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Williams LJ, Agustini B, Stuart AL, Pasco JA, Hodge JM, Samarasinghe RM, Bjerkeset O, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Berk M. Lithium use and bone health in women with bipolar disorder: A cross-sectional study. Acta Psychiatr Scand 2024; 149:332-339. [PMID: 38240178 DOI: 10.1111/acps.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/21/2023] [Accepted: 01/06/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Several psychiatric disorders and medications used to treat them appear to be independently associated with skeletal deficits. As there is increasing evidence that lithium possesses skeletal protective properties, we aimed to investigate the association between lithium use and bone health in a group of women with bipolar disorder. METHOD Women with bipolar disorder (n = 117, 20+ years) were recruited from south-eastern Australia. Bipolar disorder was confirmed using a clinical interview (SCID-I/NP). Bone mineral density (BMD; g/cm2 ) was measured at the spine, hip and total body using dual-energy x-ray absorptiometry and low bone mass determined by BMD T-score of <-1.0. Weight and height were measured, socioeconomic status (SES) determined and information on medication use and lifestyle factors self-reported. Linear and logistic regression were used to test associations between lithium and (i) BMD and (ii) low bone mass, respectively. RESULTS Thirty-five (29.9%) women reported current lithium use. Lithium users and non-users differed in regard to SES and BMD; otherwise, groups were similar. After adjustments, mean BMD among lithium users was 5.1% greater at the spine (1.275 [95% CI 1.229-1.321] vs. 1.214 [1.183-1.244] g/cm2 , p = 0.03), 4.2% greater at the total hip (0.979 [0.942-1.016] vs. 0.938 [0.910-0.966] g/cm2 , p = 0.03) and 2.2% greater at the total body (1.176 [1.148-1.205] vs. 1.150 [1.129-1.171] g/cm2 , p = 0.08) compared to participants not receiving lithium. Lithium users were also less likely to have low bone mass (22.9% vs. 43.9%, p = 0.031). Associations persisted after adjustment for confounders. CONCLUSION These data suggest lithium is associated with greater BMD and reduced risk of low bone mass in women with bipolar disorder. Research into the underlying mechanisms is warranted.
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Affiliation(s)
- Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Bruno Agustini
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Amanda L Stuart
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Julie A Pasco
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason M Hodge
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Rasika M Samarasinghe
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Shae E Quirk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Risto Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- Orygen, National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
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Sjöblom S, Suuronen J, Rikkonen T, Honkanen R, Kröger H, Sirola J. The diagnostic cut-off points for components of sarcopenia in Finnish Caucasian women: A retrospective cross-sectional study. J Frailty Sarcopenia Falls 2023; 8:211-220. [PMID: 38046438 PMCID: PMC10690131 DOI: 10.22540/jfsf-08-211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives To determine the diagnostic cut-off values of components for sarcopenia in Caucasian women. Methods The present retrospective cross-sectional study based on the REFERENCE sample included 400 healthy women aged 20 to 40 years, and the OSTPRE sample included 344 women aged 63 to 75. The subjects of the OSTPRE population were re-measured five and ten years later after the baseline. Both samples underwent grip strength (GS), quadriceps strength (QS), and total-body DXA (TB-DXA) measurements, from which Relative Skeletal Muscle Mass Index (RSMI) was calculated. Results In the REFERENCE population, the -1 SD / -2 SD cut-off points were for RSMI 5.8 kg/m2 / 5.1 kg/m2, for GS 32.0 kg / 26.4 kg, and for QS 39.8 kg / 29.8 kg. The prevalence of under -2 SD distributions in REFERENCE were: RSMI 1.8%, GS 1.3%, and QS 2.0%, and in OSTPRE (15/20/25 years measurements): RSMI 1.2 %/1.9 %/0.5 %, GS 52.2%/42.3%/48.8%, and QS 47.4%/55.2%/not available. The distributions of GS and QS were statistically significantly different between REFERENCE and all OSTPRE measurement points (p<0.001 in Chi-squared). Conclusions The diagnostic cut-offs for components of sarcopenia are RSMI 5.1 kg/m2, grip strength 26.4 kg, and quadriceps strength 29.8 kg in Finnish Caucasian women.
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Affiliation(s)
- Samu Sjöblom
- Kuopio Musculoskeletal Research Unit (KMRU) Mediteknia Building, University of Eastern Finland, Kuopio, Finland
| | - Juha Suuronen
- Kuopio Musculoskeletal Research Unit (KMRU) Mediteknia Building, University of Eastern Finland, Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU) Mediteknia Building, University of Eastern Finland, Kuopio, Finland
| | - Risto Honkanen
- Department of Psychiatry, University Hospital of Oulu, Oulu, Finland
| | | | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU) Mediteknia Building, University of Eastern Finland, Kuopio, Finland
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Rikkonen T, Sund R, Koivumaa-Honkanen H, Sirola J, Honkanen R, Kröger H. Effectiveness of exercise on fall prevention in community-dwelling older adults: a 2-year randomized controlled study of 914 women. Age Ageing 2023; 52:7136744. [PMID: 37097767 PMCID: PMC10128158 DOI: 10.1093/ageing/afad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Communal exercise interventions may help prevent falls and injuries. However, pragmatic trials demonstrating the effectiveness of such strategies are sparse. METHODS We determined whether a cost-free 12-month admission to the city's recreational sports facilities including initial 6 months of supervised weekly gym and Tai Chi sessions decreases the number of falls and related injuries. The mean (SD) follow-up time was 22·6 (4.8) months in 2016-19. A total of 914 women from a population-based sample with a mean age of 76.5 (SD 3.3, range 71.1-84.8) years were randomized into exercise intervention (n = 457) and control (n = 457) groups. Fall information was collected through biweekly short message (SMS) queries and fall diaries. Altogether 1,380 falls were recorded for the intention-to-treat analysis, with 1,281 (92.8%) being verified by telephone. RESULTS A 14.3% fall rate reduction was detected in the exercise group (Incidence rate ratio (IRR) = 0.86; CI 95% 0.77-0.95) compared with the control group. Approximately half of the falls caused moderate (n = 678, 52.8%) or severe (n = 61, 4.8%) injury. In total, 13.2% (n = 166) of falls (including 73 fractures) required medical consultation with a 38% lower fracture rate in the exercise group (IRR = 0.62; CI 95% 0.39-0.99). Overall, the greatest reduction of 41% (IRR = 0.59; CI 95% 0.36-0.99) was observed in falls with severe injury and pain. CONCLUSIONS A community-based approach for a 6-month exercise period combined with a 12-month free use of sports premises can reduce falls, fractures and other fall-related injuries in aging women.
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Affiliation(s)
- Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland Kuopio, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Kuopio, Finland
- Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Stuart AL, Pasco JA, Berk M, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Mohebbi M, Williams LJ. Falls in community-dwelling women with bipolar disorder: a case-control study. BMC Psychiatry 2022; 22:620. [PMID: 36127652 PMCID: PMC9487100 DOI: 10.1186/s12888-022-04258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/09/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common occurrence in psychiatric hospital settings, however population-based research among individuals with psychiatric disorders, in particular bipolar disorder (BD) is scant. Thus, we aimed to investigate falls risk in community-dwelling women diagnosed with BD. METHODS Women with BD (cases, n = 119) were recruited from health care settings located in southeast Victoria, Australia. Age-matched controls (n = 357, ratio 3:1) without BD were participants in the Geelong Osteoporosis Study drawn from the same geographical region. Lifetime history of BD was identified by semi-structured clinical interview (SCID-IV/NP). Previous 12-month falls data were obtained via questionnaire. Information on mobility, alcohol use, general health, medication use, blood pressure, body mass index, socioeconomic status and use of a walking aid was collected. Generalised Estimating Equations, binary and ordinal logistic regression were used to determine the odds ratio (OR) and 95% confidence interval (CI) for falls following adjustment for confounders. RESULTS During the 12-month period, 34 (28.6%, median age 48.4 yr) cases and 70 (19.6%, median age 49.1 yr) controls reported one fall; 22 (18.5%) cases and 18 (5.0%) controls reported ≥ two falls (p < 0.001). Cases had 2.5-fold increased odds of at least one fall and 2.9-fold increased likelihood of increasing falls categories (0 vs. 1 vs. 2 +), compared to controls [adjOR 2.5, 95%CI (1.8, 3.4), adjOR OR 2.9, 95%CI (2.0, 4.1)]. CONCLUSION Risk of falls was greater among women with BD. Balance training could be a research and clinical focus for falls prevention programs among women with bipolar disorder to prevent the detrimental outcomes associated with falling.
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Affiliation(s)
- Amanda L. Stuart
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia
| | - Julie A. Pasco
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia ,grid.414257.10000 0004 0540 0062Barwon Health University Hospital, Geelong, Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine-Western Health, The University of Melbourne, St Albans, Australia ,grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Berk
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia ,grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Psychiatry, The University of Melbourne, Parkville, Australia ,grid.418025.a0000 0004 0606 5526Florey Institute of Neuroscience and Mental Health, Parkville, Australia ,grid.488501.00000 0004 8032 6923Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Shae E. Quirk
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland ,grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland ,grid.410705.70000 0004 0628 207XMental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- grid.9668.10000 0001 0726 2490Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Mohammadreza Mohebbi
- grid.1021.20000 0001 0526 7079Faculty of Health, Deakin University, Burwood, Australia
| | - Lana J. Williams
- grid.414257.10000 0004 0540 0062School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, PO Box 281, Geelong, 3220 Australia
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Williams LJ, Stuart AL, Berk M, Brennan-Olsen SL, Hodge JM, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Chandrasekaran V, Cleminson JR, Pasco JA. Bipolar disorder and bone health: A case-control study. J Affect Disord 2022; 308:39-43. [PMID: 35398110 DOI: 10.1016/j.jad.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/19/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with significant psychological and physical comorbidity. Yet little is known about the bone health of individuals with BD. Thus, we aimed to investigate the association between BD and bone health in a population-based sample of women. METHODS Women with a history of BD (cases; n = 117) were recruited from public and private health care settings and controls, without BD, were drawn from the Geelong Osteoporosis Study (n = 909). BD was identified using a semi-structured clinical interview (SCID-I/NP). Bone mineral density (BMD) was measured at the spine, femoral neck and total body using dual energy x-ray absorptiometry, and bone quality by quantitative heel ultrasound and included the following parameters: Speed of Sound (SOS), Broadband Ultrasound Attenuation (BUA) and Stiffness Index (SI). Weight and height were measured and information on medication use and lifestyle was obtained. RESULTS Adjusted mean BMD among the cases was 4.3% lower at the hip and 1.6% lower at the total body compared to controls. Age was an effect modifier at the spine. Among women <50 years, mean spine BMD for cases was 3.5% lower than controls. No differences in spine BMD for those ≥50 years were detected. Cases also had a 1.0%, 3.2% and 7.8% lower adjusted mean SOS, BUA and SI compared to controls, respectively. LIMITATIONS Course, chronicity and recovery of BD were not explored in relation to bone health. CONCLUSION These data suggest BD is associated with low bone quantity and quality in women. Replication and research into underlying mechanisms is warranted.
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Affiliation(s)
- Lana J Williams
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia.
| | - Amanda L Stuart
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Parkville, Victoria, Australia
| | - Sharon L Brennan-Olsen
- Deakin University, Institute for Health Transformation, Geelong, Victoria, Australia; Deakin University, School of Health and Social Development, Geelong, Victoria, Australia; The University of Melbourne, Department of Medicine-Western Health, St Albans, Victoria, Australia; University of Melbourne and Western Health, Australian Institute for Musculoskeletal Science, St Albans, Victoria, Australia
| | - Jason M Hodge
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; Geelong Centre for Emerging Infectious Diseases, Geelong, Victoria, Australia
| | - Shae E Quirk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland; Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland
| | - Jeremi Heikkinen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland; Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Vinoomika Chandrasekaran
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Jasmine R Cleminson
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Julie A Pasco
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; The University of Melbourne, Department of Medicine-Western Health, St Albans, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Vilpunaho T, Sund R, Koivumaa-Honkanen H, Honkanen R, Kröger H, Rikkonen T. Urban RCT participants were healthier than non-participants or rural women. J Clin Epidemiol 2021; 140:44-55. [PMID: 34487834 DOI: 10.1016/j.jclinepi.2021.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/19/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate sociodemographic characteristics and physical and mental health indicators between participants and nonparticipants of a large-scale 2-year exercise RCT including noninvited women living in nearby rural area in Finland. STUDY DESIGN AND SETTING From a previous OSTPRE study cohort, 914 women (aged 72-84) participated in Kuopio Fall Prevention Study in 2016-2019. The participants were compared to non-participants (n = 4,536) and noninvited OSTPRE women (n = 7,119) living outside the urban recruitment area. RESULTS Participants were younger (P< 0.001) with higher education (P< 0.001) and had more often regular hobbies (P< 0.001) and physical exercising (P< 0.001) than nonparticipants or noninvited. They reported better functional capability (P< 0.001), mental (P< 0.001) and subjective health (P< 0.001), lower number of medications (P< 0.001), less fear of falls (P< 0.001), but more frequent falls (P= 0.002) and more often musculoskeletal diseases (P= 0.006). Participants also showed better functional capacity in the clinical measurements. In register analysis, urban-rural differences in the prevalence of diseases were detected. CONCLUSION In population-based exercise interventions, participants are more likely to be better off in respect to physical and mental wellbeing, functional capability and sociodemographic status. Recruiting participants only from cities increases unavoidable selection bias due to urban-rural differences which should be noticed when interpreting and generalizing RCT results. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT02665169.
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Affiliation(s)
- Tommi Vilpunaho
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland.
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland; Institute of Clinical Medicine, Psychiatry, University of Eastern Finland (UEF), Kuopio, Finland; Mental Health and Wellbeing Center, Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland; Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
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Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Kavanagh BE, Williams LJ. Exploring the comorbidity of musculoskeletal and personality disorders among adults: a scoping review protocol. Syst Rev 2021; 10:182. [PMID: 34148544 PMCID: PMC8215781 DOI: 10.1186/s13643-021-01721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 01/17/2021] [Accepted: 05/28/2021] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Separately, mental and musculoskeletal disorders (MSDs) are prevalent across the life course and are leading contributors to disability worldwide. While people with personality disorder (PD) have been shown to have an increased risk of certain physical health comorbidities-associations with MSDs have not been thoroughly explored. The proposed scoping review aims to explore the existing clinical- and population-based literature on the comorbidity of PD and MSDs among adults ≥ 18 years and the burden associated with their comorbidity, identify knowledge gaps on this topic, and propose recommendations for future research. METHODS This protocol describes the methodology to undertake the scoping review. It is guided by Arksey and O'Malley's framework and the extensions recommended by the Joanna Briggs Institute. A comprehensive search strategy will be used to identify relevant articles, which will be underpinned by Population, Concept, and Context (PCC) inclusion criteria. One author will perform the search and two authors will independently screen titles/abstracts followed by a full-text review for articles considered relevant. The supervising author will confirm the final selection of articles to be included. One author will extract relevant information from the articles using a predetermined charting form, while a second will perform validation of all information entered. DISCUSSION Information will be synthesised to inform a discussion of what is known regarding associations between PD and MSDs, and the burden associated with their comorbidity in different contexts, with future research directions proposed. SYSTEMATIC REVIEW REGISTRATION This protocol is registered in Open Science Framework Registries ( https://osf.io/mxbr2/ ).
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Affiliation(s)
- Shae E Quirk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia.,Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Bianca E Kavanagh
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Lana J Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia. .,University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
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Rikkonen T, Sund R, Sirola J, Honkanen R, Poole KES, Kröger H. Obesity is associated with early hip fracture risk in postmenopausal women: a 25-year follow-up. Osteoporos Int 2021; 32:769-777. [PMID: 33095419 PMCID: PMC8026440 DOI: 10.1007/s00198-020-05665-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/01/2020] [Indexed: 12/15/2022]
Abstract
UNLABELLED Association of body mass index and hip fracture has been controversial. In this study, women with lowest and highest body weight had the highest fracture incidence. A 25-year follow-up indicated that obesity associates with early hip fracture risk and suggested increasing trend in normal-weight women at a later stage. INTRODUCTION Obesity is a pandemic health issue. Its association with hip fracture risk remains controversial. We studied the long-term relationship of body mass index and hip fracture incidence in postmenopausal women. METHODS The cohort of 12,715 Finnish women born in 1932-1941 was followed for 25 years, covering ages from 58 up to 83. Fractures and deaths were obtained from national registries. Women were investigated in deciles of BMI as well as in WHO weight categories (normal, overweight, or obese). The follow-up analysis was carried out in two age strata as "early" (58-70 years) and "late" (> 70 years). Body weight information was updated accordingly. Femoral neck BMD was recorded for a subsample (n = 3163). Altogether, 427 hip fractures were observed. RESULTS A higher risk of early hip fracture was observed in obese and normal-weight compared with overweight women with hazard ratios (HRs) of 2.3 ((95% CI) 1.4-3.7) and 2.0 (1.3-3.1) while no difference was observed in late hip fracture risk between the three WHO categories (log rank p = 0.14). All-cause mortality during the follow-up was 19.3%. Compared with normal weight women, the obese women had a higher risk of death with an HR of 1.6 (1.4-1.8) and higher baseline BMD (p < 0.001). Faster bone loss was observed in the obese compared with other women (p < 0.001). CONCLUSION Obesity associates with earlier hip fracture and higher postfracture mortality. The obese women with low BMD have clearly the highest risk of hip fracture. This combination increases hip fracture risk more than either of the factors alone. After 75 years of age, risk appears to increase more in normal weight women, but this trend is in need of further confirmation.
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Affiliation(s)
- T Rikkonen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
| | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - J Sirola
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Orthopaedics and Traumatology, Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - R Honkanen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, University of Oulu, Oulu, Finland
| | - K E S Poole
- University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - H Kröger
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Orthopaedics and Traumatology, Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Värri M, Niskanen L, Tuomainen TP, Honkanen R, Kröger H, Tuppurainen MT. Metabolite Profiling of Osteoporosis and Atherosclerosis in Postmenopausal Women: A Cross-Sectional Study. Vasc Health Risk Manag 2020; 16:515-524. [PMID: 33293818 PMCID: PMC7719314 DOI: 10.2147/vhrm.s279028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/19/2020] [Indexed: 02/02/2023] Open
Abstract
Purpose Atherosclerosis (AS) and osteoporosis (OP) are common causes of morbidity and mortality in postmenopausal women and are connected via an unknown mechanistic link. Metabolite profiling of blood samples may allow the identification of new biomarkers and pathways for this enigmatic association. Patients and Methods We studied the difference in 148 metabolite levels from serum samples in postmenopausal women with AS and OP compared with those in healthy participants in this cross-sectional study. Quantitative AS was assessed by carotid artery intima-media thickness (cIMT) and carotid artery calcifications (CACs) by ultrasound, as well as OP by femoral neck (FN) bone mineral density (BMD) and 148 metabolic measures with high-throughput proton (1H) nuclear magnetic resonance (NMR) in serum samples from 280 postmenopausal (PM) women. Subjects were a randomly selected subsample from the population-based Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study. The final study population included the following groups: OP with CAC (n=16, group I), non-OP with no CAC (n=59, group II), high cIMT tertile with OP (n=11, group III) and low cIMT tertile without OP (n=48, group IV). Results There were differences in several metabolite levels between groups I and II. The acetate level was lower in group I compared to that in group II (group I mean ± SD: 0.033 ± 0.0070; group II: 0.041 ± 0.014, CI95%: 0.018‒0.15, p=0.014). The result was similar with diacylglycerol (p=0.002), leucine (p=0.031), valine (p=0.022) and several very low-density lipoprotein (VLDL) metabolite levels, which were lower in group I compared to those in group II. However, no associations were found in adjusted analyses with total body (TB) fat mass (FM), age and statin use (p>0.05). Conclusion Our novel study found differences in the metabolite profiling of altered amino acid and lipoprotein metabolism in participants with OP and AS compared with those in healthy women. The causative mechanisms remain unknown and further studies are needed.
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Affiliation(s)
- Miika Värri
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Leo Niskanen
- Department of Endocrinology and Metabolism, Abdominal Centre, Helsinki University Hospital, Universities of Helsinki and Eastern Finland, Helsinki, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Lapland Hospital District, Rovaniemi, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Marjo T Tuppurainen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland
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10
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Afrin N, Honkanen R, Koivumaa-Honkanen H, Sund R, Rikkonen T, Williams L, Kröger H. Depression, falls, and fractures. Osteoporos Int 2020; 31:1173-1174. [PMID: 32088732 DOI: 10.1007/s00198-020-05348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Affiliation(s)
- N Afrin
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211, Kuopio, Finland.
| | - R Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211, Kuopio, Finland
- Department of Psychiatry, University Hospital of Oulu, Oulu, Finland
| | - H Koivumaa-Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211, Kuopio, Finland
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- South-Savonia Hospital District, Mikkeli, Finland
- North Karelia Central Hospital, Joensuu, Finland
- SOTE, Iisalmi, Finland
- Oulu University Hospital, Oulu, Finland
| | - R Sund
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211, Kuopio, Finland
| | - T Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211, Kuopio, Finland
| | - L Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - H Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211, Kuopio, Finland
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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11
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Afrin N, Sund R, Honkanen R, Koivumaa-Honkanen H, Rikkonen T, Williams L, Kröger H. A fall in the previous 12 months predicts fracture in the subsequent 5 years in postmenopausal women. Osteoporos Int 2020; 31:839-847. [PMID: 31858171 PMCID: PMC7170829 DOI: 10.1007/s00198-019-05255-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/02/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate if a history of falls predicts future postmenopausal fractures and if this prediction variesaccording to frequency, mechanism, and severity of falls and site of fractures. METHODS This study used data from OSTPRE prospective cohort. Total study population consisted of 8744 postmenopausal women (mean age 62.2 years) who responded to postal enquiry in 1999 (baseline) and in 2004 (follow-up). RESULTS Women were classified by frequency (non/occasional/frequent fallers), mechanism (slip/nonslip), and severity (injurious/ non-injurious) of falls and fractures by site (major osteoporotic/other). A total of 1693 (19.4%) women reported a fall during the preceding 12 months in 1999; 812 a slip fall, 654 a nonslip, 379 an injurious fall, and 1308 a non-injurious fall. A total of 811 women (9.3%) sustained a fracture during the 5-year follow-up period (1999-2004); 431 major osteoporotic fractures and 380 other fractures. Compared with non-fallers, earlier falls predicted subsequent fractures with an OR of 1.41 (95% CI 1.19-1.67, p ≤ 0.001), 1.43 (95% CI 1.14-1.80, p = 0.002) for earlier slip falls, and 1.35 (95% CI 1.04-1.74, p = 0.02) for earlier nonslip falls. Earlier injurious falls predicted future fractures (OR = 1.64, 95% CI 1.21-2.23, p ≤ 0.01), especially other fractures (OR = 1.86, 95% CI 1.24-2.80, p ≤ 0.01), but not major osteoporotic fractures (OR = 1.37, 95% CI 0.89-2.10, p = 0.151). Fracture risk predictions for earlier non-injurious falls was OR = 1.36, 95% CI 1.12-1.64, p = 0.002. These risk patterns remain same after adjustments. CONCLUSION History of falls (especially injurious falls) predicts subsequent fractures (mainly other fractures compared with major osteoporotic fractures) inpostmenopausal women. We aimed to investigate if history of falls (frequency, mechanism, and severity) is a predictor of future fractures in postmenopausal women. Our results indicate that history of falls (especially injurious falls) appeared to be an indicator for subsequent fracture overall. Earlier injurious falls were stronger predictors for future other fractures than for typical major osteoporotic fractures.
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Affiliation(s)
- N. Afrin
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland
| | - R. Sund
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland
| | - R. Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland
- Department of Psychiatry, University Hospital of Oulu, Oulu, Finland
| | - H. Koivumaa-Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland
- Department of Psychiatry, University Hospital of Oulu, Oulu, Finland
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, South-Savonia Hospital District, Mikkeli, Finland
- Department of Psychiatry, North Karelia Central Hospital, Joensuu, Finland
- Department of Psychiatry, SOTE, Iisalmi, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - T. Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland
| | - L. Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - H. Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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12
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Williams LJ, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Pasco JA, Stuart AL, Kavanagh BE, Heikkinen J, Berk M. Personality Disorder and Physical Health Comorbidities: A Link With Bone Health? Front Psychiatry 2020; 11:602342. [PMID: 33363487 PMCID: PMC7752862 DOI: 10.3389/fpsyt.2020.602342] [Citation(s) in RCA: 3] [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] [Received: 09/03/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022] Open
Abstract
We examined whether personality disorders (PDs) (any, cluster A/B/C) were associated with bone mineral density (BMD) in a population-based sample of Australian women (n = 696). Personality and mood disorders were assessed using semi-structured diagnostic interviews. BMD was measured at the spine, hip, and total body using dual-energy x-ray absorptiometry (GE-Lunar Prodigy). Anthropometrics, medication use, physical conditions, and lifestyle factors were documented. The association between PDs (any, cluster A/B/C) and BMD (spine/hip/total body) was examined with multiple linear regression models. The best models were identified by backward elimination including age, weight, physical activity, smoking status, alcohol consumption, dietary calcium intake, mood disorders, physical multimorbidity, socioeconomic status, and medications affecting bone. The variables were retained in the model if p < 0.05. All potential interactions in final models were tested. Those with cluster A PD, compared to those without, had 6.7% lower hip BMD [age, weight adjusted mean 0.853 (95% CI 0.803-0.903) vs. 0.910 (95% CI 0.901-0.919) g/cm2, p = 0.027] and 3.4% lower total body BMD [age, weight, smoking, alcohol, calcium adjusted mean 1.102 (95% CI 1.064-1.140) vs. 1.139 (95% CI 1.128-1.150) g/cm2, p = 0.056]. No associations were observed between cluster B/C PDs and hip/total body BMD or between any of the PD clusters and spine BMD. To our knowledge, this study is the first to investigate the bone health of women with PD in a population-based sample. Given the paucity of literature, replication and longitudinal research including the examination of underlying mechanisms and sex differences are warranted.
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Affiliation(s)
- Lana J Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Shae E Quirk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia.,Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Departments of Psychiatry, South-Savonia Hospital District, Mikkeli, Finland.,Departments of Psychiatry, North Karelia Central Hospital, Joensuu, Finland.,Departments of Psychiatry, SOTE, Iisalmi, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Risto Honkanen
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Julie A Pasco
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
| | - Amanda L Stuart
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
| | - Bianca E Kavanagh
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
| | - Jeremi Heikkinen
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Orygen the National Center of Excellence in Youth Mental Health, Center for Youth Mental Health, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
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13
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Vilpunaho T, Kröger H, Honkanen R, Koivumaa-Honkanen H, Sirola J, Kuvaja-Köllner V, Sund R, Rikkonen T. Randomised controlled trial (RCT) study design for a large-scale municipal fall prevention exercise programme in community-living older women: study protocol for the Kuopio Fall Prevention Study (KFPS). BMJ Open 2019; 9:e028716. [PMID: 31230026 PMCID: PMC6596943 DOI: 10.1136/bmjopen-2018-028716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Falls are a substantial health problem in seniors, causing fractures and being the leading cause of fatal injuries. The benefits of physical activity in fall prevention have been shown in randomised controlled trials (RCTs) in small cohorts (eg, ≤200 persons), but there is a gap between the known health effects of exercise and the large-scale implementation of effective activity in communities. Mental health and subjective well-being (SWB) should also be studied since they are strongly related to healthy ageing. Thus far, the proven efficacy of communal strategies to reduce falls and improve healthy ageing is sparse. METHODS AND ANALYSIS In 2016, a 2-year RCT was launched in Kuopio, Finland to estimate the efficacy of a large, population-based, fall prevention exercise programme in community-living older women (born 1932-1945). Both the intervention and control group (n=457+457) receive health education. The intervention group is also offered free 6-month supervised training courses (weekly gym training and Taiji sessions), followed by a free 6-month unsupervised use of exercise facilities, as well as unsupervised low-cost exercise is also offered for another 12 months. During the whole 24-month follow-up, controls are free to pursue all their normal physical activities. Both study groups undergo the study measurements three times. Outcome measures include recording of falls, injuries, bone mineral density, changes in health and functional status and cognitive performance, deaths and SWB. Finally, the cost-effectiveness and cost-utility analysis will be conducted from the societal view. The main analyses comparing outcomes between study groups will be conducted using the intention to treat principle. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Research Ethics Committee of the Hospital District of North Savo. All regulations and measures of ethics and confidentiality are handled in accordance with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT02665169; Pre-results.
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Affiliation(s)
- Tommi Vilpunaho
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Finland
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland - Kuopio Campus, Finland
- Department of Psychiatry, Kuopio University Hospital, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Finland
| | - Virpi Kuvaja-Köllner
- Department of Health and Social Management, University of Eastern Finland - Kuopio Campus, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
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Heikkinen J, Honkanen R, Williams L, Leung J, Rauma P, Quirk S, Koivumaa-Honkanen H. Depressive disorders, anxiety disorders and subjective mental health in common musculoskeletal diseases: A review. Maturitas 2019; 127:18-25. [PMID: 31351516 DOI: 10.1016/j.maturitas.2019.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 04/11/2019] [Accepted: 05/28/2019] [Indexed: 02/03/2023]
Abstract
Globally, musculoskeletal diseases (MSDs) and mental disorders are the leading causes of disability, but their mutual relationships have been little studied. The objective of the current review is to summarize the evidence on the relationships between depressive and anxiety disorders, subjective mental health and common MSDs in adults aged 45 years and over. A review of studies published in English, identified using MEDLINE, was conducted. Search terms included spinal stenosis, intervertebral disc displacement, osteoarthritis, osteoporosis, depressive disorder, anxiety disorders, mental health, subjective well-being, subjective quality of life, life satisfaction and personal satisfaction. A total of 287 records were initially identified, and an additional 190 records were identified from their reference lists. Eight studies were considered eligible and were, thus, included in the current review. The included studies reported that: 1) major depressive disorder is associated with chronic back pain; 2) anxiety disorders are associated with cervical or lumbar disc herniation; 3) mood and anxiety disorders are associated with lower bone mineral density in men; 4) life satisfaction and its improvement prevent bone loss in postmenopausal women; and 5) quality of life reduces progressively as the number of osteoporotic fractures increases. In conclusion, common MSDs are associated with mental disorders and subjective mental health in adults aged 45 years or more, but longitudinal research is needed.
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Affiliation(s)
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit, Clinical Research Center, University of Eastern Finland, Finland; Department of Psychiatry, Oulu University Hospital, Finland
| | | | - Janni Leung
- Faculty of Health and Behavioural Sciences, University of Queensland, Australia
| | - Päivi Rauma
- Department of Psychiatry, Kuopio University Hospital, Finland; Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Finland
| | - Shae Quirk
- Kuopio Musculoskeletal Research Unit, Clinical Research Center, University of Eastern Finland, Finland
| | - Heli Koivumaa-Honkanen
- Department of Psychiatry, Kuopio University Hospital, Finland; Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Finland; Departments of Psychiatry: South-Savonia Hospital District, Mikkeli, North Karelia Central Hospital, Joensuu, SOTE, Iisalmi, Oulu University Hospital, Oulu, Finland
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15
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Qazi SL, Sirola J, Kröger H, Honkanen R, Isanejad M, Airaksinen O, Rikkonen T. High Postural Sway Is an Independent Risk Factor for Osteoporotic Fractures but Not for Mortality in Elderly Women. J Bone Miner Res 2019; 34:817-824. [PMID: 30811685 DOI: 10.1002/jbmr.3664] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/12/2018] [Accepted: 12/22/2018] [Indexed: 12/26/2022]
Abstract
The aim of this prospective cohort study was to investigate the independent effect of postural sway on overall fracture and osteoporotic fracture risk after controlling for other established fracture risk factors. As a secondary outcome, mortality was also investigated. The study sample is a stratified random sample of 1568 women born between 1932 and 1941, residing in Kuopio province, eastern Finland. Fracture data were obtained through study questionnaires and verified through hospital records. Mortality data were verified through the National Registry. Using static posturography, postural sway was recorded for 1568 women at the fifth year of follow-up in 1994 through 1997. Mediolateral (ML), anteroposterior (AP), and total sway parameters were used for analysis. Mean follow-up time for any fractures, osteoporotic fractures, and mortality was 10.6, 11.4, and 17.5 years, respectively. After adjustment, subjects in the highest quartile of ML sway (HR, 2.0; 95% CI, 1.5 to 2.8) and total sway (HR, 1.6; 95% CI, 1.2 to 2.2) had a higher risk for any fracture. Osteoporotic fracture risk was also higher in the fourth quartile of ML sway (HR, 1.9; 95% CI, 1.1 to 3.0) and total sway (HR, 1.7; 95% CI, 1.0 to 2.8). The models were adjusted for fracture risk assessment tool risk factors and leg-extension strength. Further, women having both lowest bone density and highest postural sway were at 4.9 (95% CI, 2.6 to 9.5) times higher risk of overall fracture and 11.8 (95% CI, 2.7 to 51.3) times higher risk for osteoporotic fracture in comparison with subjects having highest bone density and lowest postural sway. The association between postural sway and mortality was not significant after adjustment. In conclusion, high postural sway is an independent risk factor for any fractures as well as for osteoporotic fractures. A combination of low bone density and high postural sway poses even higher fracture risk than either factor alone. Postural sway does not predict mortality independently. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sarang Latif Qazi
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Masoud Isanejad
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Olavi Airaksinen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
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Afrin N, Honkanen R, Koivumaa-Honkanen H, Sund R, Rikkonen T, Williams L, Kröger H. Role of musculoskeletal disorders in falls of postmenopausal women. Osteoporos Int 2018; 29:2419-2426. [PMID: 30014157 DOI: 10.1007/s00198-018-4631-5] [Citation(s) in RCA: 4] [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: 02/14/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED We aimed to investigate the role of musculoskeletal disorders (MSDs) as risk factors for falls among postmenopausal women. Our results indicate that MSDs are common and are associated with increased falling risk, especially nonslip falls. Excess number of falls due to MSDs is greater than that due to any other disease class. PURPOSE Falls are a major public health problem worldwide. The aim of the study was to investigate the role of MSDs as risk factors for falls among postmenopausal women. METHODS This cohort study utilized data from a population-based, prospective cohort study (OSTPRE). The study population consisted of 8656 women aged 57-66 years (in 1999) living in Kuopio Province, Eastern Finland, who responded to postal enquiries in 1999 and 2004. Information on MSDs and other morbidities was obtained from the 1999 enquiry and information on falls from the 2004 enquiry. Women were classified as fallers or non-fallers according to their falling events in the preceding 12 months. The fallers were further divided into women with slip and nonslip falls. RESULTS Of the study sample, 53.3% reported a MSD and 39.2% reported a fall during the preceding 12 months. MSDs predicted falls (OR = 1.38; 95% CI 1.26-1.50) and the association was stronger for nonslip (OR = 1.56; 95% CI 1.39-1.75) than slip falls (OR 1.22; 95% CI 1.08-1.38) compared to the women without MSDs. The risk of falls increased with increasing number (1, 2, ≥ 3) of MSDs: 1.25 (95%CI 1.13-1.38), 1.48 (95%CI 1.30-1.68), and 1.92 (95%CI 1.60-2.31), respectively. After adjustments, the risk of falling related to MSDs reduced by about 5% (adjusted p < 0.001). The population attributable fraction of falls due to MSDs was 10.3% of all falls, greater than that due to any other disease class. CONCLUSION MSDs are common and an important risk factor for falls and especially nonslip falls among postmenopausal women. The number of excess falls due to MSDs in this population group is greater than that due to any other disease class.
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Affiliation(s)
- N Afrin
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), P.O. Box 1627, 70211, Kuopio, Finland.
| | - R Honkanen
- KMRU, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland
| | - H Koivumaa-Honkanen
- KMRU, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland
- Institute of Clinical Medicine (Psychiatry), UEF, Kuopio, Finland
- Departments of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- Lapland Hospital District, Rovaniemi, Finland
| | - R Sund
- KMRU, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland
- Centre for Research Methods, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - T Rikkonen
- KMRU, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland
| | - L Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - H Kröger
- KMRU, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Rikkonen T, Poole K, Sirola J, Sund R, Honkanen R, Kröger H. Long-term effects of functional impairment on fracture risk and mortality in postmenopausal women. Osteoporos Int 2018; 29:2111-2120. [PMID: 29860666 DOI: 10.1007/s00198-018-4588-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 02/22/2018] [Accepted: 05/24/2018] [Indexed: 12/19/2022]
Abstract
UNLABELLED Our findings imply that simple functional tests can predict both hip fracture risk and excess mortality in postmenopausal women. Since the tests characterize general functional capacity (one-legged stance, squatting down, and grip strength), these simple measures should have clinical utility in the assessment of women at risk of falls and fragility fracture. INTRODUCTION Functional impairment is associated with the risk of fall, which is the leading cause of hip fracture. We aimed to determine how clinical assessments of functional impairment predict long-term hip fracture and mortality. METHODS A population-based prospective cohort involved 2815 Caucasian women with the average baseline age of 59.1 years. The mean follow-up time in 1994-2014 was 18.3 years. Three functional tests and their combinations assessed at baseline were treated as dichotomous risk factors: (1) inability to squat down and touch the floor (SQ), (2) inability to stand on one leg for 10 s (SOL), and (3) having grip strength (GS) within the lowest quartile (≤ 58 kPa, mean 45.6 kPa). Bone mineral density (BMD) at the proximal femur was measured by DXA. Fractures and deaths were verified from registries. Hazard ratios were determined by using Cox proportional models. Age, body mass index (BMI), and BMD were included as covariates for fracture risk estimates. Age, BMI, and smoking were used for mortality. RESULTS Altogether, 650 (23.1%) women had 718 follow-up fractures, including 86 hip fractures. The mortality during the follow-up was 16.8% (n = 473). Half of the women (56.8%, n = 1600) had none of the impairments and were regarded as the referent group. Overall, women with any of the three impairments (43.2%, n = 1215) had higher risks of any fracture, hip fracture, and death, with hazard ratios (HR) of 1.3 ((95% CI) 1.0-1.5, p < 0.01), 2.4 (1.5-3.4, p < 0.001), and 1.5 (1.3-1.8, p < 0.001), respectively. The strongest single predictor for hip fracture was failing to achieve a one-leg stand for 10 s (prevalence 7.1%, n = 200), followed by inability to squat down (27.0%, n = 759) and weak grip strength (24.4%, n = 688), with their respective HRs of 4.3 (2.3-8.0, p < 0.001), 3.1 (2.0-5.0, p < 0.001), and 2.0 (1.2-3.4, p < 0.001). In addition, age, lower BMD, BMI, and smoking were significant covariates. CONCLUSIONS These findings suggest that functional tests provide long-term prediction of fracture and death in postmenopausal women. Whether reversal of these impairments is associated with a reduction in adverse outcomes is an area for future trials.
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Affiliation(s)
- T Rikkonen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Yliopistonranta 1b, PL 1627,, 70211, Kuopio, Finland.
| | - K Poole
- Addenbrookes' Hospital, Box 157, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Sirola
- Department of Orthopaedics, Traumatology and Handsurgery, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 700029, Kuopio, Finland
| | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Yliopistonranta 1b, PL 1627,, 70211, Kuopio, Finland
| | - R Honkanen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Yliopistonranta 1b, PL 1627,, 70211, Kuopio, Finland
| | - H Kröger
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Yliopistonranta 1b, PL 1627,, 70211, Kuopio, Finland
- Department of Orthopaedics, Traumatology and Handsurgery, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 700029, Kuopio, Finland
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Quirk SE, Stuart AL, Berk M, Pasco JA, Brennan Olsen SL, Koivumaa-Honkanen H, Honkanen R, Lukkala PS, Chanen AM, Kotowicz M, Williams LJ. Personality disorder is an excess risk factor for physical multimorbidity among women with mental state disorders. Psychiatry Res 2017; 257:546-549. [PMID: 28888138 DOI: 10.1016/j.psychres.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/12/2017] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
We examined whether mental state disorders (lifetime mood, anxiety, eating, substance misuse) with comorbid personality disorder are associated with physical multimorbidity in a population-based sample of women. Mental state and personality disorders were assessed using semi-structured diagnostic interviews. Clinical measures were performed and medical conditions, medication use and lifestyle factors were documented by questionnaire. Mental state disorders were associated with higher odds of physical multimorbidity; risk was especially high for those with comorbid personality disorder. These findings suggest that mental state and physical comorbidity might be worsened by the additional comorbidity of personality disorder.
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Affiliation(s)
- Shae E Quirk
- Deakin University, Geelong, Australia; Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | | | - Michael Berk
- Deakin University, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Department of Psychiatry, University of Melbourne, Australia; Florey Institute for Neuroscience and Mental Health, Melbourne, Australia; Barwon Health University Hospital, Geelong, Australia
| | - Julie A Pasco
- Deakin University, Geelong, Australia; Barwon Health University Hospital, Geelong, Australia; Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Australia
| | - Sharon L Brennan Olsen
- Deakin University, Geelong, Australia; Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne-Western Precinct, St Albans, Australia
| | - Heli Koivumaa-Honkanen
- Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; School of Medicine, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland
| | - Risto Honkanen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland; Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pyry S Lukkala
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland; Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Mark Kotowicz
- Deakin University, Geelong, Australia; Barwon Health University Hospital, Geelong, Australia; Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Australia
| | - Lana J Williams
- Deakin University, Geelong, Australia; Barwon Health University Hospital, Geelong, Australia.
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Qazi S, Rikkonen T, Kröger H, Honkanen R, Isanejad M, Airaksinen O, Sirola J. Relationship of body anthropometric measures with skeletal muscle mass and strength in a reference cohort of young Finnish women. J Musculoskelet Neuronal Interact 2017; 17:192-196. [PMID: 28860421 PMCID: PMC5601264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES 1) To study if limb length explains variability in appendicular and total muscle mass better than height and 2) if muscle mass adjusted for limb length rather than height correlates better with grip and knee extension strength. METHODS 400 healthy women aged 20-40 were recruited as a reference population. Body composition, limb length, grip strength and knee extension strength were measured. New relative muscle mass indexes were computed by adjusting upper limb muscle mass for upper limb length (ULRSMI) and lower limb muscle mass for lower limb length (LLRSMI). RESULTS Height correlated strongest with all muscle mass measures. Height had the highest R² values for predicting variability in appendicular skeletal muscle mass (0.33), upper limb skeletal muscle mass (0.20), lower limb skeletal muscle mass (0.34) and total skeletal muscle mass (0.36). Correlation of relative skeletal muscle mass index (RSMI) with grip and knee extension strength (r=0.47 and 0.43) was higher when compared with correlation of ULRSMI and LLRSMI with these measures. CONCLUSION Compared to limb length, height correlates better with regional and total muscle mass. Muscle mass adjusted for height correlates better with grip strength and knee strength when compared with muscle mass adjusted for limb length.
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Affiliation(s)
- S.L. Qazi
- Kuopio Musculoskeletal Research Unit (KMRU), Mediteknia Building, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland,Corresponding author: Sarang Latif Qazi, Kuopio Musculoskeletal Research Unit (KMRU) Mediteknia Building, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland E-mail:
| | - T. Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Mediteknia Building, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - H. Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Mediteknia Building, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, 70029 Kuopio, Finland
| | - R. Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Mediteknia Building, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - M. Isanejad
- Kuopio Musculoskeletal Research Unit (KMRU), Mediteknia Building, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - O. Airaksinen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio Finland
| | - J. Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), Mediteknia Building, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, 70029 Kuopio, Finland
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Saarelainen J, Hakulinen M, Rikkonen T, Kröger H, Koivumaa-Honkanen H, Honkanen R, Jurvelin JS. Inclusion of Regional Body Composition Parameters Improves Bone Mineral Density Cross-Calibration Between GE Lunar Prodigy and iDXA Densitometers. J Clin Densitom 2017; 20:97-105. [PMID: 27546558 DOI: 10.1016/j.jocd.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/13/2016] [Revised: 06/30/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022]
Abstract
Since 1989, the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE, n = 14220) Study has followed long-term changes of bone mineral density (BMD) and body composition in women with GE Lunar devices. During the course of OSTPRE, the dual-energy X-ray absorptiometry device had to be replaced by a newer model. Then, it was essential to determine whether systematic measurement differences in BMD and body composition will occur. As a part of the OSTPRE study, BMD was measured in 54 women, whereas body composition was determined in 55 women, aged 27-71, by using both the GE Healthcare Lunar Prodigy and iDXA narrow-angle fan beam densitometers during the same visit. The total body fat mass (FM) and lean body mass (LBM) results of these scanners showed a high linear correlation (r = 0.981-0.994, p < 0.0001). However, the mean total body FM and LBM values measured by iDXA were on average 2.3% (0.5 kg, 95% confidence interval: 0.3-0.7 kg) higher and 0.8% (0.3 kg, 95% confidence interval: 0.1-0.6 kg) lower, respectively, than those measured by Prodigy. Inclusion of local soft tissue measurements (total body LBM, legs/android FM) improved the agreement of total body, total hip, and lumbar spine BMD values between the devices but not femoral neck BMD agreement. Equations, based on linear regression analyses, were derived to minimize differences between the instruments. Then, the differences in BMD and body composition measurements were negligible between Prodigy and iDXA. Using correction equations enables an objective comparison of longitudinal BMD and body composition measurements.
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Affiliation(s)
- J Saarelainen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - M Hakulinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - H Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - H Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland; Departments of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Department of Psychiatry, South-Savonia Hospital District, Mikkeli, Finland; Department of Psychiatry, North Karelia Central Hospital, Joensuu, Finland; Department of Psychiatry, SOSTERI, Savonlinna, Finland; Department of Psychiatry, SOTE, Iisalmi, Finland; Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland; Clinic of Child Psychiatry, University Hospital of Oulu, Oulu, Finland
| | - R Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - J S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
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Afrin N, Honkanen R, Koivumaa-Honkanen H, Lukkala P, Rikkonen T, Sirola J, Williams LJ, Kröger H. Multimorbidity predicts falls differentially according to the type of fall in postmenopausal women. Maturitas 2016; 91:19-24. [DOI: 10.1016/j.maturitas.2016.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
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Saarelainen J, Hassi S, Honkanen R, Koivumaa-Honkanen H, Sirola J, Kröger H, Komulainen MH, Tuppurainen M. Bone loss and wrist fractures after withdrawal of hormone therapy: The 15-year follow-up of the OSTPRE cohort. Maturitas 2016; 85:49-55. [DOI: 10.1016/j.maturitas.2015.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
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Värri M, Niskanen L, Tuomainen T, Honkanen R, Kröger H, Tuppurainen MT. Association of adipokines and estradiol with bone and carotid calcifications in postmenopausal women. Climacteric 2016; 19:204-11. [PMID: 26849745 DOI: 10.3109/13697137.2016.1139563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/23/2022]
Abstract
OBJECTIVES Carotid artery calcifications (CAC) and high carotid artery intima-media thickness (cIMT) are associated with low bone mineral density (BMD) by unknown mechanisms in postmenopausal women. Leptin, adiponectin and estradiol may mediate these associations. Our aim was to study the relationships of the aforementioned factors to bone health (BMD) and carotid atherosclerosis (CAC and cIMT). METHOD Participants (n = 290, mean age 73.6 years) for this cross-sectional OSTPRE-BBA study (Kuopio Osteoporosis Risk Factor and Prevention - Bone, Brain and Atherosclerosis) were randomly selected from the OSTPRE cohort in 2009. Femoral neck and total body BMDs, trunk and total body fat mass were measured with dual-energy X-ray absorptiometry, and cIMT (mm) and CAC (no/yes) were measured with B-type ultrasound. Free estradiol, adiponectin and leptin were measured from serum samples. RESULTS Circulating estradiol levels were associated with leptin (β = 0.131, p < 0.001), but not with adiponectin (p > 0.05), when adjusted for total body fat mass. There were no associations between estradiol tertiles and BMDs, or with cIMT or CAC. Adiponectin levels were inversely associated with femoral neck BMD (p = 0.019, β = -0.138) and total body BMD (p = 0.009, β = -0.142), adjusted for total body fat mass, age, current smoking and estradiol, but showed no relationship with CAC or cIMT. Leptin levels were not associated with BMDs or cIMT; but the odds ratio was 1.5 between the CAC and leptin quartiles (p = 0.014), adjusted for total body fat mass, age, statin use and calcium intake. CONCLUSION The adipokines are associated with vascular calcification and low BMD. Moreover, estradiol was not independently associated with BMD or CAC.
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Affiliation(s)
- M Värri
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - L Niskanen
- b Endocrinology , Helsinki University Hospital and University of Helsinki , Finland
| | - Tp Tuomainen
- c Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland
| | - R Honkanen
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland ;,d Lapland Hospital District , Rovaniemi , Finland
| | - H Kröger
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland ;,e Department of Orthopaedics, Traumatology and Hand Surgery , Kuopio University Hospital , Kuopio , Finland
| | - M T Tuppurainen
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland ;,f Department of Obstetrics and Gynaecology , Kuopio University Hospital , Kuopio , Finland
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Suuronen J, Sjöblom S, Honkanen R, Koivumaa-Honkanen H, Kröger H, Sirola J, Rikkonen T. The relationship of severe health disorders with bone loss, grip strength, and mobility in postmenopausal women - a 15-year follow-up study. Disabil Rehabil 2015; 38:1407-14. [PMID: 26693679 DOI: 10.3109/09638288.2015.1103789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/13/2022]
Abstract
PURPOSE To investigate the relationships of severe health disorders (SHD) with bone loss, grip strength (GS) and mobility in postmenopausal women. METHOD The study sample consisted of 2227 Finnish women (mean age 53.2) from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) cohort. Postal inquiries and clinical measurements were completed during the 15-year follow-up at 5-year intervals between 1989 and 2004. Femoral neck bone mineral density (BMD) and GS were measured. Life-style factors and mobility were obtained via postal inquiries. Work disability pension according to the ICD-9 was an indicator of a SHD. RESULTS At the baseline 242 women had SHD, 506 got late SHD during 1989-1995, whereas 1479 women had none until 1996. The women with baseline SHD had higher annual bone loss (0.44%) than those without SHD (0.34%) (p < 0.05), those with late SHD (0.39%) no difference was seen. Bone loss was highest with respiratory diseases, but BMD was lowest throughout the follow-up in nervous and sense organ diseases. Lower GS and mobility was also associated with SHD. CONCLUSION Effects of SHDs on BMD, GS, and mobility are disease-specific. Thus, rehabilitation should be encouraged in postmenopausal women with SHD, especially in case of diseases of respiratory and nervous system. Implications for Rehabilitation Osteoporosis, muscle strength and co-morbidity Women with severe health disorders (SHD) leading to work disability have impaired musculoskeletal health. Active monitoring of the musculoskeletal health is advised for those with SHD. Women with SHD may benefit from rehabilitative treatment in order to avoid complications of musculoskeletal impairments.
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Affiliation(s)
- Juha Suuronen
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Samu Sjöblom
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Risto Honkanen
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Heli Koivumaa-Honkanen
- b Department of Psychiatry, Institute of Clinical Psychiatry , University of Eastern Finland , Kuopio , Finland.,c Kuopio University Hospital, South-Savonia Hospital District , Mikkeli , Finland.,d North Karelia Central Hospital , Joensuu , Finland.,e SOSTERI , Savonlinna , Finland.,f SOTE , Iisalmi , Finland.,g Lapland Hospital District , Rovaniemi , Finland.,h Clinic of Child Psychiatry , Oulu University Hospital , Oulu , Finland
| | - Heikki Kröger
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland.,i Department of Orthopaedics, Traumatology and Hand Surgery , Kuopio University Hospital , Kuopio , Finland
| | - Joonas Sirola
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland.,i Department of Orthopaedics, Traumatology and Hand Surgery , Kuopio University Hospital , Kuopio , Finland
| | - Toni Rikkonen
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
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Alha A, Honkanen R, Karlsson M, Laiho K, Linnoila M, Lukkari I. Practical aspects of the routine measurement of alcohol and drugs in drivers. A preliminary report. Mod Probl Pharmacopsychiatry 2015; 11:42-5. [PMID: 967166 DOI: 10.1159/000399450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Williams LJ, Pasco JA, Stuart AL, Jacka FN, Brennan SL, Dobbins AG, Honkanen R, Koivumaa-Honkanen H, Rauma PH, Berk M. Psychiatric disorders, psychotropic medication use and falls among women: an observational study. BMC Psychiatry 2015; 15:75. [PMID: 25884941 PMCID: PMC4394398 DOI: 10.1186/s12888-015-0439-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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] [Received: 08/06/2013] [Accepted: 03/12/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Psychotropic agents known to cause sedation are associated with an increased risk of falls, but the role of psychiatric illness as an independent risk factor for falls is not clear. Thus, this study aimed to investigate the association between psychiatric disorders, psychotropic medication use and falls risk. METHODS This study examined data collected from 1062 women aged 20-93 yr (median 50 yr) participating in the Geelong Osteoporosis Study, a large, ongoing, population-based study. Depressive and anxiety disorders for the preceding 12-month period were ascertained by clinical interview. Current medication use and falls history were self-reported. Participants were classified as fallers if they had fallen to the ground at least twice during the same 12-month period. Anthropometry, demographic, medical and lifestyle factors were determined. Logistic regression was used to test the associations, after adjusting for potential confounders. RESULTS Fifty-six women (5.3%) were classified as fallers. Those meeting criteria for depression within the past 12 months had a 2.4-fold increased odds of falling (unadjusted OR = 2.4, 95% CI 1.2-4.5). Adjustment for age and mobility strengthened the relationship (adjusted OR = 2.7, 95% CI 1.4-5.2) between depression and falling, with results remaining unchanged following further adjustment for psychotropic medication use (adjusted OR = 2.7, 95% CI 1.3-5.6). In contrast, past (prior to 12-month) depression were not associated with falls. No association was observed between anxiety and falls risk. Falling was associated with psychotropic medication use (unadjusted OR = 2.8, 95% CI 1.5-5.2), as well as antidepressant (unadjusted OR = 2.4, 95% CI 1.2-4.8) and benzodiazepine use (unadjusted OR = 3.4, 95% CI 1.6-7.3); associations remained unchanged following adjustment for potential confounders. CONCLUSION The likelihood of falls was increased among those with depression within the past 12 months, independent of psychotropic medication use and other recognised confounders, suggesting an independent effect of depression on falls risk. Psychotropic drug use was also confirmed as an independent risk factor for falls, but anxiety disorders were not. Further research into the underlying mechanisms is warranted.
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Affiliation(s)
- Lana J Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, PO Box 281 (Barwon Health), Geelong, 3220, Australia.
| | - Julie A Pasco
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, PO Box 281 (Barwon Health), Geelong, 3220, Australia. .,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, Western Health, St Albans, Australia.
| | - Amanda L Stuart
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, PO Box 281 (Barwon Health), Geelong, 3220, Australia.
| | - Felice N Jacka
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, PO Box 281 (Barwon Health), Geelong, 3220, Australia. .,Department of Psychiatry, The University of Melbourne, Parkville, Australia.
| | - Sharon L Brennan
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, PO Box 281 (Barwon Health), Geelong, 3220, Australia. .,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, Western Health, St Albans, Australia. .,Australian Institute for Musculoskeletal Sciences, Melbourne, Australia.
| | - Amelia G Dobbins
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, PO Box 281 (Barwon Health), Geelong, 3220, Australia.
| | - Risto Honkanen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland. .,Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Joensuu, Finland.
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Joensuu, Finland. .,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland. .,Department of Psychiatry, South-Savonia Hospital District, Mikkeli, Finland. .,Department of Psychiatry, North Karelia Central Hospital, Joensuu, Finland. .,Department of Psychiatry, SOSTERI, Savonlinna, Finland. .,Department of Psychiatry, SOTE, Iisalmi, Finland. .,Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland.
| | - Päivi H Rauma
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland. .,Department of Social Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Finland, Finland.
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, PO Box 281 (Barwon Health), Geelong, 3220, Australia. .,Department of Psychiatry, The University of Melbourne, Parkville, Australia. .,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia. .,Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Australia.
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Salo S, Leinonen V, Rikkonen T, Vainio P, Marttila J, Honkanen R, Tuppurainen M, Kröger H, Sirola J. Association between bone mineral density and lumbar disc degeneration. Maturitas 2014; 79:449-55. [PMID: 25266266 DOI: 10.1016/j.maturitas.2014.09.003] [Citation(s) in RCA: 22] [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: 06/08/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Higher vertebral bone mineral density (BMD) has been found to be related with lumbar disc degeneration (LDD), while relationship between femoral neck BMD and LDD remains controversial. The aim of our research was to study the relationship between LDD and BMD of the lumbar spine and femoral neck. STUDY DESIGN The study population consisted of 168 postmenopausal women (aged 63.3-75.0 years, mean 68.6 years) from the prospective OSTPRE and OSTPRE-FPS study cohorts. The severity of LDD was graded from T2-weighted MRI images using the five-grade Pfirrmann classification. Four vertebral levels (L1-L4) were studied (total 672 discs). The association between lumbar BMD and Z-score and the severity of LDD was studied separately for each vertebral level with AN(C)OVA analysis, using potential confounders as covariates. RESULTS Higher lumbar BMD and Z-score were associated with more severe LDD at all studied levels (L1-L4): between L4-L5 disc and L4 BMD (p=0.044) and L4 Z-score (p=0.052), between L2-L3 disc and L3 BMD (p=0.001) and at all other levels (p<0.001). The mean degeneration grade of the studied discs was associated with the mean L1-L4 BMD and Z-score (p<0.001). Statistical significance of any result did not alter after controlling for confounding factors. There was no significant association between femoral neck BMD and LDD. CONCLUSIONS Higher lumbar BMD/Z-score were associated with more severe LDD. There was no significant association between femoral neck BMD and disc degeneration. Femoral neck BMD may be a more reliable measurement for diagnosing osteoporosis in postmenopausal women with degenerative changes in the lumbar spine.
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Affiliation(s)
- Sami Salo
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Toni Rikkonen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pauli Vainio
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Jarkko Marttila
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Lapland Hospital District, Rovaniemi, Finland
| | - Marjo Tuppurainen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital, Finland
| | - Heikki Kröger
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Värri M, Tuomainen TP, Honkanen R, Rikkonen T, Niskanen L, Kröger H, Tuppurainen MT. Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study. Maturitas 2014; 78:304-9. [DOI: 10.1016/j.maturitas.2014.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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Sund R, Honkanen R, Johansson H, Odén A, McCloskey E, Kanis J, Kröger H. Evaluation of the FRAX model for hip fracture predictions in the population-based Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE). Calcif Tissue Int 2014; 95:39-45. [PMID: 24792689 DOI: 10.1007/s00223-014-9860-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 01/08/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
Calibration of the Finnish FRAX model was evaluated using a locally derived population-based cohort of postmenopausal women (n = 13,917). Hip fractures were observed from national register-based data and verified from radiological records. For a subpopulation of 11,182 women, there were enough data to calculate the fracture probabilities using the Finnish FRAX tool (without bone mineral density). A 10-year period prevalence of hip fractures to this subpopulation was 0.66 %. The expected numbers of hip fractures were significantly higher than the self reported ones (O/E ratio 0.46; 95 % CI 0.33-0.63), had a tendency to be greater than the observed ones (O/E ratio 0.83; 95 % CI 0.65-1.04), and calibration in terms of goodness-of-fit of absolute probabilities was questionable (P = 0.015). Strikingly, the 10-year period prevalence of hip fractures to the whole cohort was higher (0.84 %) than for the women with FRAX measurements (0.66 %). This was mainly the result of difference between people who had and who had not responded to postal enquiries (0.71 vs. 1.77 %, P < 0.0001). Self-reports missed to capture 38 % of all hip fractures in those who responded and about 45 % of hip fractures in women who had a FRAX estimate. The Finnish FRAX tool seems to provide appropriate discrimination for hip fracture risk, but caution is required in the interpretation of absolute risk, especially if used for population that may not be representing general population per se. Our study also showed that patients with no response had significantly higher hip fracture risk and that the use of purely self-reported hip fractures in calculations results in biased incidence and period prevalence estimates. Such important biases may remain unnoticed if there are no data from other sources available.
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Affiliation(s)
- Reijo Sund
- Bone and Cartilage Research Unit (BCRU), University of Eastern Finland, Kuopio, Finland,
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Sjöblom S, Suuronen J, Rikkonen T, Honkanen R, Kröger H, Sirola J. Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia. Maturitas 2013; 75:175-80. [PMID: 23628279 DOI: 10.1016/j.maturitas.2013.03.016] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of the study was to determine the relationship between the components of clinical sarcopenia and osteoporosis in postmenopausal women. METHODS A population-based cohort of 590 Finnish postmenopausal women (mean age 67.9; range 65-72) was selected from the Osteoporosis Fracture Prevention (OSTPRE-FPS) study in 2002. Bone mineral density (BMD) and lean tissue mass were assessed by dual X-ray absorptiometry (DXA). The study sample was divided into three categories according to the WHO BMD classification: normal, osteopenia and osteoporosis. The study sample was divided into non-sarcopenic, presarcopenic, sarcopenic and non-classified groups according to quartiles of RSMI i.e. relative skeletal muscle index (appendicular muscle mass (kg)/square of height (m)), hand grip strength (kPa) and walking speed. RESULTS In logistic regression analysis sarcopenic women had 12.9 times higher odds of having osteoporosis (p ≤ 0.001, OR=12.9; 95% CI=3.1-53.5) in comparison to non-sarcopenic women. In comparison to women in the highest grip strength quartile, women within the lowest quartile had 11.7 times higher odds of having osteoporosis (p=0.001, OR=11.7; 2.6-53.4). Sarcopenic women had 2.7 times higher odds of having fractures than their non-sarcopenic counterparts (p=0.005, OR=2.732; 1.4-5.5). Sarcopenic women had also 2.1 times higher risk of falls during the preceding 12 months compared to non-sarcopenic women (p=0.021, OR=2.1; 1.1-3.9). Adjustment for age, body mass index (BMI), physical activity and hormone therapy (HT) did not significantly alter these results. CONCLUSIONS The components of clinical sarcopenia are strongly associated with osteoporosis. Grip strength is the most significant measurement to reveal the association between sarcopenia and osteoporosis, falls and fractures.
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Affiliation(s)
- Samu Sjöblom
- Bone and Cartilage Research Unit (BCRU) Mediteknia Building, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
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Honkanen R, Leppänen V. Routing in Coloured Sparse Optical Tori by Using Balanced WDM and Network Sparseness. International Journal of Distributed Systems and Technologies 2012. [DOI: 10.4018/jdst.2012100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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]
Abstract
The authors present a WDM (Wavelength-Division Multiplexing) based all-optical network architecture, and study scheduled routing on it. Their architecture can be seen as a communication system of parallel multi-core computer or a large-scale high bandwidth routing switch of e.g., telecommunication network. The goal is to construct such a scalable architecture and a supporting routing protocol for it so that no electro-optical conversions are needed on the routing paths, all packets are routed along one of the shortest paths, processor nodes can inject packets constantly into the network, and all the packets injected into the routing machinery reach their targets without collisions. The authors’ CSOT is a sparse network. A large fraction of the nodes are intermediate nodes instead of processor nodes. Only the processor nodes are sources and sinks of packets. The number of all nodes is and is the number of processor nodes in our construction. For scheduled routing to work, the authors consider routing problems as a set of h-relations. They achieved work-optimal routing of -relations for a reasonable size of . The efficiency of routing is based on routing latency hiding which is made possible by WDM and sparseness based increase bandwidth per processor node.
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Affiliation(s)
| | - Ville Leppänen
- Department of Information Technology, University of Turku, Turku, Finland
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Rikkonen T, Sirola J, Salovaara K, Tuppurainen M, Jurvelin JS, Honkanen R, Kröger H. Muscle strength and body composition are clinical indicators of osteoporosis. Calcif Tissue Int 2012; 91:131-8. [PMID: 22733383 DOI: 10.1007/s00223-012-9618-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [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: 02/08/2012] [Accepted: 05/15/2012] [Indexed: 11/24/2022]
Abstract
We examined the role of muscle strength, lean tissue distribution, and overall body composition as indicators of osteoporosis (OP) in a pooled sample of 979 Finnish postmenopausal women (mean age 68.1 years) from the Kuopio Osteoporosis Risk Factor and Prevention study. Bone mineral density (BMD) at the femoral neck (FN) and total body composition were assessed by dual-energy X-ray absorptiometry scans. The women (n = 979) were divided into three groups according to WHO criteria, based on FN BMD T score: normal (n = 474), osteopenia (n = 468), and OP (n = 37). Soft tissue proportions, fat mass index (FMI, fat/height²), lean mass index (LMI, lean/height²), and appendicular skeletal muscle mass (ASM, (arms + legs)/height²) were calculated. Handgrip and knee extension strength measurements were made. OP subjects had significantly smaller LMI (p = 0.001), ASM (p = 0.001), grip strength (p < 0.0001), and knee extension strength (p < 0.05) but not FMI (p > 0.05) compared to other subjects. Grip and knee extension strength were 19 and 16 % weaker in OP women compared to others, respectively. The area under the receiver operating characteristic curve was 69 % for grip and 71 % for knee extension strength. In tissue proportions only LMI showed predictive power (63 %, p = 0.016). An overall linear association of LMI (R² = 0.007, p = 0.01) and FMI (R² = 0.028, p < 0.001) with FN BMD remained significant. In the multivariate model, after adjusting for age, grip strength, leg extension strength, FMI, LMI, number of medications, alcohol consumption, current smoking, dietary calcium intake, and hormone therapy, grip strength (adjusted OR = 0.899, 95 % CI 0.84-0.97, p < 0.01), leg extension strength (OR = 0.998, 95 % CI 0.99-1, p < 0.05), and years of hormone therapy (OR = 0.905, 95 % CI 0.82-1, p < 0.05) remained as significant determinants of OP. Muscle strength tests, especially grip strength, serve as an independent and useful tool for postmenopausal OP risk assessment. In addition, lean mass contributes to OP in this age group. Muscle strength and lean mass should be considered separately since both are independently associated with postmenopausal BMD.
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Affiliation(s)
- Toni Rikkonen
- Bone and Cartilage Research Unit, Mediteknia Building, University of Eastern Finland, Kuopio, Finland.
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Saarelainen J, Kiviniemi V, Kröger H, Tuppurainen M, Niskanen L, Jurvelin J, Honkanen R. Body mass index and bone loss among postmenopausal women: the 10-year follow-up of the OSTPRE cohort. J Bone Miner Metab 2012; 30:208-16. [PMID: 21938384 DOI: 10.1007/s00774-011-0305-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 10/01/2010] [Accepted: 07/20/2011] [Indexed: 10/17/2022]
Abstract
Obesity protects against osteoporosis, but the magnitude of this association has been difficult to assess from cross-sectional or short term studies. We examined the time course of bone loss as a function of body mass index (BMI) in early and late postmenopausal women. Our study population (n = 300) was a random sample of the population-based Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) Study, Finland. We excluded women without complete BMD results, premenopausal women during the second bone densitometry and women who had used hormone replacement therapy, bisphosphonates or calcitonin. BMI along with femoral neck and spinal bone mineral density (BMD) were assessed three times by dual-energy X-ray absorptiometry during a mean follow-up of 10.5 years (SD 0.5). The mean baseline age was 53.6 years (SD 2.8), time since menopause 2.9 years (SD 4.3) and BMI 27.3 kg/m(2) (SD 4.4). The data was analyzed by linear mixed models. Thus, we were able to approximate the bone loss up to 20 postmenopausal years. To illustrate, a woman with a baseline BMI of 20 kg/m(2) became osteopenic 2 (spine) and 4 (femoral neck) years after menopause, while obesity (BMI of 30 kg/m(2)) delayed the incidence of osteopenia by 5 (spine) and 9 (femoral neck) years, respectively. The delay was due to high baseline BMD of the obese, while bone loss rate was similar for both lean and obese subjects. This lean versus obese difference may also be partly due to altered X-ray attenuation due to fat mass.
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Affiliation(s)
- Jarmo Saarelainen
- Bone and Cartilage Research Unit, Clinical Research Center, University of Eastern Finland, P. O. Box 1627, 70211, Kuopio, Finland.
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Saarelainen J, Honkanen R, Kröger H, Tuppurainen M, Jurvelin JS, Niskanen L. Body fat distribution is associated with lumbar spine bone density independently of body weight in postmenopausal women. Maturitas 2011; 69:86-90. [PMID: 21388758 DOI: 10.1016/j.maturitas.2011.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 02/08/2011] [Accepted: 02/08/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the association between the body fat distribution and axial bone mineral density (BMD) in postmenopausal women with or without hormone replacement therapy (HRT). DESIGN Cross-sectional population-based study. SETTING University of Eastern Finland, Bone and Cartilage Research Unit, Kuopio, Finland. POPULATION 198 postmenopausal women, mean age 67.5 (1.9 SD), mean BMI 27.1 (3.9 SD). METHODS Regional body composition and BMD assessed by dual X-ray absorptiometry (DXA, Prodigy). MAIN OUTCOME MEASURES Spinal and Femoral BMD. RESULTS Out of the body composition parameters, FM was the main determinant of postmenopausal bone mass. Only the lumbar spine (L2-L4) BMD, not the femoral neck BMD, was positively associated with the trunk FM. Positive trends for association were revealed between the spinal BMD and the trunk FM regardless of the use of HRT. Adjustments did not change the results. CONCLUSIONS Higher trunk fat mass was associated with the spinal BMD, but not with the hip BMD in postmenopausal women, irrespective of the HRT use. In addition to biological factors, uncertainties related to DXA measurements in patients with varying body mass may contribute to this phenomenon.
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Affiliation(s)
- J Saarelainen
- Bone and Cartilage Research Unit, Clinical Research Center, University of Eastern Finland, Kuopio, Finland.
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Sirola J, Salovaara K, Rikkonen T, Kärkkäinen M, Tuppurainen M, Jurvelin JS, Honkanen R, Kröger H. Bone health-related factors and the use of bisphosphonates in community setting--15-year follow-up study. Osteoporos Int 2011; 22:255-64. [PMID: 20422155 DOI: 10.1007/s00198-010-1254-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/18/2009] [Accepted: 03/17/2010] [Indexed: 01/28/2023]
Abstract
UNLABELLED The present study investigated the bone health related factors that were associated with the use of bisphosphonates (BP) among 2,050 postmenopausal Finnish women. Low BMD + low trauma energy fracture was the strongest determinant of BP use, while other secondary causes of osteoporosis were less strongly related with BP use. BP use was associated with reduced femoral neck (FN) and lumbar spine (LS) bone loss rate. INTRODUCTION The aim was to identify bone health related factors associated with the use of BP in a community setting. METHODS A population-based sample of 2,050 Finnish postmenopausal women was measured with dual X-ray absorptiometry at the FN and LS in 1989, 1994, 1999 and 2004, and information on osteoporosis risk factors, including low-trauma energy fractures, were collected with postal inquiries. Self-reported use of BP in 2004 was considered as the end point variable. RESULTS Among BP users, 12% had T-score > -2.0 SD and no fracture during follow-up (FU). In women without any bone medication, 26% had T-score < -2.0 SD or low-trauma energy fracture or both during the FU. In BP users, a significant reduction in FN and LS bone loss rate, cumulative with duration of use, was observed in ANCOVA (p < 0.001). Among BP users, there was a significantly higher proportion of women with several independent risk factors for osteoporosis and more spine and humerus fractures but less ankle fractures. T-score < -2 SD combined with low-trauma energy fracture was significantly related to the use of BPs (p < 0.001, OR = 15.96) and T-score < -2 SD was a stronger predictor of BP use (p < 0.001, OR = 13.29) than fracture (p > 0.05, OR = 1.35) in multivariate logistic regression. Other factors related with BP use were vitamin D use (p = 0.001, OR = 2.27), high number of medications (p < 0.001, OR = 1.26) and rheumatoid arthritis (p < 0.05, OR 2.55). CONCLUSIONS These findings reveal the recent bone health-related indications for BP prescription.
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Affiliation(s)
- J Sirola
- Bone and Cartilage Research Unit (BCRU), University of Kuopio, Mediteknia Building, P.O. Box 1627, 70211, Kuopio, Finland.
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Affiliation(s)
- Joonas Sirola
- Bone and Cartilage Research Unit, University of Kuopio, 70211 Kuopio, Finland,*Joonas Sirola:
| | - Manuel Diaz Curiel
- Metabolic Bone Diseases, Department of Internal Medicine, Autonomous University of Madrid and Jimenez Diaz Foundation, 28049 Madrid, Spain
| | - Risto Honkanen
- Bone and Cartilage Research Unit, University of Kuopio, 70211 Kuopio, Finland
| | - Jun Iwamoto
- Institute for Integrated Sports Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
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Kärkkäinen M, Tuppurainen M, Salovaara K, Sandini L, Rikkonen T, Sirola J, Honkanen R, Jurvelin J, Alhava E, Kröger H. Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: a 3-year randomized population-based trial (OSTPRE-FPS). Osteoporos Int 2010; 21:2047-55. [PMID: 20204604 DOI: 10.1007/s00198-009-1167-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [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: 09/30/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
Abstract
SUMMARY The Osteoporosis Risk Factor and Prevention-Fracture Prevention Study (OSTPRE-FPS) was a randomized population-based open trial (n = 593). The supplementation group (n = 287) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group (n = 306) received neither supplementation nor placebo. Daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women. INTRODUCTION vitamin D deficiency is common in the elderly, and vitamin D levels are associated with low bone mineral density (BMD). The working hypothesis was that vitamin D and calcium supplementation could prevent bone loss in ambulatory postmenopausal women. METHODS the OSTPRE-FPS was a randomized population-based open trial with a 3-year follow-up in 3,432 women (aged 66 to 71 years). A randomly selected subsample of 593 subjects underwent BMD measurements. The supplementation group (n = 287) received daily cholecalciferol 800 IU + calcium 1,000 mg for 3 years while the control group (n = 306) received neither supplementation nor placebo. RESULTS in the intention-to-treat analysis, total body BMD (n = 362) increased significantly more in the intervention group than in the control group (0.84% vs. 0.19%, p = 0.011). The BMD change differences at the lumbar spine (p = 0.372), femoral neck (p = 0.188), trochanter (p = 0.085), and total proximal femur (p = 0.070) were statistically nonsignificant. Analyses in compliant women (≥ 80% of use) resulted in stronger and statistically significant effects at the total body and femoral regions. CONCLUSION daily vitamin D and calcium supplementation have a positive effect on the skeleton in ambulatory postmenopausal women with adequate nutritional calcium intake.
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Affiliation(s)
- M Kärkkäinen
- Bone and Cartilage Research Unit, Mediteknia Building, University of Kuopio, P.O. Box 1627, 70211, Kuopio, Finland.
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Rikkonen T, Salovaara K, Sirola J, Kärkkäinen M, Tuppurainen M, Jurvelin J, Honkanen R, Alhava E, Kröger H. Physical activity slows femoral bone loss but promotes wrist fractures in postmenopausal women: a 15-year follow-up of the OSTPRE study. J Bone Miner Res 2010; 25:2332-40. [PMID: 20533310 DOI: 10.1002/jbmr.143] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [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] [Indexed: 11/07/2022]
Abstract
Results on fracture risk among physically active persons are contradictory. The aim of this study was to investigate the long-term association between the self-reported physical activity (PA), the risk of fractures, and bone loss among peri- and postmenopausal women. The association between PA and fracture risk was examined during 15 years of follow-up in the population-based Osteoporosis Risk Factor and Prevention (OSTPRE) Study among 8560 women with a mean age of 52.2 years (range 47 to 56 years) at baseline. The amount and type of PA, as well as the types and mechanisms of fractures, were registered with self-administered questionnaires at 5-year intervals (ie, 1989, 1994, 1999, and 2004). A total of 2641 follow-up fractures were verified in 2073 women (24.2%). The study cohort was divided into quartiles by average hours of reported PA during the whole follow-up. Areal bone mineral density (aBMD) at the proximal femur (n = 2050) and lumbar spine (L(2)-L(4); n = 1417) was followed at 5-year intervals from a random stratified subsample with dual X-ray absorptiometry (DXA). Risk of fracture was estimated by using the Cox proportional hazards model with a mean follow-up time of 15.2 years. Weekly average time spent on leisure-time PA was 0.4, 1.7, 3.3, and 7.0 hours from the least to the most active quartiles, respectively. The risk of wrist fracture was higher in the active quartiles (II to IV) than in the most inactive quartile (I), with hazard ratios (HRs) of 1.3 [95% confidence interval (CI) 1.05-1.57, p = .014] for the second (II), 1.2 (95% CI 1.01-1.51, p = .045) for the third (III), and 1.4 (95% CI 1.14-1.69, p = .001) for the fourth (IV) quartile, respectively. Overall, most of the fractures were reported as a result of a fall (69.0%), with a 2.1 times higher rate of wrist fractures during the winter (November to April) than during summer season. There were no significant associations of PA with any other fracture types. Bone loss at the femoral neck, trochanter, and Ward's triangle was significantly associated with long-term PA (ANCOVA p < .05), whereas no associations of bone loss and PA in lumbar spine were seen. PA is associated with a moderate rise in wrist fracture risk, which might be explained in part by a higher number of outdoor activities. Regular PA of at least 1½ hours per week does not seem to increase the risk of other fractures and might significantly decrease proximal femur bone loss among peri- and postmenopausal women.
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Affiliation(s)
- Toni Rikkonen
- Bone and Cartilage Research Unit, University of Kuopio, Kuopio, Finland.
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Kröger H, Kärkkäinen M, Honkanen R. Calcium and Vitamin D in Promotion of Postmenopausal Bone Health. Womens Health (Lond Engl) 2010; 6:773-6. [DOI: 10.2217/whe.10.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Heikki Kröger
- Bone & Cartilage Research Unit, University of Eastern Finland, Kuopio, Finland and Department of Orthopaedics & Traumatology, Kuopio University Central Hospital, Kuopio, Finland
| | - Matti Kärkkäinen
- Bone & Cartilage Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Risto Honkanen
- Bone & Cartilage Research Unit, Mediteknia, University of Eastern Finland, Box 1627, 70211 Kuopio, Finland and Mesitie 17, 70280 Kuopio, Finland 17, 70280 Kuopio, Finland, Tel.: +35 500 377160,
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Salovaara K, Tuppurainen M, Kärkkäinen M, Rikkonen T, Sandini L, Sirola J, Honkanen R, Alhava E, Kröger H. Effect of vitamin D(3) and calcium on fracture risk in 65- to 71-year-old women: a population-based 3-year randomized, controlled trial--the OSTPRE-FPS. J Bone Miner Res 2010; 25:1487-95. [PMID: 20200964 DOI: 10.1002/jbmr.48] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [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] [Indexed: 12/31/2022]
Abstract
Antifracture efficacy of high-dose vitamin D (800 IU) and calcium (1000 mg) remains controversial. To determine whether daily 800 IU of vitamin D and 1000 mg of calcium supplementation prevents fractures, we randomized 3432 women of the population-based Osteoporosis Risk Factor and Prevention (OSTPRE) Study cohort (ages 65 to 71 years) living in the region of northern Savonia, Finland (latitude 62 degrees to 64 degrees N) for 3 years to receive 800 IU of cholecalciferol and 1000 mg of calcium as calcium carbonate or to a control group that did not receive placebo. The main outcome measure was incident fractures. Fracture data were collected in telephone interviews and validated. Data on 3195 women, 1586 in the intervention group and 1609 in the control group, were available for analysis. In adjusted Cox proportional hazards models, the risk of any fracture decreased in the vitamin D and calcium group by 17% [adjusted hazard ratio (aHR) = 0.83; 95% confidence interval (CI) 0.61-1.12], and the risk of any nonvertebral fracture decreased by 13% (aHR = 0.87; 95% CI 0.63-1.19). The risk of distal forearm fractures decreased by 30% (aHR = 0.70; 95% CI 0.41-1.20), and the risk of any upper extremity fractures decreased by 25% (aHR = 0.75; 95% CI 0.49-1.16), whereas the risk of lower extremity fractures remained essentially equal (aHR = 1.02; 95% CI 0.58-1.80). None of these effects reached statistical significance. In conclusion, this study did not produce statistically significant evidence that vitamin D and calcium supplementation prevents fractures in a 65- to 71-year-old general population of postmenopausal women.
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Affiliation(s)
- Kari Salovaara
- Bone and Cartilage Research Unit, Clinical Research Centre, University of Kuopio, Kuopio, Finland.
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Tuppurainen M, Härmä K, Komulainen M, Kiviniemi V, Kröger H, Honkanen R, Alhava E, Jurvelin J, Saarikoski S. Effects of continuous combined hormone replacement therapy and clodronate on bone mineral density in osteoporotic postmenopausal women: a 5-year follow-up. Maturitas 2010; 66:423-30. [PMID: 20547017 DOI: 10.1016/j.maturitas.2010.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 03/29/2010] [Accepted: 04/23/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the effects of HRT with or without clodronate on bone mineral density (BMD) change and bone turnover markers. DESIGN Prospective, partly randomized trial. SETTING Kuopio University Hospital, Finland. POPULATION 167 osteoporotic women (61+/-2.7 years; T-score<or=-2.5 SD). METHODS Estradiol 2 mg+NETA 1 mg, randomization to additional 800 mg clodronate (n=55, HT+C-group) or placebo (n=55, HT-group); if contraindications to HRT, clodronate (n=57, C-group). MAIN OUTCOME MEASURES BMD by DXA after 1, 3 and 5 years, serum osteocalcin (OC) and bone-specific alkaline phosphatase (BAP) at the baseline and after 3 years. RESULTS After 5 years, adjusted lumbar BMD increased by 4.2% in the HT-group and 3.7% in the HT+C-group. The C-group showed a decrease of -1.1%, the total difference being 5.3% and 4.8% between HT, HT+C vs. C-group, respectively (p<0.001). In the femoral neck, the adjusted 5-year BMD benefit was 1.3% and 2.4% in the HT- and HT+C-groups, respectively, the net loss of BMD in the C-group was -3.3% (p<0.05 between HT+C vs. C). By 3 years, OC decreased by 55.0%, 70.3% and 53.8% in the HT-, HT+C- and C-groups, respectively (p<0.001 vs. baseline). The significant decreases of BAP were 39.4% in the HT-group, 42.1% in the HT+C-group and 30.2% in the C-group with no significant differences between the groups after adjustments. CONCLUSIONS In postmenopausal women with osteoporosis, HRT increased spinal and femoral BMD, but the combination of HRT and clodronate did not offer an extra gain of bone mass.
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Affiliation(s)
- Marjo Tuppurainen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.
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Kärkkäinen MK, Tuppurainen M, Salovaara K, Sandini L, Rikkonen T, Sirola J, Honkanen R, Arokoski J, Alhava E, Kröger H. Does daily vitamin D 800IU and calcium 1000mg supplementation decrease the risk of falling in ambulatory women aged 65–71 years? A 3-year randomized population-based trial (OSTPRE-FPS). Maturitas 2010; 65:359-65. [DOI: 10.1016/j.maturitas.2009.12.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/26/2009] [Accepted: 12/16/2009] [Indexed: 10/20/2022]
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Sirola J, Koistinen AK, Salovaara K, Rikkonen T, Tuppurainen M, Jurvelin JS, Honkanen R, Alhava E, Kröger H. Bone Loss Rate May Interact with Other Risk Factors for Fractures among Elderly Women: A 15-Year Population-Based Study. J Osteoporos 2010; 2010:736391. [PMID: 20981330 PMCID: PMC2957188 DOI: 10.4061/2010/736391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 09/08/2009] [Revised: 11/15/2009] [Accepted: 12/31/2009] [Indexed: 01/23/2023] Open
Abstract
Aim was to investigate fracture risk (FR) according to bone loss (BL) rate. A random sample of 1652 women aged 53.5 years was measured with dual X-ray absorptiometry in femoral neck in 1989 and 1994 and divided into tertiles of annual BL rate: high >0.84%, moderate 0.13%-0.84%, and low <0.13%. Low trauma energy fractures during following 10 years were recorded. There were no differences in FR between BL tertiles in Cox regression model. Factors predicting lower FR in Cox model were in high tertile: high T-score (HR 0.71; 95% CI 0.54-0.93, P = .012), no sister's fracture (HR 0.35; 0.19-0.64, P = .001), no mother's fracture (HR 0.52; 0.31-0.88, P = .015), in moderate tertile: high T-score (HR 0.69;0.53-0.91, P = .008) and good grip strength (HR 0.98; 0.97-0.99, P = .022). In low tertile there were no predictors for FR. BL predicted FR in women with mother's fracture in univariate and multivariate model (OR 2.6; 1.15-5.7, P = .021) but with sister's fracture this was observed only in multivariate model (OR 2.66; 1.09-6.7, P = .039). Accordingly, the risk factors for postmenopausal fractures, especially mother's fracture, may interact with BL.
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Affiliation(s)
- Joonas Sirola
- Bone and Cartilage Research Unit (BCRU), University of Kuopio, 70211 Kuopio, Finland,Department of Orthopedics and Traumatology, Kuopio University Hospital, 70211 Kuopio, Finland,*Joonas Sirola:
| | - Anna-Kaisa Koistinen
- Bone and Cartilage Research Unit (BCRU), University of Kuopio, 70211 Kuopio, Finland
| | - Kari Salovaara
- Bone and Cartilage Research Unit (BCRU), University of Kuopio, 70211 Kuopio, Finland,Department of Orthopedics and Traumatology, Kuopio University Hospital, 70211 Kuopio, Finland
| | - Toni Rikkonen
- Bone and Cartilage Research Unit (BCRU), University of Kuopio, 70211 Kuopio, Finland
| | - Marjo Tuppurainen
- Bone and Cartilage Research Unit (BCRU), University of Kuopio, 70211 Kuopio, Finland,Department of Obstetrics and Gynaecology, Kuopio University Hospital, 70211 Kuopio, Finland
| | - Jukka S. Jurvelin
- Department of Clinical Physiology & Nuclear Medicine, Kuopio University Hospital, 70211 Kuopio, Finland
| | - Risto Honkanen
- Bone and Cartilage Research Unit (BCRU), University of Kuopio, 70211 Kuopio, Finland
| | - Esko Alhava
- Department of Surgery, Kuopio University Hospital, 70211 Kuopio, Finland
| | - Heikki Kröger
- Bone and Cartilage Research Unit (BCRU), University of Kuopio, 70211 Kuopio, Finland,Department of Orthopedics and Traumatology, Kuopio University Hospital, 70211 Kuopio, Finland
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Sirola J, Tuppurainen M, Rikkonen T, Honkanen R, Koivumaa-Honkanen H, Kröger H. Correlates and predictors of self-rated health and ambulatory status among elderly women - Cross-sectional and 10 years population-based cohort study. Maturitas 2009; 65:244-52. [PMID: 20018468 DOI: 10.1016/j.maturitas.2009.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 10/31/2009] [Accepted: 11/13/2009] [Indexed: 10/20/2022]
Abstract
AIM To investigate the correlates and predictors of self-rated health (SRH) and self-reported ambulatory status (AMB) among elderly women. SUBJECTS AND METHODS A random sample of 1620 postmenopausal women aged 53-66 years in 1994 was selected from Osteoporosis Risk Factor and Prevention (OSTPRE) - study cohort in Finland. SRH and AMB were assessed in baseline (1994) and after 10-year follow-up (2004). A prognostic model was developed to predict the probability of good 10-year SRH and AMB. RESULTS Full AMB was correlated with and predicted by good SRH (OR=4.3, p<0.001). Good quality of life (QoL) was both correlate and predictor of good 10-year SRH (OR=2.0, p<0.001) and full AMB (OR=2.6, p<0.001). Low BMI was associated with good SRH (OR=0.97, p<0.049) and full AMB (OR=0.92, p<0.001), good grip strength with good SRH (OR=2.7, p<0.001) and ability to squat down with full AMB (OR=1.7, p=0.002). Cardiovascular diseases, arthritis and back pain were common significant negative correlates (p<0.001) of baseline AMB and SRH out of variety of chronic diseases with significant association with either one. The significant (p<0.05) baseline predictors in final prognostic model for good 10-year SRH included baseline AMB and SRH, QoL, age, BMI, grip strength and psychiatric diseases (C-index=0.81) and for full 10-year AMB ability to squat, baseline AMB and SRH, QoL, BMI, hypertension and arthritis (C-index=0.81). These risk scores had better predictive power in comparison to that of baseline SRH and AMB alone (p<0.001 in univariate Z-score test). CONCLUSIONS Among elderly women AMB is strongly linked to SRH. SRH and AMB are affected mostly by musculoskeletal, cardiovascular and psychiatric diseases as well as body anthropometry, muscle strength and subjective QoL. The present study provides a novel algorithm for predicting probability of full AMB and good SRH in postmenopausal women.
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Affiliation(s)
- Joonas Sirola
- University of Kuopio, Bone and Cartilage Research Unit (BCRU), OSTPRE Study Group, P.O. Box 1627, 70211 Kuopio, Finland.
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Pentti K, Tuppurainen MT, Honkanen R, Sandini L, Kröger H, Alhava E, Saarikoski S. Hormone therapy protects from diabetes: the Kuopio osteoporosis risk factor and prevention study. Eur J Endocrinol 2009; 160:979-83. [PMID: 19321660 DOI: 10.1530/eje-09-0151] [Citation(s) in RCA: 42] [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] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The purpose of this population-based prospective cohort study was to examine the effect of hormone therapy (HT) on incidence of diabetes mellitus (DM). DESIGN AND METHODS Eight thousand four hundred and eighty-three DM-free post-menopausal women aged 52-62 from the population-based Kuopio osteoporosis risk factor and prevention study were followed for 5 years from 1994-1999. Information about the use of HT and health events was obtained from three repeated questionnaires in 1989, 1994, and 1999. DM morbidity before and during the follow-up was obtained from the Registry of Specially Refunded Drugs of the Finnish Social Insurance Institution. Kaplan-Meyer survival curves and Cox's proportional-hazards models were used to estimate the risk of incident DM in relation to the use of HT. RESULTS During the follow-up, 40.8% DM-free post-menopausal women had never used HT, 27.3% women were HT past users and 31.9% women had used HT presently during the follow-up. During the follow-up, 162 incident DM cases were recorded. Compared with never users of HT, the adjusted hazard ratio of DM was 0.81 (95% confidence interval (CI) 0.57-1.16) for only past users, 0.53 (95% CI 0.24-1.15) in part-time (during the follow-up <2.5 years) users and 0.31 (95% CI 0.16-0.60) in continuous (during the follow-up 2.5-5.0 years) users of HT. CONCLUSIONS HT use decreases the incidence of DM in post-menopausal women.
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Affiliation(s)
- Kati Pentti
- Department of Obstetrics and Gynecology, Kuopio University Hospital, FIN-70211 Kuopio, Finland.
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Pentti K, Tuppurainen MT, Honkanen R, Sandini L, Kröger H, Alhava E, Saarikoski S. Use of calcium supplements and the risk of coronary heart disease in 52-62-year-old women: The Kuopio Osteoporosis Risk Factor and Prevention Study. Maturitas 2009; 63:73-8. [PMID: 19394167 DOI: 10.1016/j.maturitas.2009.03.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 03/07/2009] [Accepted: 03/10/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND To analyse prospectively the effect of calcium or calcium+D supplementation on coronary heart disease (CHD) in 52-62-year-old women. METHODS AND RESULTS 10,555 52-62-year-old women from the population-based Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) who did not have CHD at baseline were followed for nearly 7 years in 1994-2001. Information about use of calcium supplements and health events was obtained from two repeated questionnaires in 1989 and 1994. Information about causes of death during the follow-up was obtained from the Statistics Finland. Information about CHD and other disease morbidity before and during the follow-up was obtained from the Registry of Specially Refunded Drugs of the Finnish Social Insurance Institution (SII). Cox's proportional-hazards models were used to estimate the risk of CHD morbidity related to the use of calcium supplements. At baseline, 2723 women reported current use of calcium or calcium+D supplementation. During the follow-up, CHD was diagnosed in 513 women. Compared to non-users of calcium/calcium+D supplements, the multivariate adjusted hazard ratio (HR) of CHD was 1.24 (95% CI 1.02-1.52) in women who used these supplements. The multivariate adjusted HR for CHD morbidity in postmenopausal women who used calcium/calcium+D supplements was 1.26 (95% CI 1.01-1.57). CONCLUSIONS Calcium or calcium+D supplementation appears to increase the risk of CHD among women before old age.
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Affiliation(s)
- Kati Pentti
- Kuopio University Hospital, Department of Obstetrics and Gynecology, Finland
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Kärkkäinen M, Rikkonen T, Kröger H, Sirola J, Tuppurainen M, Salovaara K, Arokoski J, Jurvelin J, Honkanen R, Alhava E. Physical tests for patient selection for bone mineral density measurements in postmenopausal women. Bone 2009; 44:660-5. [PMID: 19138768 DOI: 10.1016/j.bone.2008.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [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: 02/16/2008] [Revised: 11/26/2008] [Accepted: 12/08/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There is a need for cost-effective clinical methods to select women for bone densitometry. The aim of the present study was to determine whether relatively simple and clinically applicable physical tests could be useful in prediction of bone density in postmenopausal women. METHODS A total of 606 women (age range 66-71 years) taking part in the population based OSTPRE Fracture Prevention Study were investigated. Spinal and femoral bone mineral density (BMD) was measured by Dual X-ray Absorptiometry (DXA). Physical tests included the standing-on-one-foot (SOOF), grip strength (GS), leg extension strength, ability to squat down, standing 10 s eyes closed, chair rising, regular walk for 10 m and tandem walk for 6 m. All linear regression models were adjusted for age, body mass index, years on hormone therapy, years since menopause, current smoking and use of oral glucocorticoids. RESULTS The SOOF was associated with lumbar spine BMD (r2=0.16, p=0.004) and the femoral regions (r2 values from 0.17 to 0.23 and p-values all<0.001). The GS was associated with lumbar spine BMD (r2=0.16, p=0.011) and the femoral regions (r2 values from 0.16 to 0.21 and p-values from <0.001 to 0.004). The ability to squat down on the floor was associated with the femoral regions (r2 values from 0.15 to 0.21 and p-values from 0.028 to 0.040). In addition, functional capacity was decreased in women with femoral neck osteoporosis (WHO classification) compared to women with normal or osteopenic BMD: SOOF -39% (p=0.001), GS -18% (p<0.001), leg extension strength -19% (p=0.007) and ability to squat down on the floor -40% (p=0.004). For osteoporosis prediction (ROC analysis) a threshold of a 22 kg in GS would yield a true-positive rate (sensitivity) of about 58% and a true-negative rate (specificity) of 86% (AUC 0.76). CONCLUSIONS We suggest that grip strength could be used in medical decision making to identify those women who would benefit from BMD measurements albeit alone it may not provide accurate enough tool for osteoporosis screening.
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Affiliation(s)
- Matti Kärkkäinen
- Bone and Cartilage Research Unit, Clinical Research Center, University of Kuopio, P.O. Box 1627, 70211, Kuopio, Finland.
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Komulainen MH, Kroger H, Tuppurainen MT, Heikkinen AM, Alhava E, Honkanen R, Saarikoski S. HRT and Vit D in prevention of non-vertebral fractures in postmenopausal women; a 5 year randomized trial. Maturitas 2008; 61:85-94. [DOI: 10.1016/j.maturitas.2008.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kärkkäinen M, Rikkonen T, Kröger H, Sirola J, Tuppurainen M, Salovaara K, Arokoski J, Jurvelin J, Honkanen R, Alhava E. Association between functional capacity tests and fractures: an eight-year prospective population-based cohort study. Osteoporos Int 2008; 19:1203-10. [PMID: 18236100 DOI: 10.1007/s00198-008-0561-y] [Citation(s) in RCA: 50] [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] [Received: 08/07/2007] [Accepted: 01/02/2008] [Indexed: 10/22/2022]
Abstract
UNLABELLED This study of postmenopausal women (n=2,928) with an eight-year follow-up revealed that impairment in functional status associated with the increased fracture risk. The standing-on-one-foot and grip strength tests and a question about self-assessed ability to move can be used to identify women with a high risk of suffering a fracture. INTRODUCTION Poor functional status has pointed to associate with injurious falls and consequent fractures. Our aim was to define association between functional capacity and fractures. METHODS This study was based on the Osteoporosis Risk Factor and Prevention Study (OSTPRE). A total of 2,928 postmenopausal women took part in the functional capacity and muscle strength tests. The duration of fracture follow-up varied from 6.43 to 9.86 (mean 8.37) years and the first fracture was the end-point event for the statistical analyses. All analyses were done with Cox-regression. RESULTS A total of 261 end-point fractures occurred. In multivariate analysis the inability to stand-on-one-foot for 10 seconds increased the risk of hip fracture (hazard ratio with 95% CI) 9.11-fold (1.98-42.00). Decreased grip strength associated with 1.05-fold (1.01-1.09) increased risk of hip fractures. Low leg extension strength associated with 1.02-fold (1.00-1.03) higher risk for all fractures. The self-assessed ability to walk less than 100 meters at baseline increased the risk of ankle 2.36-fold (1.10-5.08), hip 11.57-fold (2.73-49.15) and clinical vertebral fractures 3.85-fold (1.45-10.22). CONCLUSION According to these results the standing-on-one-foot less than 10 seconds, grip strength and a question about ability to walk less than 100 meters may help to predict postmenopausal fractures.
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Affiliation(s)
- M Kärkkäinen
- Bone and Cartilage Research Unit, University of Kuopio, P.O. Box 1627, Mediteknia Building, 70211 Kuopio, Finland.
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Saarelainen J, Rikkonen T, Honkanen R, Kröger H, Tuppurainen M, Niskanen L, Jurvelin JS. Is discordance in bone measurements affected by body composition or anthropometry? A comparative study between peripheral and central devices. J Clin Densitom 2007; 10:312-8. [PMID: 17451985 DOI: 10.1016/j.jocd.2007.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 09/13/2006] [Revised: 03/09/2007] [Accepted: 03/13/2007] [Indexed: 11/28/2022]
Abstract
Screening of osteoporosis using peripheral bone measurements has become more common, even though diagnostic discrepancies are known to exist between peripheral dual-energy X-ray (pDXA) or quantitative ultrasound (QUS) and central DXA measurements. Values of diagnostic parameters such as bone mineral density, speed of (ultra)sound, and broadband ultrasound attenuation are affected by bone size and soft tissue composition. However, their significance for the discordance between peripheral and central techniques is unclear. In this study, bone status and total body composition of 139 women (mean age 68.3 yr [1.7 SD], mean body mass index 26.5 kg/m2 [3.6 SD]) were assessed by 3 GE Lunar devices. Heel pDXA and heel QUS were conducted using peripheral instantaneous X-ray imaging (PIXI) and Achilles, respectively, and central DXA measurements were taken at the posterior-anterior lumbar spine (L2-L4) and at the left femoral neck using Prodigy. Positive significant associations were found between body height or fat (%) and most DXA or QUS parameters. The discordance between the site-dependent DXA or QUS T-score values typically increased (p<0.05) as a function of body weight or fat (%), but not with body height. On an average, body adiposity accounted for less than 11% of the differences between the techniques; however, increase of total body fat from 20% to 45% led to a discrepancy of one T-score between DXA(HEEL) and QUS(HEEL). To avoid diagnostic bias, comparative assessment of the devices using the same population is recommended.
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Affiliation(s)
- J Saarelainen
- Bone and Cartilage Research Unit, Clinical Research Center, University of Kuopio, Kuopio, Finland.
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