Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: a-10 year prospective population-based study.

BACKGROUND: Age-related losses in bone mineral density (BMD), muscle strength, balance, and gait have been linked to an increased risk of falls, fractures and disability, but few prospective studies have compared the timing, rate and pattern of changes in each of these measures in middle-aged and older men and women. This is important so that targeted strategies can be developed to optimise specific musculoskeletal and functional performance measures in older adults. Thus, the aim of this 10-year prospective study was to: 1) characterize and compare age- and gender-specific changes in BMD, grip strength, balance and gait in adults aged 50 years and over, and 2) compare the relative rates of changes between each of these musculoskeletal and functional parameters with ageing. METHODS: Men (n = 152) and women (n = 206) aged 50, 60, 70 and 80 years recruited for a population-based study had forearm BMD, grip strength, balance and gait velocity re-assessed after 10-years. RESULTS: The annual loss in BMD was 0.5-0.7% greater in women compared to men aged 60 years and older (p < 0.05- < 0.001), but there were no gender differences in the rate of loss in grip strength, balance or gait. From the age of 50 years there was a consistent pattern of loss in grip strength, while the greatest deterioration in balance and gait occurred from 60 and 70 years onwards, respectively. Comparison of the changes between the different measures revealed that the annual loss in grip strength in men and women aged <70 years was 1-3% greater than the decline in BMD, balance and gait velocity. CONCLUSION: There were no gender differences in the timing (age) and rate (magnitude) of decline in grip strength, balance or gait in Swedish adults aged 50 years and older, but forearm BMD decreased at a greater rate in women than in men. Furthermore, there was heterogeneity in the rate of loss between the different musculoskeletal and function parameters, especially prior to the age of 70 years, with grip strength deteriorating at a greater rate than BMD, balance and gait.

Forearm bone mineral density and incidence of hip fractures in Swedish urban and rural men 1987-2002.

BACKGROUND: It is not known whether the recently described break in the trend in hip fracture incidence in many settings applies in both women and men, depends on changes in bone mineral density (BMD) or changes in other risk factors, or whether it is apparent in both urban and rural settings. METHODS: We evaluated changes in annual hip fracture incidence from 1987 to 2002 in Swedish men aged ≥60 years in one urban (n = 25,491) and one rural population (n = 16,432) and also secular differences in BMD, measured by single-photon absorptiometry at the distal radius and multiple other risk factors for hip fracture in a population-based sub-sample of the urban and the rural men aged 60-80 years in 1988/89 (n = 202 vs. 121) and in 1998/99 (n = 79 vs. 69). RESULTS: No statistically significant changes in the annual age-adjusted hip fracture incidence per 10,000 were apparent from 1987 to 2002 in urban (0.38 per year, 95% CI -0.12 to 0.88) or rural men (-0.05 per year, 95% CI -0.63 to 0.53). BMD was similar in 1988/89 and 1998/99 when examining both urban (-19.6 mg/cm(2), 95% CI -42.6 to 3.5) and rural (-23.0 mg/cm(2), 95% CI -52.1 to 6.1) men. CONCLUSIONS: Since no secular change in age-adjusted hip fracture incidence was found during the study period, a levelling off in hip fracture incidence is present also in Swedish men. Because BMD on a group level was similar in 1988/89 and 1998/99, changes in other risk factors ought to be either of minor importance or counteracted by changes in different risk factors.

Normative calcaneal quantitative ultrasound data as an estimation of skeletal development in Swedish children and adolescents.

We present age- and gender-specific normative bone status data evaluated by quantitative ultrasound (QUS) in the calcaneus with the Lunar Achilles device and compare these estimates with bone mineral content (BMC) and bone mineral density (BMD) estimated by dual X-ray absorptiometry (DXA). Included were a sample of 518 population-based collected Swedish girls and 558 boys aged 6-19 years. QUS measurements included speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI) in the calcaneus. DXA measurements included BMC and BMD in the femoral neck (FN), lumbar spine (L2-L4), and total body (TB). Height and weight were measured with standard equipment. Age, height, and weight were significantly associated with SOS, BUA, and SI. Compared to SOS, in both girls and boys there was a higher correlation between BUA and FN BMC (r = 0.71 and r = 0.73, respectively), FN BMD (r = 0.68 and r = 0.67, respectively), L2-L4 BMC (r = 0.70 and r = 0.64, respectively), L2-L4 BMD (r = 0.69 and r = 0.64, respectively), TB BMC (r = 0.76 and r = 0.75, respectively), and TB BMD (r = 0.74 and r = 0.74, respectively). The correlations between SOS and FN BMC (r = 0.38 and r = 0.52, respectively), FN BMD (r = 0.41 and r = 0.52, respectively), L2-L4 BMC (r = 0.31 and r = 0.40, respectively), L2-L4 BMD (r = 0.32 and r = 0.41, respectively), TB BMC (r = 0.42 and r = 0.49, respectively), and TB BMD (r = 0.48 and r = 0.54, respectively) were lower, although still significant (all P < 0.001). BUA seems to be the QUS parameter that best resembles the changes in BMC during growth.

Bone mineral density and incidence of hip fracture in Swedish urban and rural women 1987-2002.

BACKGROUND AND PURPOSE: Although the incidence of hip fracture during the past 50 years has increased, a break in this trend has been reported in the last decade. Whether this change is attributable to changes in bone mineral density (BMD) or whether it varies between urban and rural regions is unknown. METHODS: We evaluated changes in annual hip fracture incidence in women aged > or = 50 years in one urban population (n = 51,757) and one rural population (n = 26,446) from 1987 to 2002. We also examined secular differences in BMD (mg/cm(2)), evaluated by single-photon absorptiometry at the distal radius, prevalence of osteoporosis, and several other risk factors for hip fracture in one population-based sample of urban women and one sample of rural women aged 50-80 years at two time points: 1988/89 (n = 257 and n = 180, respectively) and 1998/99 (n = 171 and n = 118, respectively). RESULTS: No statistically significant changes were evident in annual age-adjusted hip fracture incidence per 10(4) when analyzing all women (-0.01 per year (95% CI: -0.37, 0.35)), rural women (-0.38 per year (-1.05, 0.28)), or urban women (0.19 per year (-0.28, 0.67)). BMD (expressed as T-score) was similar in 1988/99 and 1998/99 when analyzing all women (-0.09 (-0.26, 0.09)), urban women (-0.04 (-0.27, 0.19)), or rural women (-0.15 (-0.42, 0.13)) women. INTERPRETATION: Since no changes in age-adjusted hip fracture incidence and no differences in BMD were found during the study period, changes evident in the other risk factors for hip fracture that we investigated (such as gait velocity and balance) are either of minor importance or are counteracted by changes in other risk factors.

Prevalence of osteoporosis and incidence of hip fracture in women--secular trends over 30 years.

BACKGROUND: The number of hip fractures during recent decades has been reported to be increasing, partly because of an increasing proportion of elderly women in the society. However, whether changes in hip fracture annual incidence in women are attributable to secular changes in the prevalence of osteoporosis is unclear. METHODS: Bone mineral density was evaluated by single-photon absorptiometry at the distal radius in 456 women aged 50 years or above and living in the same city. The measurements were obtained by the same densitometer during three separate time periods: 1970-74 (n = 106), 1987-93 (n = 175) and 1998-1999 (n = 178), and the age-adjusted prevalence of osteoporosis in these three cohorts was calculated. Additionally, all hip fractures sustained in the target population of women aged 50 years or above between 1967 and 2001 were registered, whereupon the crude and the age-adjusted annual incidence of hip fractures were calculated. RESULTS: There was no significant difference in the age-adjusted prevalence of osteoporosis when the three cohorts were compared (P = 1.00). The crude annual incidence (per 10,000 women) of hip fracture in the target population increased by 110% from 40 in 1967 to 84 in 2001. The overall trend in the crude incidence between 1967 and 2001 was increasing (1.58 per 10,000 women per year; 95 percent confidence interval, 1.17 to 1.99), whereas the age-adjusted incidence was stable over the same period (0.22 per 10,000 women per year; 95 percent confidence interval, -0.16 to 0.60). CONCLUSIONS: The increased number of hip fracture in elderly women is more likely to be attributable to demographic changes in the population than to secular increase in the prevalence of osteoporosis.

Normative dual energy X-ray absorptiometry data in Swedish children and adolescents.

AIM: To present normative dual energy X-ray absorptiometry data in healthy young Swedes. METHODS: Included were 710 girls and 759 boys aged 6-30 years from southern Sweden. Bone mineral content, bone mineral density, bone size, lean body and fat mass were measured by dual energy X-ray absorptiometry in total body, lumbar spine, hip, arms and legs. RESULTS: Swedish children had similar bone mass to children in the Netherlands but higher than children in Canada and Korea. Height, weight, bone mass, bone size and lean mass increased at a constant rate from age 6 until the rapid increase in all traits at puberty. The pubertal growth spurt started earlier in girls than in boys, while the spurt in boys was larger in magnitude and occurred for a longer period. Around one-quarter of the adult total body and lumbar spine peak bone mineral content was gained during the 2 years with the fastest gain in both genders. CONCLUSION: This study presents normative bone mass data in Swedish children, data that are similar to that in Dutch children but higher than in Canadian and Korean children. The gain in Swedish children seems to mimic the gain seen in children in other settings.

Association between changes in habitual physical activity and changes in bone density, muscle strength, and functional performance in elderly men and women.

OBJECTIVES: To investigate the long-term effects of habitual physical activity on changes in musculoskeletal health, functional performance, and fracture risk in elderly men and women. DESIGN: Ten-year prospective population-based study. SETTING: Malmö-Sjöbo Prospective Study, Sweden. PARTICIPANTS: Participants were 152 men and 206 women aged 50, 60, 70, and 80 who were followed for 10 years. MEASUREMENTS: Distal radius bone mineral density (BMD) (single photon absorptiometry), upper limb muscle (grip) strength, balance, gait velocity, occupational and leisure-time activity, and fractures (interview-administered questionnaire) were reassessed after 10 years. Annual changes for all measures were compared between participants with varying habitual physical activity histories at baseline and follow-up: inactive-inactive (n=202), active-inactive (n=47), inactive-active (n=49), and active-active (n=60). Data for men and women were pooled, because there were no sex-by-activity group interactions. To detect possible differences in fracture incidence between the varying habitual activity groups, participants were classified into two activity groups based on their activity classification at baseline and follow-up: inactive:less active versus active:more active. RESULTS: The annual rate of bone loss was 0.6% per year less in individuals classified as active at both time points than in those classified as inactive at both time points (P<.01). Similar results were observed for balance, but there was no effect of varying habitual activity on changes in muscle strength or gait velocity. There were also no differences in fracture incidence between individuals categorized as active:more active and those categorized as inactive:less active during the follow-up (adjusted hazard ratio=0.90, 95% confidence interval (CI)=0.42-1.90). CONCLUSION: This study showed that elderly men and women who maintained a habitually active lifestyle over 10 years had lower bone loss and retained better balance than those who remained habitually inactive.

The Hansson Twin Hook is adequate for fixation of trochanteric fractures: 2 fixation failures in a series of 157 prospectively followed patients.

BACKGROUND AND PURPOSE: The Hansson Twin Hook (HTH) is an alternative to the lag screw in the treatment of trochanteric fractures. In osteoporotic bone, mechanical tests have indicated that the HTH has better fixation properties than the lag screw. We evaluated the fixation stability of the HTH in a large series of elderly patients with trochanteric fractures. Many surgeons were involved in assessment of whether the device was user-friendly. PATIENTS AND METHODS: In a prospective bicentric study, 55 surgeons used the HTH and a standard plate in 157 consecutive patients with trochanteric fractures, 83% of which were unstable. The mean age of the patients was 83 (43-98) years. They were followed regularly clinically and radiographically for at least 4 months, with a radiographic file search at 2 years. RESULTS: Technical errors occurred intraoperatively in 7 cases. The reduction of the fracture was inaccurate in these patients; thus, the HTH had not been placed centrally in the femoral head. One of these errors was immediately and easily corrected without interference with the standard plate, and caused no further problems. 2 of the remaining 6 intraoperative errors developed into failures of fixation during the 2-year period. INTERPRETATION: The HTH gives adequate fixation in the bone of elderly patients with trochanteric fractures and has a low failure rate. It is also easy to use.

Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden.

BACKGROUND AND PURPOSE: Few economic or quality-of-life studies have investigated the long-term consequences of fragility fractures. This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral, and wrist fracture 13-18 months after the fracture, based on 684 patients surviving 18 months after fracture. PATIENTS AND METHODS: Data regarding resource use and quality of life related to fractures was collected using questionnaires at 7 research centers in Sweden. Information was collected using patient records, register sources, and by asking the patient. Quality of life was estimated using the EQ-5D questionnaire. Direct and indirect costs were estimated from a societal standpoint. RESULTS: The mean fracture-related cost 13-18 months after a hip, vertebral, or wrist fracture were estimated to be euro2,422, euro3,628, and euro316, respectively. Between 12 and 18 months after hip, vertebral, and wrist fracture, utility increased by 0.03, 0.05, and 0.02, respectively. Compared to prefracture levels, the mean loss in quality of life between 13 and 18 months after fracture was estimated to be 0.05, 0.11, and 0.005 for hip, vertebral, and wrist fracture. INTERPRETATION: The sample of vertebral fracture patients was fairly small and included a high proportion of fractures leading to hospitalization, but the results indicate higher long-term costs and greater loss in quality of life related to vertebral fracture than previously believed.

Costs and quality of life associated with osteoporosis-related fractures in Sweden.

This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral and wrist fracture 1 year after the fracture, based on a patient sample consisting of 635 male and female patients surviving a year after fracture. Data regarding resource use and quality of life related to fractures was collected by questionnaires at baseline, 4 months and 12 months. Information was collected by the use of patients' records, register sources and by asking the patient. Quality of life was estimated with the EQ-5D questionnaire. Costs were estimated from a societal perspective, including direct and indirect costs. The mean fracture-related cost the year after a hip, vertebral and wrist fracture were estimated, in euros (), at 14,221, 12,544 and 2,147, respectively [converted from Swedish krona (SEK) at an exchange rate of 9.1268 SEK/]. The mean reduction in quality of life was estimated at 0.17, 0.26 and 0.06 for hip, vertebral and wrist fracture, respectively. Based on the results, the yearly burden of osteoporosis in Sweden could be estimated at 0.5 billion (SEK 4.6 billion). The patient sample for vertebral fracture was fairly small and included a high proportion of fractures leading to hospitalization, but they indicate a higher cost and loss of quality of life related to vertebral fracture than previously perceived.

Primary hemiarthroplasty in old patients with displaced femoral neck fracture: a 1-year follow-up of 103 patients aged 80 years or more.

103 patients with displaced femoral neck fractures (Garden 3-4) treated with primary hemiarthroplasty in the Department of Orthopedics, Malmö University Hospital, Sweden 1998-1999 were followed in a prospective, consecutive study for 1 year. Inclusion criteria were age of at least 80 years, signs of mental changes and/or residence in an institution. The control group consisted of 69 patients with internal fixation (Hansson hook pins). The arthroplasty group required more blood transfusions, a longer operation and had more superficial infections. No differences were detected as regards other complications, length of hospital stay, in-hospital mortality or ability to return home. The 1-year mortality rates were similar in the arthroplasty (29/103) and control groups (28/69). Within 1 year, we found a lower failure rate in the arthroplasty group (6/103) than in the control group (18/69). In the arthroplasty group, 2/103 had dislocations. Of the surviving arthroplasty patients at 12 months, 31/74 could walk as well as before the fracture and 55/74 had no pain. We recommend primary hemiarthroplasty for demented and/or institutionalized patients over 80 years with displaced femoral neck fractures.