Grip strength in men and women aged 50-79 years is associated with non-vertebral osteoporotic fracture during 15 years follow-up: The Tromsø Study 1994-1995.

In 50-79-year-olds who participated in the Tromsø Study (1994-1995), the risk of non-vertebral osteoporotic fractures during 15 years follow-up increased by 22% in men and 9% in women per 1 SD lower grip strength. The strongest association was observed in men aged 50-64 years. INTRODUCTION: We aimed to explore whether low grip strength was associated with increased risk of non-vertebral osteoporotic fracture in the population-based Tromsø Study 1994-1995. METHODS: Grip strength (bar) was measured by a Martin Vigorimeter and fractures were retrieved from the X-ray archives at the University Hospital of North Norway between 1994 and 2010. At baseline, weight and height were measured, whereas information on the other covariates were obtained through self-reported questionnaires. Cox regression was used to estimate the hazard ratio (HR) of fracture in age- and gender-specific quintiles of grip-strength, and per 1 SD lower grip strength. Similar analyses were done solely for hip fractures. Adjustments were made for age, height, body mass index (BMI), marital status, education, smoking, physical activity, use of alcohol, self-perceived health, and self-reported diseases. RESULTS: In 2891 men and 4002 women aged 50-79 years, 1099 non-vertebral osteoporotic fractures-including 393 hip fractures-were sustained during the median 15 years follow-up. Risk of non-vertebral osteoporotic fracture increased with declining grip strength: hazard ratios per SD decline was 1.22 (95% CI 1.05-1.43) in men and 1.09 (95% CI 1.01-1.18) in women. HR for fracture in lower vs. upper quintile was 1.58 (95% CI 1.02-2.45) in men and 1.28 (95% CI 1.03-1.59) in women. The association was most pronounced in men aged 50-64 years with HR = 3.39 (95% CI 1.76-6.53) in the lower compared to the upper quintile. CONCLUSIONS: The risk of non-vertebral osteoporotic fracture increased with declining grip-strength in both genders, particularly in men aged 50-64 years.

Excess mortality following hip fracture: impact of self-perceived health, smoking, and body mass index. A NOREPOS study.

Self-perceived health, smoking, and body mass index measured years before the hip fracture predicted excess post-hip fracture mortality, and even hip fracture patients with the most favorable levels of these risk factors had higher mortality than subjects who did not fracture. INTRODUCTION: This study aimed to investigate the impact of pre-fracture self-perceived health, smoking, and body mass index (BMI) on excess post-hip fracture mortality using matched peers without hip fracture as reference. METHODS: The study was based on the Cohort of Norway (CONOR) consisting of 10 regional health studies (1994-2003) and the NOREPOS hip fracture database (1994-2008). A matched cohort design was used to compare survival between hip fracture patients and subjects without fracture (matched on gender, age at participation in CONOR, and study site). Subjects aged ≥60 years were included. Hazard ratios were estimated using stratified Cox regression. Age-standardized mortality was also calculated. RESULTS: Overall, hip fracture patients (N = 3177) had a 2.26-fold (95 % CI 2.13, 2.40) increased mortality compared to matched subjects (N = 20,282). The highest excess mortality was found in hip fracture patients reporting poor health (HR 4.08, 95 % CI 3.17, 5.26) and daily smoking (HR 3.25, 95 % CI 2.89, 3.66) and in patients with BMI <18.5 (HR 3.07, 95 % CI 2.11, 4.47) prior to the fracture. However, excess mortality was also observed in hip fracture patients in all other categories of BMI, self-perceived health, and smoking. CONCLUSIONS: Information on self-perceived health, smoking, and BMI collected years before hip fracture predicted excess post-hip fracture mortality, and even hip fracture patients with the most favorable levels of these risk factors had higher mortality than the matched subjects who did not fracture. This suggests that both pre-fracture health status and factors related to the hip fracture itself might affect post-hip fracture mortality.

Forecasting the burden of future postmenopausal hip fractures.

SUMMARY: A growing elderly population is expected worldwide, and the rate of hip fractures is decisive for the future fracture burden. Significant declines in hip fracture rates in Norway, the USA, France, Germany, and the UK are required to counteract the impact of the ageing effects. INTRODUCTION: This study aims to evaluate the consequences of the expected growth of the elderly population worldwide on the hip fracture burden using Norway as an example. Furthermore, we wanted to estimate the decline in hip fracture rates required to counteract the anticipated increase in the burden of hip fracture for Norway, the USA, France, Germany, and the UK. METHODS: The burden of future postmenopausal hip fractures in Norway were estimated given (1) constant age-specific rates, (2) continued decline, and (3) different cohort scenarios. Based on population projection estimates and population age-specific hip fracture rates in women 65 years and older, we calculated the required declines in hip fracture rates needed to counteract the growing elderly populations in Norway, the USA, France, Germany, and the UK. RESULTS: The level of age-specific hip fracture rates had a huge impact on the future hip fracture burden in Norway. Even if the hip fracture rates decline at the same speed, a 22 % increase in the burden of hip fractures can be expected by 2040. An annual decline in hip fracture rates of 1.1-2.2 % until 2040 is required to counteract the effects of the growing elderly population on the future burden of hip fractures in Norway, the USA, France, Germany, and the UK. CONCLUSIONS: Hip fracture rates have a great impact on the burden of hip fractures. The rates will have to decline significantly to counteract the impact of a growing elderly population. A change in preventive strategies and further studies are warranted to identify the complex causes associated to hip fractures.

Does using lower limit of normal values enhance the ability of a single bone mineral density measure to predict fractures?

UNLABELLED: Using a single bone mineral density (BMD) measure, we demonstrated that the lower limit of normal (LLN) method is more consistent in predicting osteoporosis fractures than the T-score in white menopausal women from the Study of Osteoporosis Fracture (SOF). INTRODUCTION: In order to circumvent the inconsistencies and limitations with using the T-score when defining osteoporosis, we propose using 95% LLN values derived from centered polynomial models using the NHANES III BMD measures. The main aim of this study was to compare the two methods in prediction of fracture and agreement in osteoporosis classification using cohort data. METHODS: We compared the fracture prediction ability of the two methods using a single BMD measurement in 4,948 white women aged 67-74 years in the SOF employing kappa statistics, sensitivity, and specificity. RESULTS: The T-score provided inconsistent osteoporosis classification (46.6%) across the five hip regions of interest (ROIs) and this was significantly (p<0.0001) reduced when using the LLN method (36.5%). Kappa statistics of incident fracture during 12 years of follow-up related to the prevalence of osteoporosis at baseline was significantly improved using the LLN method compared to using T-score. Sensitivity and specificity for fracture based on a single BMD measurement of different hip ROIs were more consistent using the LLN method. CONCLUSION: The LLN method provides a more consistent and efficient method for osteoporosis fracture prediction than the T-score in 67- to 74-year-old white women.

Urinary cadmium, osteopenia, and osteoporosis in the US population.

SUMMARY: The association between cadmium and osteoporosis in a multiethnic population is unclear. We found that urinary cadmium is consistently associated with osteopenia and osteoporosis in the Third National Health and Nutrition Examination Survey, regardless of age, sex, race, and smoking status. Cadmium exposure may be an independent risk factor for osteoporosis. INTRODUCTION: Our purpose was to test whether cadmium exposure is associated with a higher prevalence of osteopenia and osteoporosis in the general US population and selected subgroups. METHODS: We used multinomial logistic regression to analyze data on 10,978 subjects (aged 30-90) from the Third National Health and Nutrition Examination Survey. We studied the association of urinary cadmium levels (adjusted for urinary creatinine) and the prevalence of osteopenia and osteoporosis as defined by the World Health Organization. RESULTS: After adjustment for age, sex, ethnicity, body mass index, calcium intake, and physical inactivity, odds ratios (ORs) for osteopenia and osteoporosis increased dose dependently with two urinary cadmium levels (in micrograms of urinary cadmium per grams of urinary creatinine: level I, 1.00-1.99 mcg/g; level II, > or =2.00 mcg/g). Osteopenia results were as follows: level I OR, 1.49 (95% confidence interval [CI], 1.24-1.80); level II OR, 2.05 (95% CI, 1.52-2.78). Osteoporosis results were as follows: level I OR, 1.78 (95% CI, 1.26-2.52); level II OR, 3.80 (95% CI, 2.36-6.14). The association was consistent in all age, sex, race, and smoking status subgroups. CONCLUSIONS: Cadmium exposure may be a potential risk factor for osteopenia and osteoporosis in the general US population.

Depression and low bone mineral density: a meta-analysis of epidemiologic studies.

SUMMARY: The association between depression and loss of bone mineral density (BMD) has been reported inconsistently. This meta-analysis, which pooled results from 14 qualifying individual studies, found that depression was associated with a significantly decreased BMD, with a substantially greater BMD decrease in depressed women and in cases of clinical depression. INTRODUCTION: The reported association between depression and loss of BMD has been controversial. This meta-analysis was conducted to determine whether depression and BMD are associated and to identify the variation in some subgroups. METHODS: English-language articles published before October 2008 were used as the data source. A total of six case-controlled and eight cross-sectional studies met prestated inclusion criteria (N = 10,523). Information on study design, participant characteristics, measurements of BMD and depression, and control for potential confounders was abstracted independently by two investigators using a standardized protocol. RESULTS: Overall, depression was associated with a significant decrease in mean BMD of spine (-0.053 g/cm(2) [95% confidence interval {CI} -0.087 to -0.018 g/cm(2)]) and hip (-0.052 g/cm(2) [95% CI -0.083 to -0.022 g/cm(2)]). A substantially greater BMD decrease was observed in depressed women (-0.076 g/cm(2) in spine; -0.059 g/cm(2) in hip) and in cases of clinical depression (-0.074 g/cm(2) in spine; -0.080 g/cm(2) in hip). CONCLUSION: Depression is associated with low BMD, with a substantially greater BMD decrease in depressed women and in cases of clinical depression. Depression should be considered as an important risk factor for osteoporosis.

Long-term mental distress, bone mineral density and non-vertebral fractures. The Tromsø Study.

The purpose of this study was to examine, prospectively, the risk of non-vertebral fractures and low bone mineral density in a population-based cohort with respect to indicators of subjective mental distress. In 1979-1980 all males born 1925-1959 and all females born 1930-1959 living in Tromsø were invited (21,441; response rate, 78%). The same individuals were invited to the subsequent studies in 1986-1987 and 1994-1995 (74% attended the first two, and 71% attended all three surveys). Non-vertebral fractures were registered by linkage to the hospital X-ray register for the period 1988-1995, and forearm bone mineral density (BMD) was available in a subsample of 4,690 who had attended three times. Questions about mental distress (depression, insomnia and coping problems) were repeated three times and analyzed as cumulated exposure. Women who reported being depressed at two time points had an adjusted odds ratio (OR) =2.5 (95% confidence interval [CI] 1.3-4.9) for sustaining a non-vertebral fracture and OR=3.1 (95% CI 1.3-7.2) for sustaining an osteoporotic fracture, compared with those without depression on any occasion. The corresponding odds ratios for those with coping problems at two time points were slightly higher, whereas sleeping problems seem only to be weakly associated with non-vertebral fractures. The pattern of associations and the magnitude of OR estimates were mainly the same in women younger than 50 years and those 50 years and older. Women using nerve medicine and reporting depression twice had an odds ratio of 4.4 (95% CI 1.1-17.7) for sustaining a non-vertebral fracture, and those using nerve medicine and reporting coping problems twice had a corresponding OR 4.7 (95% CI 1.2-18.4). Among men no significant associations were found for either fracture type. No association was found between mean BMD and number of times reporting depression, insomnia or coping problems, in women or men. Long-term mental distress is associated with risk of all non-vertebral fractures and osteoporotic fractures in middle-aged women, but not in men. Mental distress itself seems to be more important than the use of nerve medicine.

The Tromsø Study: a population-based study on the variation in bone formation markers with age, gender, anthropometry and season in both men and women.

Background information on how biological factors influence the level of bone turnover markers is crucial in order to make proper use of these measurements. In the present study, which is part of the fourth survey of a general population in Tromsø, Norway, we evaluated the variation in the bone formation markers bone alkaline phosphatase (S-BAP) and osteocalcin (S-OC) in 528 men and 605 women, age 25-74 years. In the Tromsø Study in 1994/5, the whole population above 25 years was initially invited and 7948 individuals attended an extended examination (76.4% of the invited population). The present study population is a random sample of these attendees. The variation with age, gender, height, weight, body mass index and season, and with menopausal status in women, was examined. In men there was a decrease in S-OC up to the age of 56 years with little further change, while S-BAP showed no change with age. Among women, variation in bone markers was mainly observed to change with menopause, with a 41% and 21% increase in the mean level of S-BAP and S-OC, respectively. There was a negative trend in S-OC with body mass index in both men and women. A seasonal change of 20% in the level of both bone markers in men and of S-BAP in postmenopausal women was observed in this region at a far northern latitude. We conclude that, of the factors examined, season and menopausal status must be taken into account when measuring these bone formation markers.

Academic models of clinical care for women: the National Centers of Excellence in Women's Health.

Between 1996 and 1999, 18 academic health centers were awarded the designation of National Center of Excellence (CoE) in Women's Health by the Office on Women's Health within the Department of Health and Human Services and were provided with seed monies to develop model clinical services for women. Although the model has evolved in various forms, core characteristics that each nationally designated CoE has adopted include comprehensive, women-friendly, women-focused, women-relevant, integrated, multidisciplinary care. The permanent success of these comprehensive clinical programs resides in the ability to garner support of leaders of the academic health centers who understand both the importance of multidisciplinary programs to the clinical care they provide women and the education they offer to the future providers of women's healthcare.

Forearm bone mineral density by age in 7,620 men and women: the Tromsø study, a population-based study.

Population-based studies of adult forearm bone mineral density (BMD) by age are scarce, and standardized reference values are lacking. In this cross-sectional study, men aged 55-74 years, women aged 50-74 years, and representative 5-10% samples of remaining age groups between 25 and 84 years living in Tromsø, Norway, were invited for forearm BMD measurement in 1994-1995. The authors measured 3,062 men and 4,558 women (response rate, 78%) by single x-ray absoptiometry at distal and ultradistal forearm sites. Up to age 50, the mean BMD difference was -0.1% per 1-year age group in both sexes. After age 50, the mean BMD difference per 1-year age group was -0.6% in men and -1.3% (distal) and -1.5% (ultradistal) in women. The BMD by age curve was linear for men throughout senescence, but women had a slope change to -0.7% (distal) and -0.8% (ultradistal) per 1-year age group from the 65- to 69-year age group. BMD levels and BMD by age association in the general population (n = 7,620) and in the population without bone-threatening diseases or medication (n = 5,179) were similar. Only longitudinal studies can clarify whether cohort effects or longitudinal BMD development patterns explain these cross-sectional results.

The Tromsø study: registration of fractures, how good are self-reports, a computerized radiographic register and a discharge register?

In order to compare different methods of fracture registration, we sought all nonvertebral fractures suffered during 8 years (1988-95) among 21,441 persons invited to a survey in 1979/80. We registered a total of 54 hip fracture cases through three separate sources (self-report, computer linkage to the local radiographic archives, discharge register), whereas forearm fractures (a total of 291 cases) were registered through two separate sources (self-report, computer linkage to the radiographic archives). The registration of fractures at other sites (a total of 1321 cases) were from one source (computer linkage to the local radiographic archives), and we have compared three ways of obtaining data from this single source (no ascertainment, ascertainment of records coded as fracture, ascertainment of all records). Ninety-three percent of all hip fractures and 97% of all wrist fractures in the entire study population were found by computer linkage to the radiographic archives, whereas the discharge register detected 87% of all the hip fractures. Computer linkage with ascertainment gave no overreporting of fractures. Among the 11,626 persons who answered a follow-up questionnaire in 1994/95, 97% (CI 84-100%) of all hip fractures and 72% (CI 66-78%) of all wrist fractures were self-reported. We conclude that a computerized search of radiographic archives is a viable method of fracture registration.

The Tromsø study: determinants of precision in bone densitometry.

Studies of precision determinants in bone densitometry are scarce. A total of 111 subjects recruited from the population-based multipurpose Tromsø Study (Norway), 27-75 years of age, had repeated forearm bone single X-ray absorptiometry (SXA) measurements. Measurement conditions were systematically varied in series up to eight scans. Median coefficients of variation (CV) for two scans performed 1 week apart, by two different operators were 0.79% and 0.98% at distal and ultradistal sites, respectively. The CV distribution was skewed: 5% of the subjects had individual CVs above 2.2% (distal) and 3.4% (ultradistal). Age (P = 0.0097) and repositioning were important determinants of precision. The SXA bone mineral density (BMD)-measurement method is sufficiently precise to establish BMD level. The minimal individual percentage BMD change that can be detected with 95% certainty was 2% and 3% at distal and ultradistal sites, respectively. Detection of BMD changes less than this should rely on multiple repeat measurements at each point in time.

Hormone replacement therapy: knowledge, attitudes, self-reported use - and sales figures in Nordic women.

OBJECTIVES: To evaluate knowledge about, attitudes towards and use of hormone replacement therapy (HRT) in Norwegian women - and to compare self-reported use with sales statistics of HRT in the Nordic countries during recent years. MATERIAL AND METHODS: Random samples of Norwegian women age 16-79 were interviewed by the Central Bureau of Statistics in 1994 (n=737), in 1996 (n=665) and in 1998 (n=680). Statistics on the sale of estrogen were provided by the Norwegian Medical Depot and Nordic Council on Medicines. RESULTS: One in three women had received information about HRT during the last 2 years (1994), mainly through weekly magazines and physicians. The proportion answering in accordance with the prevailing view of HRT's effects ('correct knowledge') varied from 36.4 to 47.2%. Those informed by a physician possessed correct knowledge, had positive attitudes towards HRT and were willing to use HRT more often than women informed through other channels. Women with a high level of education had received information and had correct knowledge more often than others, but they were still less willing to use HRT and did not use HRT more often than the less educated. In the age group 45-69 years the use of HRT was 16.3% in 1994, 19.1% in 1996 and 19. 1% in 1998 (P=0.421, trend). In addition to received information, attitudes towards and knowledge about estrogen were the most important factors predicting use of HRT after adjusting for other variables. According to sales figures, the use of systemic estrogen in Norway has increased more than 360% since 1990. Although no other Nordic country has experienced a corresponding increase, Iceland had the highest sales figures in 1997. CONCLUSIONS: Based on the limited proportion of women receiving information on HRT and the ambivalence found in groups of educated women, we suggest that more and better information should be given middle-aged women to make them better able to make informed choices regarding use of HRT.

Walking after stroke: does it matter? Changes in bone mineral density within the first 12 months after stroke. A longitudinal study.

Stroke patients have increased risk of hip fractures. Nearly all fractures occur on the hemiplegic side, and reduced bone mineral density (BMD) may be an important predisposing factor. The aim of this study was to investigate the degree of demineralization within the first year after stroke, and to elucidate a possible difference in patients with high versus low ambulatory levels. Forty acute stroke patients were followed (17 initially wheelchair-bound and 23 initially ambulatory). BMD was measured in the proximal femur bilaterally at a mean 6 days, 7 months and 1 year after stroke onset using dual-energy X-ray absorptiometry. Ambulatory status was independently associated with changes in BMD (p < or = 0.005) 1 year after stroke. The 17 initially wheelchair-bound patients had a significant 10% reduction in BMD at the paretic side and 5% reduction at the non-paretic side (p < 0.001), while the 23 patients initially able to walk had a significant loss (3%) only at the paretic side (p = 0.01). The analysis also indicated that the major reduction in BMD took place within the first 7 months. Two months after stroke 12 of the wheelchair-bound patients had relearned to walk. At the paretic side the 1 year changes in BMD in the patients who stayed wheelchair-bound, the patients who re-learned to walk within the first 2 months and the patients who were able to walk throughout the study were 13%, 8% and 3%, respectively, and a statistically significant trend with ambulatory level was found (p = 0.007). This study provides clear evidence that lack of mobility and weight-bearing early after stroke is an important factor for the greater bone loss in the paretic leg, but that relearning to walk within the first 2 months after stroke, even with the support of another person, may reduce the bone loss after immobilization.

The Tromsø Study: artifacts in forearm bone densitometry--prevalence and effect.

Suboptimal performance of bone densitometer, operator and/or subject may cause artifacts of consequence both for individual patient management and research. The prevalence and effects of such artifacts are largely unknown in densitometry. A cross-sectional population-based study was carried out of artifacts in forearm bone densitometry with single X-ray Absorptiometry (SXA) of the nondominant hand (distal and ultradistal site). After the screening, all scans were reviewed for artifact detection and reanalysis. The effect on the bone mineral density (BMD) result was found by comparing artifactual scans with a reanalyzed version or with normal repeat scans. All women aged 50-74 years, all men aged 55-74 years and 5-10% samples of other age groups aged >/=25 years attending the fourth Tromso health study were invited to have bone densitometry. The response rate from the background population was 80% (n = 7948). Fourteen percent of subjects had a movement artifact at either the distal or ultradistal site. The individual BMD variation was twice as large in scans with a movement artifact (0.94%) compared with normal scans (0.58%) (p = 0.0027). The radial endplate was inaccurately detected in 74% of the scans. Reanalysis of these scans led to a mean 3.8% decrease in the BMD value and an increase in the prevalence of osteoporosis of 10%. Artifacts were thus common, and their effects were clinically relevant in forearm bone densitometry. Artifacts and their effects need to be characterized in other bone densitometry settings also.

The Tromsø Study: body height, body mass index and fractures.

Tall persons suffer more hip fractures than shorter persons, and high body mass index is associated with fewer hip and forearm fractures. We have studied the association between body height, body mass index and all non-vertebral fractures in a large, prospective, population-based study. The middle-aged population of Tromsø, Norway, was invited to surveys in 1979/80, 1986/87 and 1994/95 (The Tromsø Study). Of 16,676 invited to the first two surveys, 12,270 attended both times (74%). Height and weight were measured without shoes at the surveys, and all non-vertebral fractures in the period 1988-1995 were registered (922 persons with fractures) and verified by radiography. The risk of a low-energy fracture was found to be positively associated with increasing body height and with decreasing body mass index. Furthermore, men who had gained weight had a lower risk of hip fractures, and women who had gained weight had a lower risk of fractures in the lower extremities. High body height is thus a risk factor for fractures, and 1 in 4 low-energy fractures among women today might be ascribed to the increase in average stature since the turn of the century. Low body mass index is associated with a higher risk of fractures, but the association is probably too weak to have any clinical relevance in this age category.

The Tromsø Study: physical activity and the incidence of fractures in a middle-aged population.

We have studied the relation of occupational and recreational physical activity to fractures at different locations. All men born between 1925 and 1959 and all women born between 1930 and 1959 in the city of Tromsø were invited to participate in surveys in 1979-1980 and 1986-1987 (The Tromsø Study). Of 16,676 invited persons, 12,270 (73.6%) attended both surveys. All nonvertebral fractures (n = 1435) sustained from 1988 to 1995 were registered in the only hospital in the area. Average age in the middle of the follow-up period (December 31, 1991) was 47.3 years among men and 4501 years among women, ranging from 32 to 66 years. Fracture incidence increased with age at all locations among women, but it decreased with or was independent of age among men. Low-energetic fractures constituted 74.4% of all fractures among women and 55.2% among men. When stratifying by fracture location, the most physically active persons among those 45 years or older suffered fewer fractures in the weight-bearing skeleton (relative risk [RR] 0.6, confidence interval [CI] 0.4-0.9, age-adjusted), but not in the non-weight-bearing skeleton (RR 1.0, CI 0.7-1.2, age-adjusted) compared with sedentary persons. The relative-risk of a low-energetic fracture in the weight-bearing skeleton among the most physically active middle-aged was 0.3 (CI 0.1-0.7) among men and 0.9 (CI 0.4-1.8) among women compared with the sedentary when adjusted for age, body mass index, body height, tobacco smoking, and alcohol and milk consumption. It seems that the beneficial effect on the skeleton of weight-bearing activity is reflected also in the incidence of fractures at different sites.

[Normal bone remodelling--what can go wrong in osteoporosis?]. / Normal beinremodellering--hva kan gå ved osteoporose?

The skeleton is a metabolically active organ in constant change and renewal. Specialised cells are responsible for resorbing and synthetizing bone matrix. The process of bone remodelling, by removing old and damaged bone tissue and replacing it with new, is necessary for conserving the integrity of bone. In recent years, research has given new insight into the fine relationship between different cell types in bone tissue. This has enhanced our understanding of the pathophysiology behind osteoporosis and other metabolical bone diseases. This article gives a summary of our present knowledge of the normal cell biology of bone and what contributes to its regulation. How this helps the understanding of normal and pathological bone loss is illustrated. It is important to understand bone remodelling in order to interpret measurements of bone mineral density and biochemical markers accurately.

[Can biochemical markers for bone density be recommended as diagnostic and prognostic tools in osteoporosis?]. / Kan biokjemiske markører for beinomsetning anbefales som diagnostisk og prognostisk vertkøy ved osteoporose?

Biochemical markers of bone metabolism have potential clinical value in osteoporosis, rheumatic diseases, metabolic bone diseases, and skeletal metastasis. The markers are measured in serum or urine and reflect bone synthesis or bone resorption. Knowledge of the markers' analytical and biological variation, sensitivity, and specificity is necessary to make use of these measurements. This article gives a review of the new bone markers available today: osteocalcin, bone alkaline phosphatase, procollagen peptides, pyridinolines, and telopeptides. Bone markers are clearly useful in research and in epidemiological studies, but routine clinical use is still controversial. We discuss the consequences of making use of bone markers in the diagnostics of osteoporosis, as a prognostic factor of bone loss or fractures, or to monitor therapy. We conclude that we still lack sufficient knowledge to justify use in clinical practice.

[Estrogen replacement]. / Ostrogenbehandling.

Recent research on long-term postmenopausal hormone replacement therapy (HRT) indicates a positive effect on both total mortality and morbidity. This has raised the question of widespread preventive long-term use of HRT. Possible side-effects and ideological issues related to preventive HRT have led to debate and uncertainty among health professionals, in the media, and in the population at large. In order to evaluate the level of knowledge about and attitudes towards HRT, a randomly selected group of 737 Norwegian women aged 16-79 was interviewed by the Central Bureau of Statistics. One in three women had received information about HRT in the last two years, mainly through weekly magazines and physicians. The proportion who answered the questions on knowledge correctly varied from 36% to 47%. Those who had been given information by a physician possessed accurate knowledge, had more positive attitudes towards HRT and were more willing to use HRT than women who had reviewed information through other channels. Women with a higher level of education were better informed and more knowledgeable than others, but were nevertheless more reluctant to use HRT than those who were less educated. The limited number of women who actually receive information on HRT, the low level of knowledge and the ambivalent attitudes toward HRT are a major challenge to the public health service.