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Benetou V, Orfanos P, Feskanich D, Michaëlsson K, Pettersson-Kymmer U, Byberg L, Eriksson S, Grodstein F, Wolk A, Jankovic N, de Groot LCPGM, Boffetta P, Trichopoulou A. Mediterranean diet and hip fracture incidence among older adults: the CHANCES project. Osteoporos Int 2018; 29:1591-1599. [PMID: 29656347 DOI: 10.1007/s00198-018-4517-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 02/02/2018] [Accepted: 03/28/2018] [Indexed: 12/29/2022]
Abstract
UNLABELLED The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk. INTRODUCTION Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults. METHODS A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis. RESULTS A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92-0.99, pheterogeneity = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87-0.99) and high (HR 0.94; 95% CI 0.87-1.01) adherence to the score compared with those with low adherence. CONCLUSIONS In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.
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Affiliation(s)
- V Benetou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 115 27, Athens, Greece.
| | - P Orfanos
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 115 27, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - D Feskanich
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - K Michaëlsson
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - U Pettersson-Kymmer
- Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - L Byberg
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - S Eriksson
- Department of Community Medicine, Umeå University, Umeå, Sweden
| | - F Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - A Wolk
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
- Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - N Jankovic
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry, and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - L C P G M de Groot
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - P Boffetta
- Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, Eriksson S, Wilsgaard T, Jørgensen L, Ahmed LA, Schöttker B, Brenner H, Bellavia A, Wolk A, Kubinova R, Stegeman B, Bobak M, Boffetta P, Trichopoulou A. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med 2017; 281:300-310. [PMID: 28093824 DOI: 10.1111/joim.12586] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hip fractures are associated with diminished quality of life and survival especially amongst the elderly. OBJECTIVE All-cause mortality after hip fracture was investigated to assess its magnitude. METHODS A total of 122 808 participants from eight cohorts in Europe and the USA were followed up for a mean of 12.6 years, accumulating 4273 incident hip fractures and 27 999 deaths. Incident hip fractures were assessed through telephone interviews/questionnaires or national inpatient/fracture registries, and causes of death were verified with death certificates. Cox proportional hazards models and the time-dependent variable methodology were used to assess the association between hip fracture and mortality and its magnitude at different time intervals after the injury in each cohort. We obtained the effect estimates through a random-effects meta-analysis. RESULTS Hip fracture was positively associated with increased all-cause mortality; the hazard ratio (HR) in the fully adjusted model was 2.12, 95% confidence interval (CI) 1.76-2.57, after adjusting for potential confounders. This association was stronger amongst men [HR: 2.39, 95% CI: 1.72-3.31] than amongst women [HR: 1.92, 95% CI: 1.54-2.39], although this difference was not significant. Mortality was higher during the first year after the hip fracture [HR: 2.78, 95% CI: 2.12-3.64], but it remained elevated without major fluctuations after longer time since hip fracture [HR (95% CI): 1.89 (1.50-2.37) after 1-4 years; 2.15 (1.81-2.55) after 4-8 years; 1.79 (1.57-2.05) after 8 or more years]. CONCLUSION In this large population-based sample of older persons across eight cohorts, hip fracture was associated with excess short- and long-term all-cause mortality in both sexes.
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Affiliation(s)
| | - V Benetou
- School of Medicine, Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - D Feskanich
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - F Grodstein
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - U Pettersson-Kymmer
- Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - S Eriksson
- Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - T Wilsgaard
- Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway
| | - L Jørgensen
- Department of Health and Care Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - L A Ahmed
- Department of Health and Care Sciences, UIT The Arctic University of Norway, Tromsø, Norway.,Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - A Bellavia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - R Kubinova
- National Institute of Public Health, Prague, Czech Republic
| | - B Stegeman
- Department of Epidemiology and Public Health, University College London, London, UK
| | - M Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - P Boffetta
- Hellenic Health Foundation, Athens, Greece.,Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Benetou V, Orfanos P, Feskanich D, Michaëlsson K, Pettersson-Kymmer U, Ahmed LA, Peasey A, Wolk A, Brenner H, Bobak M, Wilsgaard T, Schöttker B, Saum KU, Bellavia A, Grodstein F, Klinaki E, Valanou E, Papatesta EM, Boffetta P, Trichopoulou A. Education, marital status, and risk of hip fractures in older men and women: the CHANCES project. Osteoporos Int 2015; 26:1733-46. [PMID: 25820745 DOI: 10.1007/s00198-015-3054-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 09/24/2014] [Accepted: 01/28/2015] [Indexed: 01/12/2023]
Abstract
UNLABELLED The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk. INTRODUCTION The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA. METHODS A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regression adjusting for several factors. Summary estimates were derived using random effects models. RESULTS Individuals with higher education, compared to those with low education, had lower hip fracture risk [hazard ratio (HR) = 0.84, 95 % confidence interval (CI) 0.72-0.95]. Respective HRs were 0.97 (95 % CI 0.82-1.13) for men and 0.75 (95 % CI 0.65-0.85) for women. Overall, individuals living alone, especially those aged 60-69 years, compared to those being married/cohabiting, tended to have a higher hip fracture risk (HR = 1.12, 95 % CI 1.02-1.22). There was no suggestion for heterogeneity across cohorts (P heterogeneity > 0.05). CONCLUSIONS The combined data from >150,000 individuals 60 years and older suggest that higher education may contribute to lower hip fracture risk. Furthermore, this risk may be higher among individuals living alone, especially among the age group 60-69 years, when compared to those being married/cohabiting.
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Affiliation(s)
- V Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece.
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece.
| | - P Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece
| | - D Feskanich
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - K Michaëlsson
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - U Pettersson-Kymmer
- Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - L A Ahmed
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - A Peasey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A Wolk
- Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - M Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - T Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - K-U Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - A Bellavia
- Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - F Grodstein
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - E Klinaki
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece
| | - E Valanou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece
| | - E-M Papatesta
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece
| | - P Boffetta
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece
- Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - A Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece
- Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece
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van der Eerden BCJ, Oei L, Roschger P, Fratzl-Zelman N, Hoenderop JGJ, van Schoor NM, Pettersson-Kymmer U, Schreuders-Koedam M, Uitterlinden AG, Hofman A, Suzuki M, Klaushofer K, Ohlsson C, Lips PJA, Rivadeneira F, Bindels RJM, van Leeuwen JPTM. TRPV4 deficiency causes sexual dimorphism in bone metabolism and osteoporotic fracture risk. Bone 2013; 57:443-54. [PMID: 24084385 DOI: 10.1016/j.bone.2013.09.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 11/08/2012] [Revised: 08/16/2013] [Accepted: 09/16/2013] [Indexed: 11/20/2022]
Abstract
We explored the role of transient receptor potential vanilloid 4 (TRPV4) in murine bone metabolism and association of TRPV4 gene variants with fractures in humans. Urinary and histomorphometrical analyses demonstrated reduced osteoclast activity and numbers in male Trpv4(-/-) mice, which was confirmed in bone marrow-derived osteoclast cultures. Osteoblasts and bone formation as shown by serum procollagen type 1 amino-terminal propeptide and histomorphometry, including osteoid surface, osteoblast and osteocyte numbers were not affected in vivo. Nevertheless, osteoblast differentiation was enhanced in Trpv4(-/-) bone marrow cultures. Cortical and trabecular bone mass was 20% increased in male Trpv4(-/-) mice, compared to sex-matched wild type (Trpv4(+/+)) mice. However, at the same time intracortical porosity was increased and bone matrix mineralization was reduced. Together, these lead to a maximum load, stiffness and work to failure of the femoral bone, which were not different compared to Trpv4(+/+) mice, while the bone material was less resistant to stress and less elastic. The differential impacts on these determinants of bone strength were likely responsible for the lack of any changes in whole bone strength in the Trpv4(-/-) mice. None of these skeletal parameters were affected in female Trpv4(-/-) mice. The T-allele of rs1861809 SNP in the TRPV4 locus was associated with a 30% increased risk (95% CI: 1.1-1.6; p=0.013) for non-vertebral fracture risk in men, but not in women, in the Rotterdam Study. Meta-analyses with the population-based LASA study confirmed the association with non-vertebral fractures in men. This was lost when the non-population-based studies Mr. OS and UFO were included. In conclusion, TRPV4 is a male-specific regulator of bone metabolism, a determinant of bone strength, and a potential risk predictor for fractures through regulation of bone matrix mineralization and intra-cortical porosity. This identifies TRPV4 as a unique sexually dimorphic therapeutic and/or diagnostic candidate for osteoporosis.
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Benetou V, Orfanos P, Pettersson-Kymmer U, Bergström U, Svensson O, Johansson I, Berrino F, Tumino R, Borch KB, Lund E, Peeters PHM, Grote V, Li K, Altzibar JM, Key T, Boeing H, von Ruesten A, Norat T, Wark PA, Riboli E, Trichopoulou A. Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int 2013; 24:1587-98. [PMID: 23085859 DOI: 10.1007/s00198-012-2187-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/04/2012] [Indexed: 01/12/2023]
Abstract
UNLABELLED Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men. INTRODUCTION Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries. METHODS A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders. RESULTS Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI) = 0.89-0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR = 0.86; 95 % CI = 0.79-0.94) and high fruit (HR = 0.89; 95 % CI = 0.82-0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR = 1.18; 95 % CI = 1.06-1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate = 1.74; 95 % CI = 1.32-2.31) was also a risk factor. CONCLUSIONS In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.
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Affiliation(s)
- V Benetou
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 Mikras Asias street, 115 27 Athens, Greece.
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Englund U, Nordström P, Nilsson J, Hallmans G, Svensson O, Bergström U, Pettersson-Kymmer U. Active commuting reduces the risk of wrist fractures in middle-aged women-the UFO study. Osteoporos Int 2013; 24:533-40. [PMID: 22525983 DOI: 10.1007/s00198-012-1988-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 10/16/2011] [Accepted: 03/26/2012] [Indexed: 12/01/2022]
Abstract
SUMMARY Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus. INTRODUCTION Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture. METHODS The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years. RESULTS Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk. CONCLUSION This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.
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Affiliation(s)
- U Englund
- Division of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden.
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