norway in the age-groups 40/45, 60 and 75 years were included in the analyses. Socioeconomic regions, based on a social index dividing Oslo in two regions - East and West, were used. RESULTS: Age-adjusted mean BMD in women living in the less affluent Eastern region was 0.405 g/cm2 and significantly lower than in West where BMD was 0.419 g/cm2. Similarly, the odds ratio of low BMD (Z-score

Pakistanis living in Oslo have lower serum 1,25-dihydroxyvitamin D levels but higher serum ionized calcium levels compared with ethnic Norwegians. The Oslo Health Study.

BACKGROUND: Persons of Pakistani origin living in Oslo have a much higher prevalence of vitamin D deficiency and secondary hyperparathyroidism but similar bone mineral density compared with ethnic Norwegians. Our objective was to investigate whether Pakistani immigrants living in Oslo have an altered vitamin D metabolism by means of compensatory higher serum levels of 1,25-dihydroxyvitamin D (s-1,25(OH)2D) compared with ethnic Norwegians; and whether serum levels of ionized calcium (s-Ca2+) differ between Pakistanis and Norwegians. METHODS: In a cross-sectional, population-based study venous serum samples were drawn from 94 Pakistani men and 67 Pakistani women aged 30-60 years, and 290 Norwegian men and 270 Norwegian women aged 45-60 years; in total 721 subjects. RESULTS: Pakistanis had lower s-1,25(OH)2D compared with Norwegians (p < 0.001). Age- and gender adjusted mean (95% CI) levels were 93 (86, 99) pmol/l in Pakistanis and 123 (120, 126) pmol/l in Norwegians, p < 0.001. The difference persisted after controlling for body mass index. There was a positive relation between serum 25-hydroxyvitamin D (s-25(OH)D) and s-1,25(OH)2D in both groups. S-Ca2+ was higher in Pakistanis; age-adjusted mean (95% CI) levels were 1.28 (1.27, 1.28) mmol/l in Pakistanis and 1.26 (1.26, 1.26) mmol/l in Norwegians, p < 0.001. In both groups, s-Ca2+ was inversely correlated to serum intact parathyroid hormone levels (s-iPTH). For any s-iPTH, s-Ca2+ was higher in Pakistanis, also when controlling for age. CONCLUSION: Community-dwelling Pakistanis in Oslo with low vitamin D status and secondary hyperparathyroidism have lower s-1,25(OH)2D compared with ethnic Norwegians. However, the Pakistanis have higher s-Ca2+. The cause of the higher s-Ca2+ in Pakistanis in spite of their higher iPTH remains unclear.

Biochemical markers of bone turnover and their relation to forearm bone mineral density in persons of Pakistani and Norwegian background living in Oslo, Norway: The Oslo Health Study.

OBJECTIVE: To evaluate whether Pakistanis have increased bone turnover compared with ethnic Norwegians due to their high prevalence of vitamin D deficiency and secondary hyperparathyroidism, and whether the relation between bone turnover and bone mineral density (BMD) differs between Pakistanis and ethnic Norwegians. DESIGN: A cross-sectional, population-based study conducted in the city of Oslo in 2000-2001. Random samples of 132 community-dwelling Pakistani men and women of ages 40, 45, and 59-60 years, and 580 community-dwelling Norwegian men and women of ages 45 and 59-60 years are included in this substudy. METHODS: Venous serum samples were drawn for measurements of markers of the vitamin D endocrine system and the bone turnover markers osteocalcin (s-OC), bone alkaline phosphatase (s-bone ALP), and tartrate-resistant acid phosphatase (s-TRACP). BMD was measured at the forearm by single-energy X-ray absorptiometry. RESULTS: Pakistanis had higher s-bone ALP compared with Norwegians. Mean (95% CI) age-adjusted levels were 22.5 (21.0, 24.1) U/l in Pakistani men versus 19.3 (18.6, 20.1) U/l in Norwegian men, P < 0.0005, and 20.3 (18.4, 22.1) U/l in Pakistani women versus 16.7 (16.0, 17.4) U/l in Norwegian women, P = 0.001. There tended to be an inverse association between bone turnover and BMD in men and women of both ethnic groups, and it was strongest for s-bone ALP. Overall mean (95% CI) distal BMD decrease was -16 (-20, -11) mg/cm(2) per 1 s.d. increase in s-bone ALP (P < 0.0005) when adjusting for age, sex, and ethnicity. CONCLUSIONS: Except for somewhat higher s-bone ALP levels in Pakistanis, there were only minor ethnic differences in bone turnover, despite a strikingly different prevalence of secondary hyperparathyroidism. Bone turnover was inversely associated with forearm BMD in both ethnic groups.

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry.

The custom made Unique stem is designed to fit closely to the metaphyseal region of the femur in order to obtain maximum mechanical stability and optimal load transfer. Thirty-seven patients (38 hips) with non-inflammatory arthritis were randomized to the uncemented custom made Unique stem or the Elite Plus stem inserted with cement. The patients have been followed clinically as well as with radiostereometry (RSA) and Dual-energy X-ray Absorptiometry (DXA) for 2 years. After 2 years the RSA result showed minimal translation and rotation for the Unique stem while the Elite Plus rotated slightly (mean 1.05 degrees) into retroversion. Compared to previous studies the Elite Plus was as stable as the Charnley prosthesis. The DXA results showed a significantly higher proximal and total (10% for the Unique versus 5% for Elite) bone loss for the Unique stem compared to the Elite Plus. Thus the optimal proximal press-fit of the custom made stem did secure a stable fixation, but did not decrease the proximal bone loss.

Vertebral deformities in rheumatoid arthritis: a comparison with population-based controls.

BACKGROUND: Previous studies have shown an increased prevalence of osteoporosis in rheumatoid arthritis (RA), but the extent of osteoporotic fractures is not clarified. The aim of this study was to compare the prevalence of vertebral deformities in a representative, population-based cohort of female patients with RA with that in matched controls, and to examine the relationship between deformities and RA, bone mineral density (BMD), and corticosteroid use. METHODS: Female patients (mean age, 63.0 years; range, 50.7-73.6 years) were recruited from a county register of patients with RA. Population controls were matched for age, sex, and residential area. Participants had thoracolumbar radiographs taken according to a standardized procedure, and BMD was measured at the hip and spine (L2-L4). RESULTS: The overall number of vertebral deformities was substantially higher in the RA group compared with controls (147 vs 51, applying the morphometric criteria), with a highly significant difference between patients and controls regarding the presence of multiple deformities measured morphometrically (11.2% vs 4.8%; odds ratio, 2.60; 95% confidence interval, 1.21-6.04) and moderate or severe deformities measured semiquantitatively (17.3% vs 10.0%; odds ratio, 2.00; 95% confidence interval, 1.11-3.74). In Poisson regression analysis, vertebral deformities were independently associated with RA, BMD, and long-term corticosteroid use. CONCLUSIONS: Vertebral deformities are markedly increased in patients with RA compared with controls, especially regarding severe and multiple deformities. A diagnosis of RA was associated with vertebral deformities independently of BMD and long-term corticosteroid use. These findings have important implications for prevention of established osteoporosis in RA.

Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial.

Randomized controlled trials have shown that a combination of vitamin D and calcium can prevent fragility fractures in the elderly. Whether this effect is attributed to the combination of vitamin D and calcium or to one of these nutrients alone is not known. We studied if an intervention with 10 microg of vitamin D3 per day could prevent hip fracture and other osteoporotic fractures in a double-blinded randomized controlled trial. Residents from 51 nursing homes were allocated randomly to receive 5 ml of ordinary cod liver oil (n = 569) or 5 ml of cod liver oil where vitamin D was removed (n = 575). During the study period of 2 years, fractures and deaths were registered, and the principal analysis was performed on the intention-to-treat basis. Biochemical markers were measured at baseline and after 1 year in a subsample. Forty-seven persons in the control group and 50 persons in the vitamin D group suffered a hip fracture. The corresponding figures for all nonvertebral fractures were 76 persons (control group) and 69 persons (vitamin D group). There was no difference in the incidence of hip fracture (p = 0.66, log-rank test), or in the incidence of all nonvertebral fractures (p = 0.60, log-rank test) in the vitamin D group compared with the control group. Compared with the control group, persons in the vitamin D group increased their serum 25-hydroxyvitamin D concentration with 22 nmol/liter (p = 0.001). In conclusion, we found that an intervention with 10 microg of vitamin D3 alone produced no fracture-preventing effect in a nursing home population of frail elderly people.

Vitamin D deficiency and secondary hyperparathyroidism and the association with bone mineral density in persons with Pakistani and Norwegian background living in Oslo, Norway, The Oslo Health Study.

We studied the prevalence of poor vitamin D status and the association with bone density in men and women born in Norway (quoted as Norwegians, n = 869) and Pakistan (quoted as Pakistanis, n = 177) in the population-based Oslo Health Study, 2000-2001. We measured 25-hydroxyvitamin D, iPTH and ionized calcium in serum and bone mineral density at the forearm site with single energy X-ray absorptiometry. Mean 25-hydroxyvitamin D was 74.8 +/- 23.7 nmol/l in the Norwegians and 25.0 +/- 13.6 nmol/l in the Pakistanis (P = 0.000). The prevalence of secondary hyperparathyroidism (iPTH > or = 8.5 pmol/l, 25-hydroxyvitamin D < 50 nmol/l and Ca2+ < or = 1.35 mmol/l) was four times higher in Pakistani compared to Norwegian women. Also in Pakistani men, serious vitamin D deficiency defined as secondary hyperparathyroidism was prevalent, and five times as frequent as in Norwegian men. However, whereas BMD was significantly lower in Norwegian women with, compared to Norwegian women without, secondary hyperparathyroidism, there was no difference in BMD between Pakistani women with and without secondary hyperparathyroidism. In conclusion, vitamin D deficiency was prevalent among Pakistani immigrants, and in great contrast to the vitamin D replete Norwegians. Serious vitamin D deficiency was interestingly not associated with reduced forearm bone density among Pakistani women.

[Pain, functional level and emotional problems of women with osteoporosis and vertebral fractures]. / Smerter, funksjonsnivå og emosjonelle forhold hos kvinner med osteoporose og vertebrale brudd.

We studied symptoms of pain, anxiety, and depression and physical function in postmenopausal women with low bone mass and vertebral fractures. One hundred patients attending an out-patient clinic for osteoporosis completed a visual analogue scale (VAS) for pain, the Hospital Anxiety Depression Scale (HADS) and Short Form (SF-12). Twenty patients also completed the osteoporosis specific form QUALEFFO, and were compared to a control group. Maximal pain (VAS) during the last week was 5.3 +/- 2.8. Based on HADS, the prevalence of anxiety disorder (29 %) was significantly higher among the patients than in the norm material; for depression, however, there was no difference. For SF-12, the standardized physical component summary (PCS) was significantly lower than norm data. No difference was found for the mental component summary (MCS). Using QUALEFFO, patients reported a worse score for all domains except the mental domain. We conclude that Norwegian women with vertebral fractures sustain a high level of pain probably leading to an increased level of anxiety, but not to increased level of depression compared to age-adjusted norm data.

[Increased cortisol levels, frostbite and effects on the muscles and skeleton during extreme polar conditions]. / Økt kortisolnivå, frostskader og påvirkning av muskler og skjelett under ekstreme polarforhold.

BACKGROUND: We wanted to record physiological changes, injuries and illnesses during a long sledge expedition in North Canada. MATERIAL AND METHODS: The expedition consisted of four men aged 41 to 50, and 16 polar dogs. Measurements of cortisol in saliva were performed before, during and after the expedition. Frostbites and other injuries were registered continuously. Body weight and muscle, fat and bone mass were measured by dual X-ray absorptiometry scanning, and strength and endurance of shoulders, knees and back were tested. The group encountered extreme frost (-30 to -42 degrees C day temperature), wind, unexpected amounts of pack ice, and poorly motivated dogs. RESULTS AND INTERPRETATION: The participants showed increased free cortisol levels during their stay on the ice, probably because of increased mental stress. Three got first degree and two second-degree frostbites, but the affected areas were normal on vascular examination five months later. All members increased their muscle mass, but muscle strength and endurance remained unchanged.

Spinal deformities and lung function in adults with osteogenesis imperfecta.

INTRODUCTION: There are no larger studies of adults with osteogenesis imperfecta (OI), focusing on the impact of spinal cord deformities on lung function assessment. OBJECTIVES: To assess prevalence and severity of spinal deformities and lung function in an adult population with OI and to explore whether compromise of lung function correlated with deformities of the spine. METHODS: Ninety-two adults with OI had radiographs of the spine, 75 underwent spirometry. Deformities were assessed radiographically using a semi-quantitative (SQ) approach grading each vertebra from mild to severe (0-3 SQ grades). The spinal deformity index (SDI) was calculated by summing the SQ grades of all vertebrae from TH4 to L4. Scoliosis was measured using the Cobb method. Pulmonary function tests were performed; both current measured and arm-span height were used for calculating the predicted lung volumes and flow rates. RESULTS: Vertebral deformities were found in 67%, the majority of deformities were found in the mid thoracic region. Scoliosis was found in 46%, nine patients exhibited torsion scoliosis. Median values of SDI were 2.0 in type I, 4.0 in type IV and 2.5 in the total population. Only correction with arm-span height had a significant impact on the assessment of lung function. Significant negative correlations were obtained when spirometry variables were correlated to spine deformities. CONCLUSIONS: OI patients show spinal deformities influencing body height and lung function. Lung function tests should be corrected for reductions in body height by using arm-span height. OI patients should be evaluated with spirometry when vertebral deformities are suspected.

Mortality following the first hip fracture in Norwegian women and men (1999-2008). A NOREPOS study.

Hip fractures are associated with increased mortality and their incidence in Norway is one of the highest worldwide. The aim of this nationwide study was to examine short- and long-term mortality after hip fractures, burden of disease (attributable fraction and potential years of life lost), and time trends in mortality compared to the total Norwegian population. Information on incident hip fractures between 1999 and 2008 in all persons aged 50 years and older was collected from Norwegian hospitals. Death and emigration dates of the hip fracture patients were obtained through 31 December 2010. Standardized mortality ratios (SMRs) were calculated and Poisson regression analyses were used for the estimation of time trends in SMRs. Among the 81,867 patients with a first hip fracture, the 1-year excess mortality was 4.6-fold higher in men, and 2.8-fold higher in women compared to the general population. Although the highest excess mortality was observed during the first two weeks post fracture, the excess risk persisted for twelve years. Mortality rates post hip fracture were higher in men compared to women in all age groups studied. In both genders aged 50 years and older, approximately 5% of the total mortality in the population was related to hip fractures. The largest proportion of the potential life-years lost was in the relatively young-old, i.e. less than 80 years. In men, the 1-year absolute mortality rates post hip fracture declined significantly between 1999 and 2008, by contrast, the mortality in women increased significantly relatively to the population mortality.

Bone mass, bone markers and prevalence of fractures in adults with osteogenesis imperfecta.

UNLABELLED: Still little is known about the manifestations of osteogenesis imperfecta (OI) in adults. We therefore initiated this study of bone mass, bone turnover and prevalence of fractures in a large cohort of adult patients. We found a surprising low prevalence (10%) of osteoporosis. These patients, however, expressed the most severe disease. PURPOSE: To characterize bone mineral density, bone turnover, calcium metabolism and prevalence of fractures in a large cohort of adults with osteogenesis imperfecta. METHODS: One hundred fifty-four patients with adult OI participated and 90 (age range 25-83) provided dual X-ray absorptiometry (DXA) measurements. According to Sillence classification criteria, 68 persons were classified as OI type I, 9 as type III, 11 type IV and 2 were unclassified. Fracture numbers were based on self-reporting. Biochemical markers of bone turnover were measured and bone mineral density (BMD) of the spine, femoral neck and total body were determined by DXA. RESULTS: Only 10% of adults with OI exhibited osteoporotic T scores (T ≤ -2.5) but compared to patients with normal T scores this subgroup had a threefold higher fracture risk (22 vs. 69). s-PTH, s-Ca and 25[OH] vitamin D were all normal. Bone markers did not display major deviations from normal, but patients with OI type III displayed higher resorption marker levels than type I and IV. Multivariate regression analysis showed that only gender and total body BMD were significant determinants of fracture susceptibility, and the differences for total body BMC, BMD and Z scores were significant between the OI subtypes. CONCLUSIONS: In adult OI, DXA measurements only identified few patients as osteoporotic. These patients, however, exhibited a much higher fracture propensity. Due to deformities, low body height and pre-existing fractures, DXA assessment is complicated in this disease, and further studies are needed to work out how to minimize the impact of these confounders.