In this large population-based sample of older persons across eight cohorts, hip fracture was associated with excess short- and long-term all-cause mortality in both sexes.

SummaryWe tested whether cortical porosity of the proximal femur measured using StrAx1.0 software provides additional information to areal bone mineral density (aBMD) or Fracture Risk Assessment Tool (FRAX) in differentiating women with and without fracture. Porosity was associated with fracture independent of aBMD and FRAX and identified additional women with fractures than by osteoporosis or FRAX thresholds.IntroductionNeither aBMD nor the FRAX captures cortical porosity, a major determinant of bone strength. We therefore tested whether combining porosity with aBMD or FRAX improves identification of women with fractures.MethodsWe quantified femoral neck (FN) aBMD using dual-energy X-ray absorptiometry, FRAX score, and femoral subtrochanteric cortical porosity using StrAx1.0 software in 211 postmenopausal women aged 54–94 years with nonvertebral fractures and 232 controls in Tromsø, Norway. Odds ratios (ORs) were calculated using logistic regression analysis.ResultsWomen with fractures had lower FN aBMD, higher FRAX score, and higher cortical porosity than controls (all p < 0.001). Each standard deviation higher porosity was associated with fracture independent of FN aBMD (OR 1.39; 95 % confidence interval 1.11–1.74) and FRAX score (OR 1.58; 1.27–1.97) in all women combined. Porosity was also associated with fracture independent of FRAX score in subgroups with normal FN aBMD (OR 1.88; 1.21–2.94), osteopenia (OR 1.40; 1.06–1.85), but not significantly in those with osteoporosis (OR 1.48; 0.68–3.23). Of the 211 fracture cases, only 18 women (9 %) were identified using FN aBMD T-score < −2.5, 45 women (21 %) using FRAX threshold >20 %, whereas porosity >80th percentile identified 61 women (29 %). Porosity identified 26 % additional women with fractures than identified by the osteoporosis threshold and 21 % additional women with fractures than by this FRAX threshold.ConclusionsCortical porosity is a risk factor for fracture independent of aBMD and FRAX and improves identification of women with fracture.

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We wanted to determine the risk of non-vertebral fracture associated with type and duration of diabetes mellitus, adjusting for other known risk factors. This is a population-based 6-year follow-up of 27,159 subjects from the municipality of Tromsø, followed from 1994 until 2001. The age range was 25-98 years. Self-reported diabetes cases were validated by review of the medical records. All non-vertebral fractures were registered by computerized search in radiographic archives. A total of 1,249 non-vertebral fractures was registered, and 455 validated cases of diabetes were identified. Men with type I diabetes had an increased risk of all non-vertebral [relative risk (RR) 3.1 (95% CI 1.3-7.4)] and hip fractures [RR 17.8 (95% CI 5.6-56.8)]. Diabetic women, regardless of type of diabetes, had significantly increased hip fracture risk [RR 8.9 (95% CI 1.2-64.4) and RR 2.0 (95% CI 1.2-3.6)] for type I and type II diabetes, respectively. Diabetic men and women using insulin had increased hip fracture risk. Duration of disease did not alter hip fracture risk. An increased risk of all non-vertebral fractures and, especially, hip fractures was associated with diabetes mellitus, especially type I. Type II diabetes was associated with increased hip fracture risk in women only.

BackgroundOsteoporotic vertebral fractures are, as the hip fractures, associated with increased morbidity and mortality. Norway has one of the highest reported incidences of hip fractures in the world. Because of methodological challenges, vertebral fractures are not extensively studied. The aim of this population based study was to describe, for the first time, the age- and sex specific occurrence of osteoporotic vertebral fractures in Norway.MethodsData was collected in the Tromso Study, 2007/8 survey. By the use of dual x-ray absorptiometry (GE Lunar Prodigy) vertebral fracture assessments were performed in 2887 women and men aged from 38 to 87 years, in addition to measurements of bone mineral density at the femoral sites. Information on lifestyle was collected through questionnaires. Comparisons between fractures and non-fractures were done sex stratified, by univariate analyses, adjusting for age when relevant.ResultsThe prevalence of vertebral fractures varied from about 3% in the age group below 60 to about 19% in the 70+ group in women, and from 7.5% to about 20% in men, with an overall prevalence of 11.8% in women and 13.8% in men (p = 0.07). Among those with fractures, only one fracture was the most common; two and more fractures were present in approximately 30% of the cases. Fractures were seen from the fourth lumbar to the fifth thoracic vertebrae, most common between first lumbar and sixth thoracic vertebrae. The most common type of fracture was the wedge type in both sexes. Bone mineral density at the hip differed significantly according to type of fracture, being highest in those with wedge fractures and lowest in those with compression fractures.ConclusionsThe prevalence of vertebral fractures increased by age in women and men, but the overall prevalence was lower than expected, considering the high prevalence of hip and forearm fractures in Norway. In both sexes, the wedge type was the fracture type most frequently observed and most common in the thoracic region.

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Summary Bone mass achievement predicts later fracture risk. This population-based study describes bone mineral density levels (BMD) and associated factors in Norwegian adolescents. Compared with international reference ranges, BMD levels appear higher and physical activity levels are positively associated with BMD.Purpose Norway has one of the highest reported incidences of osteoporotic fractures. Maximization of peak bone mass may prevent later fractures. This population-based study compared BMD levels of Norwegian adolescents with international reference ranges and explored associated factors.Methods All first year upper secondary school students, aged 15-19 years in the Tromsø region were invited to the Fit Futures study in 2010-2011. Over 90% of the invited participants attended, 508 girls and 530 boys. BMD was measured at total hip, femoral neck and total body by dual x-ray absorptiometry.Lifestyle variables were collected by self-administered questionnaires and interviews. All analyses were performed sex stratified, using linear regression models.Results In girls mean BMD (SD) was 1.060 (0.124), 1.066 (0.123) and 1.142 (0.077) g/cm² at the total hip, femoral neck and total body respectively. In boys corresponding values were 1.116 (0.147), 1.103 (0.150) and 1.182 (0.097), with significant higher values than the Lunar pediatric reference at 16 years of age In girls, height and self-reported intensive physical activity of more than four hours a week and early sexual maturation were positively associated with BMD at both femoral sites (p<0.047). Among boys age, height, body mass index, physical activity and alcohol intake were positively (p<0.038), whereas early stages of sexual maturation and smoking was negatively (p<0.047) related to BMD.Conclusions Despite the heavy fracture burden, Norwegian adolescents´ BMD levels are higher than agematched Caucasians. Physical activity is associated with 1 SD increased BMD levels in those involved in competition or hard training.

In this prospective case-cohort study of hip fractures, the largest ever reported, we found an increased risk of hip fracture in subjects in the lowest compared with the highest quartile of serum 25-hydroxyvitamin D. In accordance with the findings of previous community-based studies, low vitamin D status was a modest risk factor for hip fracture.