The question as to whether abdominal obesity has an adverse effect on hip fracture remains unanswered. The purpose of this study was to investigate the associations of waist circumference, hip circumference, waist-hip ratio, and body mass index with incident hip fracture.
The data in this prospective study is based on Cohort of Norway, a population-based cohort established during 1994-2003. Altogether 19,918 women and 23,061 men aged 60-79 years were followed for a median of 8.1 years. Height, weight, waist and hip circumference were measured at baseline using standard procedures. Information on covariates was collected by questionnaires. Hip fractures (n = 1,498 in women, n = 889 in men) were identified from electronic discharge registers from all general hospitals in Norway between 1994 and 2008.
The risk of hip fracture decreased with increasing body mass index, plateauing in obese men. However, higher waist circumference and higher waist-hip ratio were associated with an increased risk of hip fracture after adjustment for body mass index and other potential confounders. Women in the highest tertile of waist circumference had an 86% (95% CI: 51-129%) higher risk of hip fracture compared to the lowest, with a corresponding increased risk in men of 100% (95% CI 53-161%). Lower body mass index combined with abdominal obesity increased the risk of hip fracture considerably, particularly in men.
Abdominal obesity was associated with an increased risk of hip fracture when body mass index was taken into account. In view of the increasing prevalence of obesity and the number of older people suffering osteoporotic fractures in Western societies, our findings have important clinical and public health implications.
We studied the relations between body height, body mass index (BMI), and fatal hip fractures prospectively in a large, representative population. During the years 1963-1975, a nationwide compulsory mass x-ray examination including standardized height and weight measurements took place in Norway covering all persons age 15 years and older. In the study presented here, we selected women (N = 357,807) and men (N = 316,041) age 50-89 years at screening. We matched the file to the national death register containing causes of death throughout 1991; we defined cases as persons with hip fracture mentioned on their death certificates. During an average follow-up of 16.4 years, we identified a total of 6,087 fatal hip fractures in the study population. There was a distinct inverse relation between BMI and fatal hip fracture, with an age-adjusted relative risk (RR) in the three highest vs the low quartile of 0.68 [95% confidence interval (CI) = 0.63-0.72] in women and 0.57 (95% CI = 0.52-0.62) in men. The risk of fatal hip fractures increased slightly with increasing body height [RR = 1.10 (95% CI = 1.04-1.16) in women and RR = 1.08 (95% CI = 1.01-1.16) in men per 10-cm increase in body height]. This study indicates that low BMI is an important risk factor for fatal hip fractures and that body height has a weak, positive association.
OBJECTIVE: To examine the bone mineral density (BMD), frequency of osteoporosis, and risk factors for BMD reduction in a representative population of female rheumatoid arthritis (RA) patients ages 20-70 years. METHODS: BMD in the femoral neck, total hip, and spine L2-4 (anterior-posterior view) was measured in 394 RA patients recruited from a validated county RA register (completeness 85%) comprising 721 women ages 20-70 years. BMD was measured with dual-energy x-ray absorptiometry, and age-specific values were compared with pooled values from a European/US population of healthy subjects free from earlier fractures, chronic diseases, and medications influencing bone metabolism. A multiple linear regression model was used to determine individual predictors of BMD. RESULTS: No statistically significant differences were found in demographic, disease activity, disease severity, or health status parameters between the RA register patients in whom BMD was measured and the remaining register patients. Femoral neck BMD was significantly reduced by 4.2% in the age group 50-59 years, and by 5.0% in those ages 60-70 years. For BMD in the total hip, the significant reductions were 3.7%, 6.0%, and 8.5% in the age groups 40-49 years, 50-59 years, and 60-70 years, respectively. No significant reduction in spine L2-4 BMD was found. A 2-fold increased frequency of osteoporosis was observed in all 4 age groups of RA patients compared with the reference population, ranging from 0% to 28.6% in the femoral neck, 0% to 29.9% in the total hip, and 1.8% to 31.5% in the spine. Predictors of reduced BMD were as follows: at the femoral neck, older age, low body weight, current use of corticosteroids, greater physical disability (as measured by the modified Health Assessment Questionnaire [M-HAQ]), and presence of rheumatoid factor; at the total hip, older age, low weight, current use of corticosteroids, and higher M-HAQ disability score; and at the lumbar spine, older age, low weight, and current use of corticosteroids. CONCLUSION: Register-based prevalence data on BMD reduction in female RA patients ages 20-70 years are presented for the first time in this report, which demonstrates a 2-fold increase in osteoporosis in this representative population.
Reduced bone mass is one of the main risk factors for fracture. An individual classification of future fracture risk can be made by relating bone mass to age- and sex-specific reference values. Since both bone mass and fracture incidence seem to be different in different populations, population-specific reference values should be studied before applying the reference values should by the manufacturers of the various types of measuring equipment. Using Lunar DPX-1, we measured bone mineral density (BMD) of the lumbar spine, femoral neck and total body in 225 women and 160 men in the age group 20-80 years, all of them from Oslo. The values were higher for men than for women. In the women the annual loss of bone increased after the age of 50 years in the lumbar spine and total skeleton, but the menopause appeared to have no effect for the femoral neck. Although the age- and sex-specific BMD differed very little from the reference values reported from Sweden and Finland, small differences in mean values and standard deviation between reference materials could create important differences in individual risk calculations if T-scores (deviation from mean value of premenopausal women calculated as standard deviation units) are used.
Fracture incidence in Oslo decreased from the 1970s to the 1990s in younger postmenopausal women, but not in older women or in men. Concurrently, hormone replacement therapy increased considerably. Using data from the Oslo Health Study, we estimated that roughly half the decline might be attributed hormone replacement therapy. INTRODUCTION: Between the late 1970s and the late 1990s, the incidence of hip fracture and distal forearm fracture decreased in younger postmenopausal women in Oslo, but not in elderly women or in men. The purpose of this report is to evaluate whether the decreased incidence was coherent with trends in use of hormone replacement therapy (HRT). METHODS: Data on estrogens were collected from official drug statistics, data on fractures from published studies and data on bone mineral density (BMD) from the Oslo Health Study. RESULTS: The sale of all estrogens increased 22 times from 1979 to 1999, and the sub-category estradiol combined with progestin increased 35 times. In the corresponding period the incidence of distal forearm fracture in women aged 50-64 years decreased by 33% and hip fracture by 39%. Based on differences in BMD between users and non-users of HRT, we estimated that up to half of this decline might be due to HRT. CONCLUSIONS: The reduction in fracture incidence in postmenopausal women in Oslo occurred in a period with a substantial increase in the use of HRT. Future surveillance will reveal whether the last years' decline in use of HRT will be translated into increasing fracture rates.
An index to predict individual postmenopausal bone loss is presented. The index is developed by means of data from a 10-year prospective Norwegian study in which bone mass of the distal forearm was measured annually in 73 women. All the women were 47 years old and premenopausal at inclusion. Independent risk factors for postmenopausal bone loss were identified by applying multivariate regression analysis on anthropometric, biochemical, nutritional, and life-style variables measured at menopause. The analysis identified low body weight, reduced renal phosphate reabsorption, and smoking as significant independent risk factors, and by means of these three factors a predictive index for postmenopausal bone loss was developed. This index was validated by using data from a 10-year longitudinal Dutch study, in which bone mass of the proximal radius was measured annually in 86 women, aged between 49 and 57 years and perimenopausal at inclusion. We defined women with the highest index score as "high-risk persons." According to this definition approximately 25% of the perimenopausal women were classified as high-risk persons, and the estimated sensitivity/specificity/positive predictive power were 36%, 89%, and 74%, respectively, when used to select women with a postmenopausal bone loss above average. We conclude that the index may be helpful in identifying healthy perimenopausal women in whom bone mass measurements should be considered.
Vertebral deformities are prevalent in chronic obstructive pulmonary disease (COPD) patients and may cause excessive loss of height. As height is used for calculating reference values for pulmonary function tests, larger than normal height reduction could cause overestimation of lung function. In this cross-sectional study of 465 COPD patients and 462 controls, we explored how often lung function is misinterpreted due to height reduction in COPD patients, and whether the number or severity of vertebral deformities correlate with height reduction. Measured height was compared to recalled tallest height (RTH) and height calculated from arm span (ASH) to assess height reduction. Vertebral deformities were assessed from radiographs and pulmonary function was assessed using standard formulae. Height reduction was frequent in both the study and control groups, and increased with the number and severity of vertebral deformities. When using current measured height, lung function was overestimated in a significant proportion of COPD patients at relatively modest height reductions. The effects were smallest for forced expiratory volume in 1 s and forced vital capacity, and most pronounced for total lung capacity and residual volume. Therefore, we propose that in COPD patients with excessive height reduction, one might use RTH or ASH in calculating predicted values. Furthermore, such patients should be evaluated for co-existing vertebral deformities and osteoporosis.
In Oslo in 1979, 1604 fractures were recorded in persons over 20 years of age. Eighty-three per cent were women. In men, the age specific incidence increased only slightly with age. In women, however, the incidence increased in the years around and after menopause, declining again after 75. Even after correcting for falls occurring in winter, the incidence was significantly higher than reported from Sweden and the U.K.