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Dahl J, Gulseth HL, Forsén L, Hoff M, Forsmo S, Åsvold BO, Schei B, Midthjell K, Meyer HE. Risk of hip and forearm fracture in subjects with type 2 diabetes mellitus and latent autoimmune diabetes of adults. The HUNT Study, Norway. Bone 2021; 153:116110. [PMID: 34252601 DOI: 10.1016/j.bone.2021.116110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/21/2022]
Abstract
Type 1 and type 2 diabetes mellitus incur an increased risk of fracture, with a generally higher risk among individuals with type 1 diabetes. The fracture risk among individuals with latent autoimmune diabetes of adulthood (LADA) is not known. The present cohort study aimed to estimate the risk of hip and forearm fracture among individuals with LADA, alongside type 1 and type 2 diabetes, using data from the second survey of the Trøndelag Health Study (HUNT2) in 1995-97. All inhabitants aged 20 years or older (N = 92,936) were invited to attend, of whom 65,234 (70%) participated. A total of 1972 (3%) reported to have diabetes; 1399 were found to have type 2 diabetes, 144 to have LADA, and 138 to have type 1 diabetes. All participants were followed prospectively with respect to hip- and forearm fractures by linkage to the local fracture registry. During a median follow-up of 16.2 years, 2695 persons with hip fractures and 3533 persons with forearm fractures were identified. There was an increased risk of hip fracture in women with type 2 diabetes (HR = 1.51, 95% CI 1.24-1.85) and LADA (HR = 2.15, 95% CI 1.25-3.72), whereas women with type 1 diabetes did not have a significantly increased risk (HR = 2.13, 95% CI 0.89-5.14). Among men, only LADA was associated with an increased risk of hip fracture (HR = 2.69, 95% CI 1.34-5.41). There was no statistically significant association between any of the diabetes types and forearm fracture. In women with type 2 diabetes, the highest risks of hip fracture were observed among those with highest HbA1c level at baseline, longest time since diagnosis, and most visual and movement impairment. We found that individuals with LADA had an increased risk of hip fracture similar to that previously reported for individuals with type 1 diabetes, and no increased risk of forearm fracture.
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Affiliation(s)
- Jesper Dahl
- Norwegian Institute of Public Health, Oslo, Norway.
| | | | - Lisa Forsén
- Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway; Department of Rheumatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Siri Forsmo
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Olav Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway; HUNT Research Center, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Levanger, Norway; Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Berit Schei
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway; Department of Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristian Midthjell
- HUNT Research Center, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Levanger, Norway
| | - Haakon E Meyer
- Norwegian Institute of Public Health, Oslo, Norway; Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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Moen MH, Forsmo S, Eik-Nes S, Schei B, Salvesen P, Sunde A. Kåre Molne. Tidsskriftet 2021. [DOI: 10.4045/tidsskr.21.0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Surakka I, Fritsche LG, Zhou W, Backman J, Kosmicki JA, Lu H, Brumpton B, Nielsen JB, Gabrielsen ME, Skogholt AH, Wolford B, Graham SE, Chen YE, Lee S, Kang HM, Langhammer A, Forsmo S, Åsvold BO, Styrkarsdottir U, Holm H, Gudbjartsson D, Stefansson K, Baras A, Abecasis GR, Hveem K, Willer CJ. MEPE loss-of-function variant associates with decreased bone mineral density and increased fracture risk. Nat Commun 2020; 11:4093. [PMID: 33097703 PMCID: PMC7585430 DOI: 10.1038/s41467-020-17315-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/26/2020] [Indexed: 01/28/2023] Open
Abstract
A major challenge in genetic association studies is that most associated variants fall in the non-coding part of the human genome. We searched for variants associated with bone mineral density (BMD) after enriching the discovery cohort for loss-of-function (LoF) mutations by sequencing a subset of the Nord-Trøndelag Health Study, followed by imputation in the remaining sample (N = 19,705), and identified ten known BMD loci. However, one previously unreported variant, LoF mutation in MEPE, p.(Lys70IlefsTer26, minor allele frequency [MAF] = 0.8%), was associated with decreased ultradistal forearm BMD (P-value = 2.1 × 10−18), and increased osteoporosis (P-value = 4.2 × 10−5) and fracture risk (P-value = 1.6 × 10−5). The MEPE LoF association with BMD and fractures was further evaluated in 279,435 UK (MAF = 0.05%, heel bone estimated BMD P-value = 1.2 × 10−16, any fracture P-value = 0.05) and 375,984 Icelandic samples (MAF = 0.03%, arm BMD P-value = 0.12, forearm fracture P-value = 0.005). Screening for the MEPE LoF mutations before adulthood could potentially prevent osteoporosis and fractures due to the lifelong effect on BMD observed in the study. A key implication for precision medicine is that high-impact functional variants missing from the publicly available cosmopolitan panels could be clinically more relevant than polygenic risk scores. Bone mineral density (BMD) is associated with fracture risk and many genetic loci with small effect sizes have been discovered by genome-wide association studies (GWAS). Here, the authors discover a large-effect rare loss-of-function genetic variant for BMD in the MEPE gene in the Norwegian HUNT study which replicates in the UK Biobank.
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Affiliation(s)
- Ida Surakka
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Lars G Fritsche
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.,Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA
| | - Wei Zhou
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA, 02142, USA.,Department of Computational Medicine and Bioinformatics, University of Michigan, Palmer Commons, 100 Washtenaw Avenue, Ann Arbor, MI, 48109, USA
| | - Joshua Backman
- Regeneron Genetics Center, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Jack A Kosmicki
- Regeneron Genetics Center, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Haocheng Lu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Ben Brumpton
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.,MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway
| | - Jonas B Nielsen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Maiken E Gabrielsen
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Anne Heidi Skogholt
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Brooke Wolford
- Department of Computational Medicine and Bioinformatics, University of Michigan, Palmer Commons, 100 Washtenaw Avenue, Ann Arbor, MI, 48109, USA
| | - Sarah E Graham
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Y Eugene Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Seunggeun Lee
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA
| | - Hyun Min Kang
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, N-7491, Levanger, Norway
| | - Siri Forsmo
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, N-7491, Levanger, Norway
| | - Bjørn O Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, N-7491, Levanger, Norway.,Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway
| | | | - Hilma Holm
- deCODE genetics/Amgen, Inc., Sturlugata 8, 101, Reykjavik, Iceland
| | - Daniel Gudbjartsson
- deCODE genetics/Amgen, Inc., Sturlugata 8, 101, Reykjavik, Iceland.,School of Engineering and Natural Sciences, University of Iceland, Sturlugata 7, 101, Reykjavik, Iceland
| | - Kari Stefansson
- deCODE genetics/Amgen, Inc., Sturlugata 8, 101, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavik, Iceland
| | - Aris Baras
- Regeneron Genetics Center, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | | | - Goncalo R Abecasis
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA.,Regeneron Genetics Center, 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Kristian Hveem
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway. .,HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, N-7491, Levanger, Norway.
| | - Cristen J Willer
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA. .,Department of Computational Medicine and Bioinformatics, University of Michigan, Palmer Commons, 100 Washtenaw Avenue, Ann Arbor, MI, 48109, USA. .,K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway. .,Department of Human Genetics, University of Michigan, 4909 Buhl Building, 1241 E. Catherine St, Ann Arbor, MI, 48109, USA.
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Hoff M, Skovlund E, Skurtveit S, Meyer HE, Langhammer A, Søgaard AJ, Syversen U, Forsmo S, Abrahamsen B, Schei B. Proton pump inhibitors and fracture risk. The HUNT study, Norway. Osteoporos Int 2020; 31:109-118. [PMID: 31741023 DOI: 10.1007/s00198-019-05206-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/22/2019] [Indexed: 12/16/2022]
Abstract
UNLABELLED Proton pump inhibitors (PPIs) have been linked to increased risk of fracture; the data have, however, been diverging. We did not find any increased risk of fractures among users of PPIs in a Norwegian population of 15,017 women and 13,241 men aged 50-85 years with detailed information about lifestyle and comorbidity. INTRODUCTION Proton pump inhibitors (PPIs) are widely prescribed and have been linked to increased risk of fracture. METHODS We used data from the Nord-Trøndelag Health Study (HUNT3), The Fracture registry in Nord-Trøndelag, and the Norwegian Prescription Database, including 15,017 women and 13,241 men aged 50-85 years. The study population was followed from the date of participating in HUNT3 (2006-2008) until the date of first fracture (forearm or hip), death, or end of study (31 December 2012). The Cox proportional hazards model with time-dependent exposure to PPIs was applied, and each individual was considered as unexposed until the first prescriptions was filled. To be included, the prescription of PPIs should minimum be equivalent to 90 defined daily doses (DDD) in the period. Individuals were defined as exposed until 6 months after end of drug supply. RESULTS The proportion of women and men using PPIs was 17.9% and 15.5%, respectively. During a median of 5.2 years follow-up, 266 women and 134 men had a first hip fracture and 662 women and 127 men, a first forearm fracture. The combined rate/1000 patient-years for forearm and hip fractures in women was 49.2 for users of PPIs compared with 64.1 among non-users; for men 18.6 and 19.8, respectively. The hazard ratios with 95% confidence interval for the first forearm or hip fracture among users of PPIs in the age-adjusted analysis were 0.82 (0.67-1.01) for women and 1.05 (0.72-1.52) for men. Adjusting for age, use of anti-osteoporotic drugs, and FRAX, the HR declined to 0.80 (0.65-0.98) in women and 1.00 (0.69-1.45) in men. CONCLUSIONS Use of PPIs was not associated with an increased risk of fractures.
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Affiliation(s)
- M Hoff
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway.
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway.
| | - E Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - S Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - H E Meyer
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - A Langhammer
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway
| | - A J Søgaard
- Norwegian Institute of Public Health, Oslo, Norway
| | - U Syversen
- Department of Endocrinology, St. Olavs Hospital, Trondheim, Norway
- Department of Clinical and and Molecular Medicine, NTNU, Trondheim, Norway
| | - S Forsmo
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway
| | - B Abrahamsen
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - B Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway
- Department of Gynecology, St Olavs Hospital, Trondheim, Norway
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Solbakken SM, Magnus JH, Meyer HE, Dahl C, Stigum H, Søgaard AJ, Holvik K, Tell GS, Emaus N, Forsmo S, Gjesdal CG, Schei B, Vestergaard P, Omsland TK. Urban-Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study. JBMR Plus 2019; 3:e10236. [PMID: 31768493 PMCID: PMC6874178 DOI: 10.1002/jbm4.10236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/04/2019] [Accepted: 08/11/2019] [Indexed: 12/02/2022] Open
Abstract
Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: <1/3, semirural: 1/3 to 2/3, and urban: >2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Siri M Solbakken
- Institute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo Norway
| | | | - Haakon E Meyer
- Institute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo Norway.,Department of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo Norway
| | - Cecilie Dahl
- Institute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo Norway
| | - Hein Stigum
- Institute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo Norway.,Department of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo Norway
| | - Anne J Søgaard
- Department of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo Norway
| | - Kristin Holvik
- Department of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo Norway
| | - Grethe S Tell
- Department of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo Norway.,Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - Nina Emaus
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway
| | - Siri Forsmo
- Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
| | - Clara G Gjesdal
- Department of Clinical Science University of Bergen Bergen Norway.,Department of Rheumatology Haukeland University Hospital Bergen Norway
| | - Berit Schei
- Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway.,Department of Gynecology St Olavs Hospital Trondheim Norway
| | - Peter Vestergaard
- Department of Clinical Medicine Aalborg University Aalborg Denmark.,Department of Endocrinology Aalborg University Hospital Aalborg Denmark.,Steno Diabetes Center North Jutland Aalborg Denmark
| | - Tone K Omsland
- Institute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo Norway
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Abstract
BACKGROUND Mammography screening may cause psychosocial harm for women experiencing a false-positive screening result. Previous studies suggest long-term consequences. The aim of the present study was to assess psychosocial consequences of false-positive findings on screening mammography within a six month follow-up. METHODS A prospective matched cohort survey study using the questionnaire 'Consequences of Screening for Breast Cancer' (COS-BC), which was translated from Danish to Norwegian. Psychometric analyses investigated the measurement properties of the Norwegian version. Two screening clinics in Norway distributed the survey to 299 women with an abnormal mammogram and 541 women with a normal screen. Women received the questionnaire when receiving the screening result, and one and six months after screening. RESULTS At six months, statistically significant differences appeared in two scales: existential values and breast examination. At six-month follow-up, women with false-positive results showed no statistically significant differences from women diagnosed with breast cancer in three outcomes: sense of dejection, anxiety, and keeping my mind off things. CONCLUSION Our results indicate that the psychosocial consequences from having false-positive screening mammography results diminish after six months. The results support previous research describing breast-specific outcomes. However, our results indicate that Norwegian women are less frightened than other Scandinavian mammography screening participants.
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Affiliation(s)
- Marit Solbjør
- Department of Public Health and Nursing, Trondheim, Norway;
- CONTACT Marit Solbjør Department of Public Health and Nursing, P.O. Box 8905, N-7491, Trondheim, Norway
| | - Siri Forsmo
- Department of Public Health and Nursing, Trondheim, Norway;
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;
- Primary Health Care Research Unit, Region Zealand, Denmark
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Hoff M, Skurtveit S, Meyer HE, Langhammer A, Søgaard AJ, Syversen U, Skovlund E, Abrahamsen B, Forsmo S, Schei B. Anti-osteoporosis drug use: too little, too much, or just right? The HUNT study, Norway. Osteoporos Int 2018; 29:1875-1885. [PMID: 29774403 DOI: 10.1007/s00198-018-4560-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/01/2018] [Indexed: 10/16/2022]
Abstract
UNLABELLED Use of anti-osteoporotic drugs (AODs) was examined in a Norwegian population 50-85 years. Among them with Fracture Risk Assessment Tool (FRAX) score for major osteoporotic fracture ≥ 20, 25% of the women and 17% of the men received AODs. The strongest predictors for AODs were high age in women and use of glucocorticoids among men. INTRODUCTION To examine the use of anti-osteoporotic drugs (AODs) and to identify predictors for prescriptions. METHODS Data were obtained from the Nord-Trøndelag Health Study (HUNT3) performed in 2006-2008 and the Norwegian Prescription Database, including 15,075 women and 13,386 men aged 50-85 years. Bone mineral density (BMD) in the femoral neck was measured in a subgroup of 4538 women and 2322 men. High fracture risk was defined as a FRAX score for major osteoporotic fracture (MOF) ≥ 20%; in the subgroup with BMD, high risk was in addition defined as FRAXMOF ≥ 20% or T-score ≤ - 2.5. Hazard ratios (HRs) for predictors of incident use of AODs within 2 years after HUNT3 were estimated by Cox' proportional hazards model. RESULTS Among individuals with FRAX MOF ≥ 20%, 25% of the women and 17% of the men were treated with AODs. Among those with FRAX MOF < 20%, 3% and 1% were treated, respectively. In the subgroup with BMD measurement, 24% of the women and 16% of the men at high risk of fractures were treated, compared to 3 and 1% in women and men not fulfilling the criteria. In women, high age was the strongest predictor for treatment (HR 3.84: 95% confidence interval 2.81-5.24), followed by use of glucocorticoids (GCs) (2.68:1.84-3.89). In men, predictors were use of GCs (5.28: 2.70-10.35) followed by multimorbidity (3.16:1.31-7.63). In the subgroup with BMD, T-score ≤ - 2.5 was the strongest predictor (women 3.98:2.67-5.89; men 13.31:6.17-28.74). CONCLUSIONS This study suggests an undertreatment of AODs in individuals at high risk of fracture.
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Affiliation(s)
- M Hoff
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.
| | - S Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - H E Meyer
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - A Langhammer
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - A J Søgaard
- Norwegian Institute of Public Health, Oslo, Norway
| | - U Syversen
- Department of Endocrinology, St. Olavs Hospital, Trondheim, Norway
- Institute of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway
| | - E Skovlund
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - B Abrahamsen
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S Forsmo
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Schei
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Gynecology, St. Olavs Hospital, Trondheim, Norway
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Forsmo S. Apotek – helsetjeneste eller butikk? Tidsskriftet 2018; 138:18-0079. [DOI: 10.4045/tidsskr.18.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Jørgensen P, Langhammer A, Krokstad S, Forsmo S. Mortality in persons with undetected and diagnosed hypertension, type 2 diabetes, and hypothyroidism, compared with persons without corresponding disease - a prospective cohort study; The HUNT Study, Norway. BMC Fam Pract 2017; 18:98. [PMID: 29212453 PMCID: PMC5719734 DOI: 10.1186/s12875-017-0672-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/28/2017] [Indexed: 12/24/2022]
Abstract
Background Suggested strategies in reducing the impact of non-communicable diseases (NCD) are early diagnosing and screening. We have limited proof of benefit of population screening for NCD. Increased mortality in persons with diagnosed NCD has been shown for decades. However, mortality in undetected NCD has barely been studied. This paper explores whether all-cause mortality differed between persons with diagnosed hypothyroidism, type 2 diabetes (T2DM), and hypertension, compared with persons with undetected-, and with persons without the corresponding disease. Methods A prospective cohort study of the general population in Nord-Trøndelag, Norway. Persons ≥20 years at baseline 1995–97 were followed until death or June 15, 2016. Cox proportional hazards models were used to compute age and multiple adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association between disease status and all-cause mortality. The number of participants in the hypothyroidism study was 31,960, in the T2DM study 37,957, and in the hypertension study 63,371. Results Mortality was increased in persons with diagnosed type 2 diabetes and hypertension, compared to persons without corresponding disease; HR 1.69 (95% CI 1.55–1.84) and HR 1.23 (95% CI 1.09–1.39), respectively. Among persons with undetected T2DM, the HR was 1.21 (95% CI 1.08–1.37), whilst among undetected hypothyroidism and hypertension, mortality was not increased compared with persons without the diseases. Further, the association with mortality was stronger in persons with long duration of T2DM (HR 1.96 (95% CI 1.57–2.44)) and hypertension (HR 1.32 (95% CI 1.17–1.49)), compared with persons with short duration (HR 1.29 (1.09–1.53) and HR 1.16 (1.03-1-30) respectively). Conclusions Mortality was increased in persons with diagnosed T2DM and hypertension, and in undetected T2DM, compared with persons without the diseases. The strength of the association with mortality in undetected T2DM was however lower compared with persons with diagnosed T2DM, and mortality was not increased in persons with undetected hypothyroidism and hypertension, compared with persons without the diseases. Thus, future research needs to test more thoroughly if early diagnosing of these diseases, such as general population screening, is beneficial for health.
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Affiliation(s)
- Pål Jørgensen
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600, Levanger, Norway
| | - Siri Forsmo
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway
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10
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Modalsli EH, Åsvold BO, Romundstad PR, Langhammer A, Hoff M, Forsmo S, Naldi L, Saunes M. Psoriasis, fracture risk and bone mineral density: the HUNT Study, Norway. Br J Dermatol 2017; 176:1162-1169. [PMID: 27718508 DOI: 10.1111/bjd.15123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND An association between psoriasis and osteoporosis has been reported. OBJECTIVES To investigate, in a large prospective population-based Norwegian study, whether psoriasis is associated with increased risk of forearm or hip fracture; to investigate the cross-sectional association between psoriasis and bone mineral density (BMD) T-score in a subpopulation. METHODS Hospital-derived fracture data from Nord-Trøndelag County (1995-2013) were linked to psoriasis information, BMD measurements and lifestyle factors from the third survey of the Nord-Trøndelag Health Study 2006-08 (HUNT3); socioeconomic data from the National Education Database; and use of medication from the Norwegian Prescription Database. RESULTS Among 48 194 participants in HUNT3, we found no increased risk of forearm or hip fracture in 2804 patients with self-reported psoriasis [overall age- and sex-adjusted hazard ratio 1·03, 95% confidence interval (CI) 0·82-1·31]. No clear association was found between psoriasis and mean BMD T-score; overall age- and sex-adjusted differences in total hip, femoral neck and lumbar spine BMD T-scores were 0·02 (95% CI -0·11 to 0·14), 0·05 (95% CI -0·06 to 0·17) and 0·07 (95% CI -0·09 to 0·24), respectively. No clear association was found between psoriasis and prevalent osteoporosis in either total hip, femoral neck or lumbar spine; overall age- and sex-adjusted odds ratio was 0·77 (95% CI 0·54-1·10). Associations did not change substantially after adjustment for education, smoking, systemic steroid use and body mass index. CONCLUSIONS We found no association between psoriasis and risk of fracture. The study did not indicate reduced BMD T-score or higher prevalence of osteoporosis among patients with psoriasis.
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Affiliation(s)
- E H Modalsli
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - B O Åsvold
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - P R Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Langhammer
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - M Hoff
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, St. Olavs Hospital, Trondheim University Hospital, Norway.,Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - S Forsmo
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - L Naldi
- Centro Studi Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED), Bergamo, Italy.,Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M Saunes
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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11
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Søgaard AJ, Holvik K, Meyer HE, Tell GS, Gjesdal CG, Emaus N, Grimnes G, Schei B, Forsmo S, Omsland TK. Continued decline in hip fracture incidence in Norway: a NOREPOS study. Osteoporos Int 2016; 27:2217-2222. [PMID: 26902091 DOI: 10.1007/s00198-016-3516-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED The previously reported decline in age-adjusted hip fracture rates in Norway during 1999-2008 continued after 2008. The annual number of hip fractures decreased in women and increased in men. INTRODUCTION Norway has among the highest hip fracture incidence rates ever reported despite previously observed declining rates from 1999 through 2008. The aim of the present study was to investigate whether this downward trend continued through 2013, and to compare gender-specific trends in 5 year age-groups during three time periods: 1999-2003, 2004-2008, and 2009-2013. METHODS All hip fractures (cervical, trochanteric, and sub-trochanteric) admitted to Norwegian hospitals were retrieved. Annual age-standardized incidence rates of hip fracture per 10,000 person-years by gender were calculated for the period 1999-2013. Time trends were tested by age-adjusted Poisson regression. RESULTS From 1999 through 2013 there were 140,136 hip fractures in persons aged 50 years and above. Age-adjusted hip fracture incidence rates declined by 20.4 % (95 % CI: 18.6-20.1) in women and 10.8 % (95 % CI: 7.8-13.8) in men, corresponding to an average annual age-adjusted decline of 1.5 % in women and 0.8 % in men. Except for the oldest men, hip fracture rates declined in all age-groups 70 years and older. The average annual number of fractures decreased in women (-0.3 %) and increased in men (+1.1 %). CONCLUSIONS During the past 15 years, hip fracture rates have declined in Norway. The forecasted growing number of older individuals might, however, cause an increase in the absolute number of fractures, with a substantial societal economic and public health burden.
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Affiliation(s)
- A J Søgaard
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
| | - K Holvik
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
| | - H E Meyer
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
- Institute of Health and Society, University of Oslo, 0318, Oslo, Norway
| | - G S Tell
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, 5020, Bergen, Norway
| | - C G Gjesdal
- Department of Clinical Science, University of Bergen, 5020, Bergen, Norway
- Department of Rheumatology, Haukeland University Hospital, 5021, Bergen, Norway
| | - N Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - G Grimnes
- Department of Clinical Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway Tromsø, 9038, Tromsø, Norway
| | - B Schei
- Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, 7005, Trondheim, Norway
| | - S Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | - T K Omsland
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
- Institute of Health and Society, University of Oslo, 0318, Oslo, Norway
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12
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Omsland TK, Eisman JA, Naess Ø, Center JR, Gjesdal CG, Tell GS, Emaus N, Meyer HE, Søgaard AJ, Holvik K, Schei B, Forsmo S, Magnus JH. Educational Inequalities in Post-Hip Fracture Mortality: A NOREPOS Study. J Bone Miner Res 2015; 30:2221-8. [PMID: 26085117 DOI: 10.1002/jbmr.2579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/03/2015] [Accepted: 06/13/2015] [Indexed: 11/06/2022]
Abstract
Hip fractures are associated with high excess mortality. Education is an important determinant of health, but little is known about educational inequalities in post-hip fracture mortality. Our objective was to investigate educational inequalities in post-hip fracture mortality and to examine whether comorbidity or family composition could explain any association. We conducted a register-based population study of Norwegians aged 50 years and older from 2002 to 2010. We measured total mortality according to educational attainment in 56,269 hip fracture patients (NORHip) and in the general Norwegian population. Both absolute and relative educational inequalities in mortality in people with and without hip fracture were compared. There was an educational gradient in post-hip fracture mortality in both sexes. Compared with those with primary education only, the age-adjusted relative risk (RR) of mortality in hip fracture patients with tertiary education was 0.82 (95% confidence interval [CI] 0.77-0.87) in men and 0.79 (95% CI 0.75-0.84) in women. Additional adjustments for Charlson comorbidity index, marital status, and number of children did not materially change the estimates. Regardless of educational attainment, the 1-year age-adjusted mortality was three- to fivefold higher in hip fracture patients compared with peers in the general population without fracture. The absolute differences in 1-year mortality according to educational attainment were considerably larger in hip fracture patients than in the population without hip fracture. Absolute educational inequalities in mortality were higher after hip fracture compared with the general population without hip fracture and were not mediated by comorbidity or family composition. Investigation of other possible mediating factors might help to identify new targets for interventions, based on lower educational attainment, to reduce post-hip fracture mortality.
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Affiliation(s)
- Tone K Omsland
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - John A Eisman
- Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia.,Department of Endocrinology, St Vincent's Hospital, Sydney, Australia.,School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Øyvind Naess
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Jacqueline R Center
- Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia.,Department of Endocrinology, St Vincent's Hospital, Sydney, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Clara G Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway
| | - Haakon E Meyer
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Kristin Holvik
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Berit Schei
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jeanette H Magnus
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway
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13
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Holvik K, Ahmed LA, Forsmo S, Gjesdal CG, Grimnes G, Samuelsen SO, Schei B, Blomhoff R, Tell GS, Meyer HE. No increase in risk of hip fracture at high serum retinol concentrations in community-dwelling older Norwegians: the Norwegian Epidemiologic Osteoporosis Studies. Am J Clin Nutr 2015; 102:1289-96. [PMID: 26377161 DOI: 10.3945/ajcn.115.110528] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/19/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Norway has the highest hip fracture rates worldwide and a relatively high vitamin A intake. Increased fracture risk at high intakes and serum concentrations of retinol (s-retinol) have been observed in epidemiologic studies. OBJECTIVE We aimed to study the association between s-retinol and hip fracture and whether high s-retinol may counteract a preventive effect of vitamin D. DESIGN We conducted the largest prospective analysis of serum retinol and hip fracture to date in 21,774 men and women aged 65-79 y (mean age: 72 y) who attended 4 community-based health studies during 1994-2001. Incident hip fractures occurring up to 10.7 y after baseline were retrieved from electronic hospital discharge registers. Retinol determined by high-pressure liquid chromatography with ultraviolet detection in stored serum was available in 1154 incident hip fracture cases with valid body mass index (BMI) data and in a subcohort defined as a sex-stratified random sample (n = 1418). Cox proportional hazards regression weighted according to the stratified case-cohort design was performed. RESULTS There was a modest increased risk of hip fracture in the lowest compared with the middle quintile of s-retinol (HR: 1.41; 95% CI: 1.09, 1.82) adjusted for sex and study center. The association was attenuated after adjustment for BMI and serum concentrations of α-tocopherol (HR: 1.16; 95% CI: 0.88, 1.51). We found no increased risk in the upper compared with the middle quintile. No significant interaction between serum concentrations of 25-hydroxyvitamin D and s-retinol on hip fracture was observed (P = 0.68). CONCLUSIONS We found no evidence of an adverse effect of high serum retinol on hip fracture or any interaction between retinol and 25-hydroxyvitamin D. If anything, there tended to be an increased risk at low retinol concentrations, which was attenuated after control for confounders. We propose that cod liver oil, a commonly used food supplement in Norway, should not be discouraged as a natural source of vitamin D for fracture prevention.
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Affiliation(s)
- Kristin Holvik
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Department of Global Public Health and Primary Care and
| | - Luai A Ahmed
- Department of Health and Care Sciences, Faculty of Health Sciences, and Institute of Public Health, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clara G Gjesdal
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Guri Grimnes
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Sven Ove Samuelsen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Department of Mathematics
| | - Berit Schei
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway; Department of Obstetrics and Gynecology, St. Olav's Hospital, Trondheim, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, and
| | - Grethe S Tell
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Department of Global Public Health and Primary Care and
| | - Haakon E Meyer
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway; and
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Abstract
BACKGROUND Studies have shown an independent association between poor self-rated health (SRH) and increased mortality. Few studies, however, have investigated any possible impact on SRH of diagnostic labelling. OBJECTIVE To test whether SRH differed in persons with known and unknown hypothyroidism, diabetes mellitus (DM) or hypertension, opposed to persons without these conditions, after 11-year follow-up. METHODS Prospective population-based cohort study in North-Trøndelag County, Norway, HUNT2 (1995-97) to HUNT3 (2006-08). All inhabitants aged 20 years and older were invited. The response rate was 69.5% in HUNT2 and 54.1% in HUNT3. In total, 34144 persons aged 20-70 years were included in the study population. The outcome was poor SRH. RESULTS Persons with known disease had an increased odds ratio (OR) to report poor SRH at follow-up; figures ranging from 1.11 (0.68-1.79) to 2.52 (1.46-4.34) (men with hypothyroidism kept out owing to too few numbers). However, in persons not reporting, but having laboratory results indicating these diseases (unknown disease), no corresponding associations with SRH were found. Contrary, the OR for poor SRH in women with unknown hypothyroidism and unknown hypertension was 0.64 (0.38-1.06) and 0.89 (0.79-1.01), respectively. CONCLUSIONS Awareness opposed to ignorance of hypothyroidism, DM and hypertension seemed to be associated with poor perceived health, suggesting that diagnostic labelling could have a negative effect on SRH. This relationship needs to be tested more thoroughly in future research but should be kept in mind regarding the benefits of early diagnosing of diseases.
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Affiliation(s)
- Pål Jørgensen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, 7489 Trondheim and
| | - Arnulf Langhammer
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Steinar Krokstad
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, 7489 Trondheim and
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15
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Prior JC, Naess M, Langhammer A, Forsmo S. Ovulation Prevalence in Women with Spontaneous Normal-Length Menstrual Cycles - A Population-Based Cohort from HUNT3, Norway. PLoS One 2015; 10:e0134473. [PMID: 26291617 PMCID: PMC4546331 DOI: 10.1371/journal.pone.0134473] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/10/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ovulatory menstrual cycles are essential for women's fertility and needed to prevent bone loss. There is a medical/cultural expectation that clinically normal menstrual cycles are inevitably ovulatory. Currently within the general population it is unknown the proportion of regular, normal-length menstrual cycles that are ovulatory. Thus, the objective of this study was to determine the population point prevalence of ovulation in premenopausal, normally menstruating women. The null hypothesis was that such cycles are ovulatory. METHODS This is a single-cycle, cross-sectional, population-based study-a sub-study of the HUNT3 health study in the semi-rural county (Nord Trøndelag) in mid-Norway. Participants included >3,700 spontaneously (no hormonal contraception) menstruating women, primarily Caucasian, ages 20-49.9 from that county. Participation rate was 51.9%. All reported the date previous flow started. A single, random serum progesterone level was considered ovulatory if ≥9.54 nmol/L on cycle days 14 to -3 days before usual cycle length (CL). RESULTS Ovulation was assessed in 3,168 women mean age 41.7 (interquartile range, [IQR] 36.8 to 45.5), cycle length 28 days (d) (IQR 28 to 28) and body mass index (BMI) 26.3 kg/m2 (95% CI 26.1 to 26.4). Parity was 95.6%, 30% smoked, 61.3% exercised regularly and 18% were obese. 1,545 women with a serum progesterone level on cycle days 14 to -3 were presumed to be in the luteal phase. Of these, 63.3% of women had an ovulatory cycle (n = 978) and 37% (n = 567) were anovulatory. Women with/ without ovulation did not differ in age, BMI, cycle day, menarche age, cigarette use, physical activity, % obesity or self-reported health. There were minimal differences in parity (96.7% vs. 94.5%, P = 0.04) and major differences in progesterone level (24.5 vs. 3.8 nmol/L, P = 0.001). CONCLUSION Anovulation in a random population occurs in over a third of clinically normal menstrual cycles.
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Affiliation(s)
- Jerilynn C. Prior
- Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, Canada
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Marit Naess
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | - Siri Forsmo
- Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, Canada
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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16
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Solbjør M, Skolbekken JA, Østerlie W, Forsmo S. Women's Experiences With Mammography Screening Through 6 Years of Participation--A Longitudinal Qualitative Study. Health Care Women Int 2015; 36:558-77. [PMID: 25510784 DOI: 10.1080/07399332.2014.989438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this article we explore women's experiences with 6 years of mammography screening. Regular and repeated mammography screening is promoted as an important tool for disease prevention among women worldwide. The purpose of the present study was to explore how continued participation in screening influences how women perceive screening and breast cancer. We carried out focus groups with 24 screening participants in 2003 and 2009. Our analysis highlights that while women were excited about the examination in 2003, it was perceived as routine in 2009. Waiting for the results became easier over the years, while stress related to receiving the results letter did not diminish. Knowledge of risk factors for breast cancer did not change. Personal risk assessment remained low, though high incidence of cancer among acquaintances suggested high risk for breast cancer among women in general. Analysis of participant experiences suggests that continuous participation in screening has led surveillance medicine to become a part of ordinary life.
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Affiliation(s)
- Marit Solbjør
- a Department of Social Work and Health Science, Norwegian University of Science and Technology , Trondheim , Norway
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17
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Søgaard AJ, Meyer HE, Emaus N, Grimnes G, Gjesdal CG, Forsmo S, Schei B, Tell GS. Cohort profile: Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Scand J Public Health 2014; 42:804-13. [PMID: 25278275 DOI: 10.1177/1403494814551858] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS This paper describes the history, purpose, data collection and contributions in the research collaboration Norwegian Osteoporosis Epidemiologic Studies (NOREPOS). METHODS NOREPOS encompasses almost 85,000 bone mineral density measurements within Cohort of Norway and data on almost 140,000 hip fractures in Norway 1994-2008. Included are anthropometric measurements, blood pressure, lipids and glucose, and 50 standard questions on sociodemographic factors, diseases and risk factors. Blood samples/DNA are stored. The main research question posed in NOREPOS is why hip fracture rates in Norway are the highest in the world. Data on hip fractures 2009-2013 will be added in 2014. RESULTS Main findings include: Every hour a Norwegian suffers a hip fracture; hip fracture incidence rates declined after 1999; only 16% of patients used anti-osteoporosis drugs 1 year after hip fracture; 25% of patients died within 1 year after the fracture; 12% suffered a new hip fracture within 10 years; rural dwellers had lower hip and forearm fracture incidence than city dwellers; magnesium in tap water may be protective whereas bacterial contamination, cadmium and lead may be harmful to bone health; low serum vitamin D and E levels were associated with higher hip fracture risk; vitamin A was not associated with fracture risk; and abdominal obesity increased the risk of hip fracture when BMI was accounted for. CONCLUSIONS NOREPOS encompasses a unique source of information for aetiological research, genetic studies as well as for biomarkers of osteoporosis and fractures. Because of the increasing number of elderly people in Europe, hip fractures will continue to pose an international public health and health care challenge.
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Affiliation(s)
| | - Haakon E Meyer
- Norwegian Institute of Public Health, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Guri Grimnes
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway Division of Internal Medicine, University Hospital of North Norway, Tromsø, Tromsø, Norway
| | - Clara Gram Gjesdal
- Department of Clinical Science, University of Bergen, Bergen Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Berit Schei
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Solbakken SM, Magnus JH, Meyer HE, Emaus N, Tell GS, Holvik K, Grimnes G, Forsmo S, Schei B, Søgaard AJ, Omsland TK. Impact of comorbidity, age, and gender on seasonal variation in hip fracture incidence. A NOREPOS study. Arch Osteoporos 2014; 9:191. [PMID: 25134979 DOI: 10.1007/s11657-014-0191-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/28/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Based on a total of 136,140 hip fractures, we found a distinct seasonal variation in hip fracture incidence present in subgroups defined by age, gender, and comorbidity. The seasonal variation was most pronounced in the youngest and the healthiest patients. PURPOSE The purpose of this study was to examine the possible seasonal variation in hip fracture incidence in Norway by comorbidity, age, and gender. METHODS Data were retrieved from the NOREPOS Hip Fracture Database containing all hip fractures in Norway during the time period 1994-2008. Hip fractures were identified by computerized hospital discharge diagnoses. Charlson comorbidity index was calculated based on additional diagnoses and categorized (0, 1, and ≥2). Summer was defined as June, July, and August and winter as December, January, and February. Incidence rate ratios for hip fracture according to season were calculated by negative binomial models. RESULTS In patients aged 50-103 years, 136,140 eligible fractures were identified (72.5 % women). The relative risk of hip fracture in winter versus summer was 1.40 (95 % confidence interval (CI) 1.36-1.45) in men and 1.26 (95 % CI 1.23-1.28) in women. June had the lowest number of fractures in both genders. We found seasonal variation in all subgroups by age and gender, although least pronounced in patients >79 years. There was a significant interaction between season and comorbidity (p = 0.022). When comparing winter to summer, we found relative risks of 1.40 (95 % CI 1.31-1.50) in patients with Charlson index = 0, 1.29 (95 % CI 1.19-1.40) in patients with Charlson index = 1, and 1.18 (95 % CI 1.08-1.28) in patients with Charlson index ≥2. CONCLUSIONS There was a distinct seasonal variation in hip fracture incidence, present in all subgroups of gender, age, or comorbidity. This variation should be accounted for when planning health-care services.
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Affiliation(s)
- Siri M Solbakken
- Institute of Health and Society, Department of Community Medicine, University of Oslo, PO Box 1130, Blindern, 0318, Oslo, Norway,
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Omsland TK, Emaus N, Tell GS, Magnus JH, Ahmed LA, Holvik K, Center J, Forsmo S, Gjesdal CG, Schei B, Vestergaard P, Eisman JA, Falch JA, Tverdal A, Søgaard AJ, Meyer HE. Mortality following the first hip fracture in Norwegian women and men (1999-2008). A NOREPOS study. Bone 2014; 63:81-6. [PMID: 24607943 DOI: 10.1016/j.bone.2014.02.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Tone K Omsland
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Institute of Health and Society, Department of Community Medicine, University of Oslo, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Nina Emaus
- Department of Health and Care Sciences, University of Tromsø, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Jeanette H Magnus
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Norway
| | - Luai Awad Ahmed
- Department of Health and Care Sciences, University of Tromsø, Norway
| | - Kristin Holvik
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Jacqueline Center
- Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Siri Forsmo
- Institute of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Clara G Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Berit Schei
- Institute of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway
| | | | - John A Eisman
- Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, NSW, Australia; Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Jan A Falch
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Aage Tverdal
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Haakon E Meyer
- Institute of Health and Society, Department of Community Medicine, University of Oslo, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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Abstract
OBJECTIVE To explore whether awareness versus unawareness of thyroid dysfunction, diabetes mellitus or hypertension is associated with self-rated health. DESIGN Large-scale, cross-sectional population-based study. The association between thyroid function, diabetes mellitus and blood pressure and self-rated health was explored by multiple logistic regression analysis. SETTING The second survey of the Nord-Trøndelag Health Study, HUNT2, 1995-1997. PARTICIPANTS 33 734 persons aged 40-70 years. PRIMARY OUTCOME MEASURES Logistic regression was used to estimate ORs for good self-rated health as a function of thyroid status, diabetes mellitus status and blood pressure status. RESULTS Persons aware of their hypothyroidism, diabetes mellitus or hypertension reported poorer self-rated health than individuals without such conditions. Women with unknown and subclinical hypothyroidism reported better self-rated health than women with normal thyroid status. In women and men, unknown and probable diabetes as well as unknown mild/moderate hypertension was not associated with poorer health. Furthermore, persons with unknown severe hypertension reported better health than normotensive persons. CONCLUSIONS People with undiagnosed but prevalent hypothyroidism, diabetes mellitus and hypertension often have good self-rated health, while when aware of their diagnoses, they report reduced self-rated health. Use of screening, more sensitive tests and widened diagnostic criteria might have a negative effect on perceived health in the population.
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Affiliation(s)
- Pål Jørgensen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnulf Langhammer
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Steinar Krokstad
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Svare A, Nilsen TIL, Asvold BO, Forsmo S, Schei B, Bjøro T, Langhammer A. Does thyroid function influence fracture risk? Prospective data from the HUNT2 study, Norway. Eur J Endocrinol 2013; 169:845-52. [PMID: 24031093 DOI: 10.1530/eje-13-0546] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To prospectively study the relation between TSH and risk of hip and forearm fractures. DESIGN A population-based cohort study. METHODS In a substudy of the second survey of the Nord Trøndelag Health Study, Norway (HUNT2, 1995-97), linked with a hospital-based fracture registry, we investigated the relation between baseline TSH and risk of hip and/or forearm fractures. POPULATION A total of 16 610 women and 8595 men aged 40 years or more, without previous self-reported thyroid disease and hip or forearm fractures. RESULTS During 12.5 years follow-up, a total of 1870 women and 342 men experienced hip or forearm fractures. Overall, there was no relation between baseline TSH and fracture risk. However, there was weak evidence that women with TSH <0.5 and >3.5 mU/l had a slightly increased risk of hip fractures (hazard ratio (HR) 1.30, 95% CI 0.97-1.94 and HR 1.19, 95% CI 0.93-1.52) compared with the reference group with TSH of 1.5-2.4 mU/l. Supplementary analyses showed higher hip fracture risk in women with TSH >4.0 mU/l and negative thyroid peroxidase antibodies (TPOAb) compared with the reference group (HR 1.75, 95% CI 1.24-2.46). CONCLUSION We found no statistically significant relation between baseline TSH and subsequent fracture risk, but the data suggest a weak positive association with hip fracture risk among women with both low and high TSH. The latter association was confined to women with negative TPOAb status.
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Affiliation(s)
- Anders Svare
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
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Natland Fagerhaug T, Forsmo S, Jacobsen GW, Midthjell K, Andersen LF, Ivar Lund Nilsen T. A prospective population-based cohort study of lactation and cardiovascular disease mortality: the HUNT study. BMC Public Health 2013; 13:1070. [PMID: 24219620 PMCID: PMC3840666 DOI: 10.1186/1471-2458-13-1070] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 11/05/2013] [Indexed: 12/02/2022] Open
Abstract
Background Recent studies suggest that lactation has long-term effects on risk for cardiovascular disease in women, but the effects on cardiovascular mortality are less well known. Method In a Norwegian population-based prospective cohort study, we studied the association of lifetime duration of lactation with cardiovascular mortality in 21,889 women aged 30 to 85 years who attended the second Nord-Trøndelag Health Survey (HUNT2) in 1995–1997. The cohort was followed for mortality through 2010 by a linkage with the Cause of Death Registry. Adjusted hazard ratios (HR) for death from all causes and cardiovascular disease were calculated using Cox regression. Results During follow-up, 1,246 women died from cardiovascular disease. Parous women younger than 65 years who had never lactated had a higher cardiovascular mortality than the reference group of women who had lactated 24 months or more (HR 2.77, 95% confidence interval [CI]: 1.28, 5.99). There was some evidence of a U-shaped association, where women who reported lactating 7–12 months had a HR of 0.55 (95% CI: 0.27, 1.09). No clear associations were observed among women 65 years or older. Conclusions Excess cardiovascular mortality rates were observed among parous women younger than 65 years who had never lactated. These findings support the hypothesis that lactation may have long-term influences on maternal cardiovascular health.
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Affiliation(s)
- Tone Natland Fagerhaug
- Department of Public Health and General Practice, Norwegian University of Science and Technology, PO Box 8904 MTFS, 7491 Trondheim, Norway.
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Odland ML, Strand KM, Nordbø SA, Forsmo S, Austgulen R, Iversen AC. Changing patterns of cytomegalovirus seroprevalence among pregnant women in Norway between 1995 and 2009 examined in the Norwegian Mother and Child Cohort Study and two cohorts from Sor-Trondelag County: a cross-sectional study. BMJ Open 2013; 3:e003066. [PMID: 24078749 PMCID: PMC3787407 DOI: 10.1136/bmjopen-2013-003066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To examine cytomegalovirus (CMV) seroprevalence and associated risk factors for CMV seropositivity in pregnant Norwegian women. DESIGN Cross-sectional study. SETTING The Norwegian Mother and Child Cohort Study (MoBa) in addition to two random samples of pregnant women from Sør-Trøndelag County in Norway. PARTICIPANTS Study group 1 were 1000 pregnant women, randomly selected among 46 127 pregnancies in the MoBa (1999-2006) at 17/18 week of gestation. Non-ethnic Norwegian women were excluded. Study groups 2 (n=1013 from 1995) and 3 (n=979 from 2009) were pregnant women at 12 weeks of gestation from Sør-Trøndelag County. OUTCOME MEASURES CMV seropositivity in blood samples from pregnant Norwegian women. RESULTS CMV-IgG antibodies were detected in 59.9% and CMV-IgM antibodies in 1.3% of pregnant Norwegian women in study group 1. Women from North Norway demonstrated a higher CMV-IgG seroprevalence (72.1%) than women from South Norway (58.5%) (OR 1.83, 95% CI 1.17 to 2.88). The CMV-IgG seroprevalence was higher among women with low education (70.5%) compared to women with higher education (OR 2.20, 95% CI 1.24 to 3.90). Between 1995 and 2009 the CMV-IgG seroprevalence increased from 63.1% to 71.4% in pregnant women from Sør-Trøndelag County (study groups 2 and 3; p<0.001). The highest CMV-IgG seroprevalence (79.0%) was observed among the youngest pregnant women (<25 years) from Sør-Trøndelag County in 2009 (study group 3). CONCLUSIONS The CMV-IgG seroprevalence of pregnant Norwegian women varies with geographic location and educational level. Additionally, the CMV-IgG seroprevalence appears to have increased over the last years, particularly among young pregnant women.
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Affiliation(s)
- Maria Lisa Odland
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kristin M Strand
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Svein Arne Nordbø
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Rigmor Austgulen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ann-Charlotte Iversen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Holvik K, Ahmed LA, Forsmo S, Gjesdal CG, Grimnes G, Samuelsen SO, Schei B, Blomhoff R, Tell GS, Meyer HE. Low serum levels of 25-hydroxyvitamin D predict hip fracture in the elderly: a NOREPOS study. J Clin Endocrinol Metab 2013; 98:3341-50. [PMID: 23678033 DOI: 10.1210/jc.2013-1468] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Despite considerable interest, the relationship between circulating 25-hydroxyvitamin D and the risk of hip fracture is not fully established. OBJECTIVE The objective of the study was to study the association between serum 25-hydroxyvitamin D concentrations [s-25(OH)D] and the risk of hip fracture in Norway, a high-latitude country that has some of the highest hip fracture rates worldwide. METHODS A total of 21 774 men and women aged 65-79 years attended 4 community-based health studies during 1994-2001. Information on subsequent hip fractures was retrieved from electronic hospital discharge registers, with a maximum follow-up of 10.7 years. Using a stratified case-cohort design, s-25(OH)D was determined by HPLC-atmospheric pressure chemical ionization-mass spectrometry in stored serum samples in hip fracture cases (n = 1175; 307 men, 868 women) and in gender-stratified random samples (n = 1438). Cox proportional hazards regression adapted for the case-cohort design was performed. RESULTS We observed an inverse association between s-25(OH)D and hip fracture; those with s-25(OH)D in the lowest quartile (<42.2 nmol/L) had a 38% [95% confidence interval (CI) 9-74%] increased risk of hip fracture compared with the highest quartile (≥67.9 nmol/L) in a model accounting for age, gender, study center, and body mass index. The association was stronger in men than in women: hazard ratio 1.65 (95% CI 1.04-2.61) vs hazard ratio 1.25 (95% CI 0.95-1.65). CONCLUSION 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.
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Affiliation(s)
- Kristin Holvik
- Department of Public Health and Primary Health Care, Institute of Medicine, University of Bergen, 5020 Bergen, Norway.
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Hatlen P, Langhammer A, Forsmo S, Carlsen SM, Amundsen T. Bone mass density, fracture history, self-reported osteoporosis as proxy variables for estrogen and the risk of non-small-cell lung cancer—A population based cohort study, the HUNT study: Are proxy variables friends or faults? Lung Cancer 2013; 81:39-46. [DOI: 10.1016/j.lungcan.2013.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 03/25/2013] [Accepted: 04/01/2013] [Indexed: 11/30/2022]
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Omsland TK, Emaus N, Tell GS, Ahmed LA, Center JR, Nguyen ND, Gjesdal CG, Forsmo S, Schei B, Søgaard AJ, Meyer HE. Ten-year risk of second hip fracture. A NOREPOS study. Bone 2013; 52:493-7. [PMID: 23000506 DOI: 10.1016/j.bone.2012.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/07/2012] [Accepted: 09/09/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Second hip fracture risk is elevated after the first, however whether risk differs with age, by sex or over time is not well known. OBJECTIVE To examine the risk of second hip fracture by sex, age and time after first hip fracture. DESIGN Data on all hip fractures in subjects 50 years and older and treated in Norwegian hospitals during 1999-2008 were retrieved. Surgical procedure codes and additional diagnosis codes were used to define incident fractures. Survival analyses with and without adjustment for competing risk of death were used to estimate the risk of second hip fracture. RESULTS Among the 81,867 persons who sustained a first hip fracture, 6161 women and 1782 men suffered a second hip fracture during follow-up. The overall age-adjusted hazard ratio (HR) of a second hip fracture did not differ between the sexes (women versus men, HR=1.03; 95% confidence interval (CI): 0.98-1.09). Taking competing risk of death into account, the corresponding age-adjusted HR of a second hip fracture was 1.40 (95% CI: 1.33-1.47) in women compared to men. The greater risk in women was due to a higher mortality in men. Based on competing risk analyses, we estimate that 15% of women and 11% of men will have suffered a second hip fracture within 10 years after the first hip fracture. The ten-year cumulative incidence was above 10% in all age-groups, except in men 90 years and older. CONCLUSION Fracture preventive strategies have a large potential in both women and men who suffer their first hip fracture due to the high risk of another hip fracture.
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Affiliation(s)
- Tone K Omsland
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
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Natland ST, Andersen LF, Nilsen TIL, Forsmo S, Jacobsen GW. Maternal recall of breastfeeding duration twenty years after delivery. BMC Med Res Methodol 2012; 12:179. [PMID: 23176436 PMCID: PMC3568415 DOI: 10.1186/1471-2288-12-179] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 10/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background Studies on the health benefits from breastfeeding often rely on maternal recall of breastfeeding. Although short-term maternal recall has been found to be quite accurate, less is known about long-term accuracy. The objective of this study was to assess the accuracy of long-term maternal recall of breastfeeding duration. Methods In a prospective study of pregnancy and birth outcome, detailed information on breastfeeding during the child’s first year of life was collected from a cohort of Norwegian women who gave birth in 1986–88. Among 374 of the participants, data on breastfeeding initiation and duration were compared to recalled data obtained from mailed questionnaires some 20 years later. Intraclass correlation coefficient (ICC), Bland-Altman plot, and Kappa statistics were used to assess the agreement between the two sources of data. Logistic regression was used to assess predictors of misreporting breastfeeding duration by more than one month. Results Recorded and recalled breastfeeding duration were strongly correlated (ICC=0.82, p < 0.001). Nearly two thirds of women recalled their breastfeeding to within one month. Recall data showed a modest median overestimation of about 2 weeks. There were no apparent systematic discrepancies between the two sources of information, but recall error was predicted by the age when infants were introduced to another kind of milk. Across categories of breastfeeding, the overall weighted Kappa statistic showed an almost perfect agreement (κ = 0.85, 95% confidence interval [CI] 0.82 – 0.88). Conclusion Breastfeeding duration was recalled quite accurately 20 years after mothers gave birth in a population where breastfeeding is common and its duration long.
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Affiliation(s)
- Siv Tone Natland
- Department of Public Health and General Practice, Norwegian University of Science and Technology, PO Box 8904 MTFS, 7491 Trondheim, Norway.
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Solbjør M, Skolbekken JA, Sætnan AR, Hagen AI, Forsmo S. Mammography screening and trust: the case of interval breast cancer. Soc Sci Med 2012; 75:1746-52. [PMID: 22906524 DOI: 10.1016/j.socscimed.2012.07.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 07/17/2012] [Accepted: 07/20/2012] [Indexed: 11/30/2022]
Abstract
Interval cancer is cancer detected between screening rounds among screening participants. In the Norwegian Breast Cancer Screening Programme, 19 per 10,000 screened women are diagnosed with interval cancer. We conducted semi-structured interviews with 26 such women. The women interpreted their interval breast cancer in two ways: that mammography can never be completely certain, or as an experience characterized by shock and doubts about the technology and the conduct of the medical experts. Being diagnosed with interval cancer thus influenced their trust in mammography, but not necessarily to the point of creating distrust. The women saw themselves as exceptions in an otherwise beneficial screening programme. Convinced that statistics had shown benefits from mammography screening and knowing others whose malignant tumours had been detected in the programme, the women bracketed their own experiences and continued trusting mammography screening. Facing a potentially lethal disease and a lack of alternatives to mammography screening left the women with few options but to trust the programme in order to maintain hope. In other words, trust may not only be a basis for hope, but also a consequence of it.
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Affiliation(s)
- Marit Solbjør
- Norwegian University of Science and Technology, Medical Faculty, Department of Public Health and General Practice, Postbox 8905, MTFS, 7491 Trondheim, Norway.
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Omsland TK, Holvik K, Meyer HE, Center JR, Emaus N, Tell GS, Schei B, Tverdal A, Gjesdal CG, Grimnes G, Forsmo S, Eisman JA, Søgaard AJ. Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates. A NOREPOS study. Eur J Epidemiol 2012; 27:807-14. [DOI: 10.1007/s10654-012-9711-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/13/2012] [Indexed: 01/01/2023]
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Natland ST, Nilsen TIL, Midthjell K, Andersen LF, Forsmo S. Lactation and cardiovascular risk factors in mothers in a population-based study: the HUNT-study. Int Breastfeed J 2012; 7:8. [PMID: 22713515 PMCID: PMC3489591 DOI: 10.1186/1746-4358-7-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 06/03/2012] [Indexed: 11/25/2022] Open
Abstract
Background Lactation has beneficial short term effects on maternal metabolic health, but the long term effects are less well known. Methods We studied the association between lifetime duration of lactation and cardiovascular risk factors in mothers later in life among 21,368 parous women aged 20 to 85 years attending the second Nord-Trøndelag Health Study (HUNT2) in 1995–1997, Norway, a cross-sectional population-based study. General linear modelling was used to calculate mean values of known cardiovascular risk factor levels in five categories of lifetime duration of lactation. Logistic regression was conducted to estimate odds ratios of hypertension, obesity and diabetes. Results Among women aged 50 years or younger, lifetime duration of lactation was significantly and inversely associated with body mass index (P-trend, < 0.001), waist circumference (P-trend, < 0.001), systolic and diastolic blood pressure (both P-trends, < 0.001), and serum levels of triglycerides, total cholesterol and low density lipoprotein cholesterol (all P-trends, < 0.001) after adjustment for covariates. Parous women aged 50 years or younger who had never lactated had higher prevalence of hypertension, obesity and diabetes. In this age group, compared to women who had lactated for 24 months or more, parous women who had never lactated had an OR for hypertension of 1.88 (95% CI 1.41, 2.51), an OR for obesity of 3.37 (95% CI 2.51, 4.51) and an OR for diabetes of 5.87 (95% CI 2.25, 15.3). Among women older than 50 years there were no clear associations. Conclusion Lifetime duration of lactation was associated with long term reduced cardiovascular risk levels in mothers aged 50 years or younger.
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Affiliation(s)
- Siv T Natland
- Department of Public Health and General Practice, Norwegian University of Science and Technology, PO Box 8904 MTFS, 7491, Trondheim, Norway.
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Grønskag AB, Romundstad P, Forsmo S, Langhammer A, Schei B. Excess mortality after hip fracture among elderly women in Norway. The HUNT study. Osteoporos Int 2012; 23:1807-11. [PMID: 22068386 DOI: 10.1007/s00198-011-1811-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 09/30/2011] [Indexed: 11/29/2022]
Abstract
UNLABELLED We wanted to study mortality after hip fractures among elderly women in Norway. We found that excess mortality was highest short time after hip fracture, but persisted for several years after the fracture. The excess mortality was not explained by pre-fracture medical conditions. INTRODUCTION The purpose of the present study was to investigate short and long term mortality after hip fracture, and to evaluate how comorbidity, bone mineral density, and lifestyle factors affect the survival after hip fractures. METHODS The study cohort emerges from a population-based health survey in the county of Nord-Trøndelag, Norway. Women aged 65 or more at participation at the health survey who sustained a hip fracture after attending the health survey are cases in this study (n = 781). A comparison cohort was constructed based on participants at HUNT 2 with no history of hip fractures (n = 3, 142). Kaplan-Meier survival curves were used to evaluate crude survival, and Cox regression analyses were used to study age-adjusted hazard ratios for mortality and for multivariable analyses involving relevant covariates. RESULTS Mean length of follow-up after fracture was 2.8 years. Within the first 3 months of follow-up, 78 (10.0%) of the hip fracture patients died, compared to only 39 (1.7%) in the control group. HR for mortality 3 months after hip fracture was 6.5 (95% CI 4.2-9.6). For the entire follow-up period women who sustained a hip fracture had an HR for mortality of 1.9 (95% CI 1.6-2.3), compared with women without a hip fracture. CONCLUSIONS We found that elderly women who sustained a hip fracture had increased mortality risk. The excess mortality was highest short time after the fracture, but persisted for several years after the fracture, and was not explained by pre-fracture medical conditions.
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Affiliation(s)
- A B Grønskag
- Department of Public Health and General Practice, Norwegian University of Science and Technology, PB 8905, 7491, Trondheim, Norway.
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Skolbekken JA, Østerlie W, Forsmo S. Risk categorisation through standard deviations – the challenge of bone density measurements: A focus group study among women attending the Nord-Trøndelag Health Study (HUNT). Health, Risk & Society 2012. [DOI: 10.1080/13698575.2012.661408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Langsetmo L, Hitchcock CL, Kingwell EJ, Davison KS, Berger C, Forsmo S, Zhou W, Kreiger N, Prior JC. Physical activity, body mass index and bone mineral density-associations in a prospective population-based cohort of women and men: the Canadian Multicentre Osteoporosis Study (CaMos). Bone 2012; 50:401-8. [PMID: 22154839 PMCID: PMC3737114 DOI: 10.1016/j.bone.2011.11.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/27/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Physical activity (PA) is an important modifiable risk factor for both bone mineral density (BMD) and body mass index (BMI). However, BMI is itself strongly predictive of BMD. Our aim was to determine the association between PA and BMD, with consideration of BMI as a potential mediating factor. METHODS The Canadian Multicentre Osteoporosis Study (CaMos) is a population-based prospective cohort study of Canadian women and men. PA was determined from interviewer-administered questionnaires at baseline and Year 5 and summarized as daily energy expenditure in total metabolic equivalents of the task multiplied by minutes/day (MET*m/d). Height, weight, and total hip and lumbar spine BMD were measured at baseline and Year 5. General linear models assessed relationships between PA and BMD, both cross-sectionally (baseline PA with baseline BMD) and longitudinally (average PA and change in PA with change in BMD). BMI was considered as a mediating factor. Potential confounders included age, center, education, caffeine intake, alcohol exposure, smoking history, history of weight-cycling, age at menarche, past use of oral contraceptives, history of >3 months missed menstruation, menopausal status, and antiresorptive use, as relevant. RESULTS The study included 2855 men and 6442 women. PA was inversely associated with BMI at baseline, and an increase in PA between baseline and Year 5 was associated with a decrease in BMI, with 0.41 (95% CI: 0.22, 0.60) kg/m(2) loss per 1000 MET*m/d increase (in men) and 0.40 (95% CI: 0.23, 0.57) kg/m(2) loss per 1000 MET*m/d increase (in women). BMI was strongly associated with BMD, both cross-sectionally and longitudinally. However, increased PA was associated with a small increase in total hip BMD, 0.004 (95% CI: 0.000-0.008) g/cm(2) per 1000 MET*m/d (in men) and 0.003 (95% CI: 0.000-0.007) g/cm(2) per 1000 MET*m/d (in women). Average PA was associated with an increase in lumbar spine BMD in women, but not in men; it was not associated with change in total hip BMD in either sex. CONCLUSION Increased PA is associated with an increase in BMD and a concomitant decrease in BMI. These findings suggest that population-level interventions to increase PA would favorably impact bone and other health outcomes.
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Affiliation(s)
- L Langsetmo
- Canadian Multicentre Osteoporosis Study, McGill University Hospital Centre Research Institute, Montréal, CA
| | | | - EJ Kingwell
- Department of Medicine (Neurology), University of British Columbia, Vancouver, CA
| | - KS Davison
- Centre hospitalier universitaire de Québec (CHUQ) Research Centre and Centre hospitalier de l’Université Laval (CHUL), Québec, CA
| | - C Berger
- Canadian Multicentre Osteoporosis Study, McGill University Hospital Centre Research Institute, Montréal, CA
| | - S. Forsmo
- Head, Department of Family Practice and Public Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - W Zhou
- Canadian Multicentre Osteoporosis Study, McGill University Hospital Centre Research Institute, Montréal, CA
| | - N Kreiger
- Department of Epidemiology, University of Toronto and Cancer Care Ontario, Toronto, CA
| | - JC Prior
- Department of Medicine (Endocrinology) and Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, CA
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Solbjør M, Skolbekken JA, Sætnan AR, Hagen AI, Forsmo S. Could screening participation bias symptom interpretation? An interview study on women's interpretations of and responses to cancer symptoms between mammography screening rounds. BMJ Open 2012; 2:bmjopen-2012-001508. [PMID: 23148341 PMCID: PMC3532989 DOI: 10.1136/bmjopen-2012-001508] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore how women with negative mammography screening results, but who were later diagnosed with interval breast cancer, reacted when they observed breast symptoms that could indicate malignancy in-between screening rounds. DESIGN Semistructured individual interviews with women who have been diagnosed with breast cancer during mammography screening intervals. SETTING Two breast diagnostic units covering two counties in Norway. PARTICIPANTS 26 women diagnosed with interval breast cancer. RESULTS Women with a screening negative result react in two ways when experiencing a possible symptom of breast cancer. Among 24 women with a self-detected palpable lesion, 14 sought medical advice immediately. Their argument was to dispose of potential cancer as soon as possible. Ten women delayed seeking medical advice, explaining their delay as a result of practical difficulties such as holidays, uncertainty about the symptom, and previous experiences of healthcare services' ability to handle diffuse symptoms. Also, a recent negative mammography scan led some women to assume that the palpable lesion was benign and wait for the next screening round. CONCLUSIONS Participating in mammography screening may contribute to a postponed reaction to breast cancer symptoms, although most women acted rapidly when detecting a palpable breast lesion. Furthermore, screening participation does not necessarily increase awareness of breast cancer symptoms.
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Affiliation(s)
- Marit Solbjør
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medical Faculty, Trondheim, Norway
| | - John-Arne Skolbekken
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ann Rudinow Sætnan
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Irene Hagen
- Department of Breast and Endocrine Surgery, Trondheim University Hospital, Trondheim, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medical Faculty, Trondheim, Norway
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Solbjør M, Forsmo S, Skolbekken JA, Sætnan AR. Experiences of Recall After Mammography Screening—A Qualitative Study. Health Care Women Int 2011; 32:1009-27. [DOI: 10.1080/07399332.2011.565530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Roten LT, Fenstad MH, Forsmo S, Johnson MP, Moses EK, Austgulen R, Skorpen F. A low COMT activity haplotype is associated with recurrent preeclampsia in a Norwegian population cohort (HUNT2). Mol Hum Reprod 2011; 17:439-46. [PMID: 21355050 PMCID: PMC3116680 DOI: 10.1093/molehr/gar014] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/23/2011] [Accepted: 02/17/2011] [Indexed: 01/15/2023] Open
Abstract
The etiology of preeclampsia is complex, with susceptibility being attributable to multiple environmental factors and a large genetic component. Although many candidate genes for preeclampsia have been suggested and studied, the specific causative genes still remain to be identified. Catechol-O-methyltransferase (COMT) is an enzyme involved in catecholamine and estrogen degradation and has recently been ascribed a role in development of preeclampsia. In the present study, we have examined the COMT gene by genotyping the functional Val108/158Met polymorphism (rs4680) and an additional single-nucleotide polymorphism, rs6269, predicting COMT activity haplotypes in a large Norwegian case/control cohort (n(cases)= 1135, n(controls)= 2262). A low COMT activity haplotype is associated with recurrent preeclampsia in our cohort. This may support the role of redox-regulated signaling and oxidative stress in preeclampsia pathogenesis as suggested by recent studies in a genetic mouse model. The COMT gene might be a genetic risk factor shared between preeclampsia and cardiovascular diseases.
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Affiliation(s)
- L T Roten
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim 7006, Norway.
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Williams LJ, Bjerkeset O, Langhammer A, Berk M, Pasco JA, Henry MJ, Schei B, Forsmo S. The association between depressive and anxiety symptoms and bone mineral density in the general population: the HUNT Study. J Affect Disord 2011; 131:164-71. [PMID: 21211851 DOI: 10.1016/j.jad.2010.11.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 10/13/2010] [Accepted: 11/18/2010] [Indexed: 01/27/2023]
Abstract
BACKGROUND Psychiatric disorders may be risk factors for reduced bone mineral density (BMD). Longitudinal evidence is limited and this is yet to be examined among community-dwelling adults with anxiety. We aimed to investigate the cross-sectional and longitudinal relationships between anxiety and depressive symptoms and BMD. METHOD This study examined data from the second Nord-Trondelag Health Study (1995-1997; 1194 men and 7842 women) and a follow-up conducted in 2001 (697 men and 2751 women). Symptomatology was ascertained using the Hospital Anxiety and Depression Scale and BMD was measured at the forearm using single-energy X-ray absorptiometry. Information on medication use and lifestyle was self-reported, and these, together with anthropometric measures were tested in multivariate analyses. RESULTS In men, adjusted BMD was 2.6% lower at the ultradistal forearm for those with depressive symptoms and 2.6% lower at the ultradistal and 2.0% lower at the distal forearm for those with anxiety symptoms. In women, adjusted BMD at the distal and ultradistal forearm was lower for heavier women with depressive symptoms but this relationship diminished with decreasing weight. Forearm BMD was similar for women with or without anxiety symptoms. Longitudinally, neither depressive nor anxiety symptoms were associated with bone loss over 4.6 years. LIMITATIONS Findings cannot be generalised to other skeletal sites and a longer follow-up period may be necessary to detect differences in bone loss. CONCLUSIONS These results indicate that depressive and anxiety symptoms are cross-sectionally associated with reduced BMD. These findings provide further evidence to support monitoring BMD in individuals diagnosed with psychiatric illness.
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Affiliation(s)
- Lana J Williams
- University of Melbourne, Department of Clinical and Biomedical Sciences: Barwon Health, Geelong, Australia.
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Aune G, Lian AM, Tingulstad S, Torp SH, Forsmo S, Reseland JE, Stunes AK, Syversen U. Increased circulating hepatocyte growth factor (HGF): a marker of epithelial ovarian cancer and an indicator of poor prognosis. Gynecol Oncol 2011; 121:402-6. [PMID: 21284996 DOI: 10.1016/j.ygyno.2010.12.355] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Hepatocyte growth factor (HGF) has been described to be increased in different cancers. In the present study we wanted to investigate whether HGF in serum can distinguish between benign and malignant ovarian tumors, and whether serum HGF levels can predict the outcome in patients with ovarian carcinomas. METHODS We included 123 consecutive patients appointed for laparotomy due to a pelvic mass. Preoperative levels of serum cancer antigen 125 (CA 125), HGF and HGF activator (HGFA) were quantified with immunological methods. We performed immunohistochemical analyses of HGFα, HGFβ and the receptor c-Met. Five-year survival of patients with advanced disease (stage III and stage IV) was analyzed with the Kaplan-Meier method. RESULTS Sixty patients had ovarian carcinomas, 23 borderline tumors, and 40 benign ovarian tumors. Patients with ovarian carcinomas had significantly higher preoperative HGF and CA 125 serum levels than patients with benign ovarian tumors, and borderline tumors. Patients with borderline tumors had significantly higher CA 125 values than benign cases. A combination of CA 125 and HGF increased the specificity in predicting carcinoma. We observed abundant HGFα, HGFβ and c-Met expressions in all ovarian tumors. Patients with advanced disease and preoperative serum HGF values ≥2SD above reference value had a shorter disease-free survival than patients with advanced disease and serum HGF <2SD above reference value. CONCLUSIONS HGF in serum is an indicator of ovarian carcinoma in women with a pelvic mass, and of a poor prognosis in advanced ovarian cancer.
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Affiliation(s)
- Guro Aune
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Fenstad MH, Johnson MP, Løset M, Mundal SB, Roten LT, Eide IP, Bjørge L, Sande RK, Johansson AK, Dyer TD, Forsmo S, Blangero J, Moses EK, Austgulen R. STOX2 but not STOX1 is differentially expressed in decidua from pre-eclamptic women: data from the Second Nord-Trondelag Health Study. Mol Hum Reprod 2010; 16:960-8. [PMID: 20643876 PMCID: PMC2989830 DOI: 10.1093/molehr/gaq064] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 07/09/2010] [Accepted: 07/14/2010] [Indexed: 02/07/2023] Open
Abstract
Variation in the Storkhead box-1 (STOX1) gene has previously been associated with pre-eclampsia. In this study, we assess candidate single nucleotide polymorphisms (SNPs) in STOX1 in an independent population cohort of pre-eclamptic (n = 1.139) and non-pre-eclamptic (n = 2.269) women (the HUNT2 study). We also compare gene expression levels of STOX1 and its paralogue, Storkhead box-2 (STOX2) in decidual tissue from pregnancies complicated by pre-eclampsia and/or fetal growth restriction (FGR) (n = 40) to expression levels in decidual tissue from uncomplicated pregnancies (n = 59). We cannot confirm association of the candidate SNPs to pre-eclampsia (P > 0.05). For STOX1, no differential gene expression was observed in any of the case groups, whereas STOX2 showed significantly lower expression in deciduas from pregnancies complicated by both pre-eclampsia and FGR as compared with controls (P = 0.01). We further report a strong correlation between transcriptional alterations reported previously in choriocarcinoma cells over expressing STOX1A and alterations observed in decidual tissue of pre-eclamptic women with FGR.
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Affiliation(s)
- M H Fenstad
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim 7006, Norway.
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Fenstad MH, Johnson MP, Roten LT, Aas PA, Forsmo S, Klepper K, East CE, Abraham LJ, Blangero J, Brennecke SP, Austgulen R, Moses EK. Genetic and molecular functional characterization of variants within TNFSF13B, a positional candidate preeclampsia susceptibility gene on 13q. PLoS One 2010; 5:e12993. [PMID: 20927378 PMCID: PMC2947510 DOI: 10.1371/journal.pone.0012993] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 09/03/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preeclampsia is a serious pregnancy complication, demonstrating a complex pattern of inheritance. The elucidation of genetic liability to preeclampsia remains a major challenge in obstetric medicine. We have adopted a positional cloning approach to identify maternal genetic components, with linkages previously demonstrated to chromosomes 2q, 5q and 13q in an Australian/New Zealand familial cohort. The current study aimed to identify potential functional and structural variants in the positional candidate gene TNFSF13B under the 13q linkage peak and assess their association status with maternal preeclampsia genetic susceptibility. METHODOLOGY/PRINCIPAL FINDINGS The proximal promoter and coding regions of the positional candidate gene TNFSF13B residing within the 13q linkage region was sequenced using 48 proband or founder individuals from Australian/New Zealand families. Ten sequence variants (nine SNPs and one single base insertion) were identified and seven SNPs were successfully genotyped in the total Australian/New Zealand family cohort (74 families/480 individuals). Borderline association to preeclampsia (p = 0.0153) was observed for three rare SNPs (rs16972194, rs16972197 and rs56124946) in strong linkage disequilibrium with each other. Functional evaluation by electrophoretic mobility shift assays showed differential nuclear factor binding to the minor allele of the rs16972194 SNP, residing upstream of the translation start site, making this a putative functional variant. The observed genetic associations were not replicated in a Norwegian case/control cohort (The Nord-Trøndelag Health Study (HUNT2), 851 preeclamptic and 1,440 non-preeclamptic women). CONCLUSION/SIGNIFICANCE TNFSF13B has previously been suggested to contribute to the normal immunological adaption crucial for a successful pregnancy. Our observations support TNFSF13B as a potential novel preeclampsia susceptibility gene. We discuss a possible role for TNFSF13B in preeclampsia pathogenesis, and propose the rs16972194 variant as a candidate for further functional evaluation.
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Affiliation(s)
- Mona H. Fenstad
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Matthew P. Johnson
- Department of Genetics, Southwest Foundation for Biomedical Research, San Antonio, Texas, United States of America
| | - Linda T. Roten
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per A. Aas
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjetil Klepper
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christine E. East
- Department of Perinatal Medicine/Department of Obstetrics and Gynaecology, Royal Women's Hospital and University of Melbourne, Parkville, Australia
| | - Lawrence J. Abraham
- The School of Biomedical Biomolecular and Chemical Sciences, The University of Western Australia Crawley, Perth, Australia
| | - John Blangero
- Department of Genetics, Southwest Foundation for Biomedical Research, San Antonio, Texas, United States of America
| | - Shaun P. Brennecke
- Department of Perinatal Medicine/Department of Obstetrics and Gynaecology, Royal Women's Hospital and University of Melbourne, Parkville, Australia
| | - Rigmor Austgulen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eric K. Moses
- Department of Genetics, Southwest Foundation for Biomedical Research, San Antonio, Texas, United States of America
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Grønskag AB, Forsmo S, Romundstad P, Langhammer A, Schei B. Incidence and seasonal variation in hip fracture incidence among elderly women in Norway. The HUNT Study. Bone 2010; 46:1294-8. [PMID: 19944199 DOI: 10.1016/j.bone.2009.11.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 11/18/2009] [Accepted: 11/18/2009] [Indexed: 12/14/2022]
Abstract
There is a substantial variation in hip fracture incidence between populations. The Scandinavian countries have the highest incidence of hip fractures worldwide, and latitude and seasonal variation have been discussed as possible reasons for the high fracture incidences. The purpose of this study was to investigate time dependent and seasonal variation of hip fractures in a population based cohort of women aged 65+ residing in a rural county in Norway and followed for 9.3 years. Information at baseline was collected as part of The Nord-Trøndelag Health Study (HUNT) during 1995-97, and 8362 women with no previous hip fracture and with a mean age of 74.3 years were included in the study. All hip fractures occurring after inclusion in the health study were registered (mean follow-up: 9.3 years) by medical journals and x-ray reports. A total of 5661 of the women had their forearm bone mineral density (BMD) measured by single energy x-ray bone densitometers (SXA) as part of HUNT. In total, 782 women sustained a first hip fracture during follow-up, and the overall hip fracture incidence rate per 1000 person-years was 13.1 (95 % CI: 12.2-14.1). The hip fracture incidence increased exponentially by age from 2.1 (95% CI: 1.2-3.8) in the age group 65-69 years to 49.7 (95% CI: 41.2-59.8) among the women aged 90+, respectively. In age-stratified analyses no changes in the incidence of hip fractures were observed during the nine years of follow up. The occurrence of fractures varied by season of the year, characterized by higher fracture rates during the winter months. In conclusion, the hip fracture rates in this population of elderly women are highest in the winter months. There was, however, no indication of an increasing hip fracture incidence in this rural area. Compared to similar studies from more urban areas in Norway, the hip fracture rates in this population seem somewhat lower.
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Affiliation(s)
- Anna Brenne Grønskag
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Abstract
OBJECTIVE To study the relationship between TSH and forearm bone mineral density (BMD) in a general female population. Design Cross-sectional, population-based study. METHODS In a substudy of the Nord-Trøndelag Health Study 1995-1997 (HUNT 2), 5778 women without and 944 with self-reported thyroid disease aged > or =40 years had their serum TSH and distal and ultra-distal forearm BMD measured. In range-based categories of TSH, excluding women with previous thyroid disease, a general linear model was used to calculate adjusted mean BMD, and a logistic regression model to compute adjusted odds ratio (OR) for osteopenia and osteoporosis. Corresponding models were used to compare BMD in women with self-reported hypothyroidism or hyperthyroidism to euthyroid women. RESULTS In women without self-reported thyroid disease, those with TSH <0.5 mU/l had 10.7 mg/cm(2) (95% confidence interval (CI) 0.2-21.1) lower distal and 9.1 mg/cm(2) (95% CI -0.7-18.9) lower ultra-distal BMD than women in the reference category (TSH 0.50-1.49 mU/l). No differences were found between the categories with TSH > or =0.50 mU/l. Compared to self-reported euthyroid women, self-reported hyperthyroid women had increased odds for osteoporosis both distally (OR 1.35, 95% CI 1.00-1.82) and ultra-distally (OR 1.48, 95% CI 1.10-1.99). CONCLUSION Women with the lowest TSH (<0.5 mU/l) had lower forearm BMD than the reference category. No differences were observed between the TSH categories > or =0.50 mU/l. The prevalence of osteoporosis was higher in women who reported hyperthyroidism than in women without self-reported thyroid disease.
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Affiliation(s)
- Anders Svare
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, N-7489 Trondheim, Norway.
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Abstract
Patients with COPD have high risk for osteoporosis and fractures. Hip and vertebral fractures might impair mobility, and vertebral fractures further reduce lung function. This review discusses the evidence of bone loss due to medical treatment opposed to disease severity and risk factors for COPD, and therapeutic options for the prevention and treatment of osteoporosis in these patients. A review of the English-language literature was conducted using the MEDLINE database until June 2009. Currently used bronchodilators probably lack adverse effect on bone. Oral corticosteroids (OCS) increase bone resorption and decrease bone formation in a dose response relationship, but the fracture risk is increased more than reflected by bone densitometry. Inhaled corticosteroids (ICS) have been associated with both increased bone loss and fracture risk. This might be a result of confounding by disease severity, but high doses of ICS have similar effects as equipotent doses of OCS. The life-style factors should be modified, use of regular OCS avoided and use of ICS restricted to those with evidenced effect and probably kept at moderate doses. The health care should actively reveal risk factors, include bone densitometry in fracture risk evaluation, and give adequate prevention and treatment for osteoporosis.
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Affiliation(s)
- Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Verdal, Norway.
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Roten L, Forsmo S, Johnson M, Moses E, Austgulen R. P162 Pre-eclampsia susceptibility regions on chromosomes 5q and 13q confirmed in a large Norwegian population-based study. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61653-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Roten LT, Johnson MP, Forsmo S, Fitzpatrick E, Dyer TD, Brennecke SP, Blangero J, Moses EK, Austgulen R. Association between the candidate susceptibility gene ACVR2A on chromosome 2q22 and pre-eclampsia in a large Norwegian population-based study (the HUNT study). Eur J Hum Genet 2008; 17:250-7. [PMID: 18781190 DOI: 10.1038/ejhg.2008.158] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Genome-wide scans in Icelandic, Australian/New Zealand and Finnish pedigrees have provided evidence for maternal susceptibility loci for pre-eclampsia on chromosome 2, although at different positions (Iceland: 2p13 and 2q23, Australia/New Zealand: 2p11-12 and 2q22, Finland: 2p25). In this project, a large population-based (n=65 000) nested case-control study was performed in Norway to further explore the association between positional candidate genes on chromosome 2q and pre-eclampsia, using single-nucleotide polymorphisms (SNPs). DNA samples from 1139 cases (women with one or more pre-eclamptic pregnancies) and 2269 controls (women with normal pregnancies) were genotyped using the Applied Biosystems SNPlex high-throughput genotyping assay. In total, 71 SNPs within positional candidate genes at 2q22-23 locus on chromosome 2 were genotyped in each individual. Genotype data were statistically analysed with the sequential oligogenic linkage analysis routines (SOLAR) computer package. Nominal evidence of association was found for six SNPs (rs1014064, rs17742134, rs1424941, rs2161983, rs3768687 and rs3764955) within the activin receptor type 2 gene (ACVR2A) (all P-values <0.05). The non-independence of statistical tests due to linkage disequilibrium between SNPs at a false discovery rate of 5% identifies our four best SNPs (rs1424941, rs1014064, rs2161983 and rs3768687) to remain statistically significant. The fact that populations with different ancestors (Iceland/Norway-Australia/New Zealand) demonstrate a common maternal pre-eclampsia susceptibility locus on chromosome 2q22-23, may suggest a general role of this locus, and possibly the ACVR2A gene, in pre-eclampsia pathogenesis.
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Affiliation(s)
- Linda T Roten
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Abstract
CONTEXT Despite much research on informed choice and the individuals' autonomy in organised medical screening, little is known about the individuals' decision-making process as expressed in their own words. OBJECTIVES To explore the decision-making process among women invited to a mammography screening programme. SETTING Women living in the counties of Sør- and Nord-Trøndelag, Norway, invited to the first round of the Norwegian Breast Cancer Screening Program (NBCSP) in 2003. METHODS Qualitative methods based on eight semistructured focus-group interviews with a total of 69 women aged 50-69 years. RESULTS The decision to attend mammography screening was not based on the information in the invitation letter and leaflet provided by the NBCSP. They perceived the invitation letter with a prescheduled appointment as if a decision for mammography had already been made. This was experienced as an aid in overcoming the postponements that easily occur in daily lives. The invitation to mammography screening was embraced as an indication of a responsible welfare state, "like a mother taking care." CONCLUSION In a welfare state where governmental institutions are trusted, mass screening for disease is acknowledged by screening participants as a valued expression of paternalism. Trust, gratitude, and convenience were more important factors than information about benefits, harms, and risks when the women made their decisions to attend screening. These elements should be included in the ethical debates on informed choice in preventive medicine.
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Affiliation(s)
- W Østerlie
- Department of Public Health and General Practice, Norwegian University of Science and Technology, MTFS, Trondheim, Norway.
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Skolbekken JA, Østerlie W, Forsmo S. Brittle bones, pain and fractures – Lay constructions of osteoporosis among Norwegian women attending the Nord-Trøndelag Health Study (HUNT). Soc Sci Med 2008; 66:2562-72. [DOI: 10.1016/j.socscimed.2008.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Indexed: 11/28/2022]
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Moses EK, Johnson MP, Tømmerdal L, Forsmo S, Curran JE, Abraham LJ, Charlesworth JC, Brennecke SP, Blangero J, Austgulen R. Genetic association of preeclampsia to the inflammatory response gene SEPS1. Am J Obstet Gynecol 2008; 198:336.e1-5. [PMID: 18068137 DOI: 10.1016/j.ajog.2007.09.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 04/24/2007] [Accepted: 09/10/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to test for a genetic association between the G-105A promoter polymorphism of the inflammatory mediator Selenoprotein S (SEPS1) and preeclampsia. STUDY DESIGN A retrospective study in a large Norwegian case-control cohort compared maternal genotype and allele frequencies of the SEPS1 g.-105G>A polymorphism genotyped by SNPlex assay in preeclamptic (n = 1139) and control (n = 2269) women. Statistical significance was determined by chi2 and multivariate regression analyses. RESULTS Women with preeclampsia were 1.34 times more likely to have the GA or AA genotype (P = .0039; 95% confidence interval [CI] 1.09 to 1.64) and 1.22 times more likely to carry the A allele (P = .023; odds ratio, 1.22; 95% CI, 1.02 to 1.46). CONCLUSION The A allele of the SEPS1-105G>A polymorphism is a significant risk factor for preeclampsia in this population.
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Affiliation(s)
- Eric K Moses
- Department of Genetics, Southwest Foundation for Biomedical Research, San Antonio, TX 78245-0549, USA.
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Forsmo S, Fjeldbo SK, Langhammer A. Childhood cod liver oil consumption and bone mineral density in a population-based cohort of peri- and postmenopausal women: the Nord-Trondelag Health Study. Am J Epidemiol 2008; 167:406-11. [PMID: 18033763 DOI: 10.1093/aje/kwm320] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Use of cod liver oil, which is rich in vitamins A and D, is traditionally recommended during the fall and winter months as a protective measure against vitamin D deficiency in several countries. It is not known whether childhood cod liver oil intake is related to variations in bone mineral density (BMD) or fractures in adult life. In 2001, a total of 3,052 Norway women aged 50-70 years had forearm BMD measured in a substudy of the population-based Nord-Trøndelag Health Study. Women reporting no childhood cod liver oil intake had statistically significantly higher BMD than those with any ingestion of cod liver oil. The odds ratio for low BMD (>1 standard deviation below age-specific mean) in women reporting cod liver oil intake throughout the year as compared with women with no intake was 2.3 (95% confidence interval: 1.4, 3.9), adjusted for body mass index, smoking, menopausal status, estrogen use, and current milk consumption. There were indications of a negative dose-response effect of childhood cod liver oil intake on bone. Although the vitamin A content of commercial cod liver oil was recently reduced by 75% in Norway, the past high concentration remains a possible explanation for the observed negative association between childhood cod liver oil intake and forearm BMD.
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Affiliation(s)
- Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
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Forsmo S. [Cervical specimens from young women]. Tidsskr Nor Laegeforen 2008; 128:70. [PMID: 18183069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
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