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Nordling Y, Sund R, Sirola J, Kröger H, Isanejad M, Rikkonen T. Body composition, balance, functional capacity and falls in older women. Aging Clin Exp Res 2024; 36:76. [PMID: 38512411 PMCID: PMC10957703 DOI: 10.1007/s40520-024-02719-5] [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] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND The aim of this study was to examine the association of body composition, muscle strength, balance, and functional capacity on falls and fall injuries among community-dwelling older women. METHODS The study comprised of a 2-year randomized controlled trial involving 914 women with an average age of 76.5 (SD = 3.3) years at baseline. The women were assigned to exercise intervention (n = 457) and control groups (n = 457). Clinical measurements were conducted at baseline, 12 months and 24 months. RESULTS During the 2-year follow up, total of 546 women (59.7%) sustained a fall. The total number of falls was 1380 and out of these, 550 (40%) of falls were non-injurious and 745 (54%) were injurious. Higher femoral neck bone mineral density (BMD) was associated with a higher overall risk of falls [RR = 2.55 (95% CI = 1.70-3.84, p < 0.001)], but was a protective factor for severe fall injuries [RR = 0.03 (95% CI = 0.003-0.035, p < 0.01)]. Slower Timed Up and Go (TUG) was associated with an increased overall risk of falls [RR = 1.07 (95% CI = 1.05-1.10, p < 0.001)] and injuries requiring medical attention [RR = 1.10 (95% CI = 1.02-1.19, p = 0.02)]. Longer single leg standing time was a protective factor for falls [RR = 0.99 (95% CI = 0.99-1.00, p < 0.01)] and overall injurious falls [RR = 0.99 (95% CI = 0.99-1.00, p = 0.02)]. CONCLUSION For postmenopausal women with higher femoral neck BMD appear to sustain more falls, but have a lower risk of severe fall injuries. Better TUG and single leg standing time predict lower risk of falls and fall injuries.
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Affiliation(s)
- Yki Nordling
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Masoud Isanejad
- Institute of Life Course and Medical Sciences, Department of Musculoskeletal and Ageing Sciences, University of Liverpool, 6 W Derby St, Liverpool, L7 8TX, UK
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
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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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Vilpunaho T, Karinkanta S, Sievänen H, Kopra J, Kröger H, Rikkonen T. Predictive ability of a self-rated fall risk assessment tool in community-dwelling older women. Aging Clin Exp Res 2023; 35:1205-1212. [PMID: 37145268 DOI: 10.1007/s40520-023-02423-w] [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] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Falls are a substantial health problem among older adults. An accessible and reliable tool for assessing individual fall risk is needed. AIMS The predictive ability of a one-page self-rated fall risk assessment form (KaatumisSeula® [KS]) was evaluated among older women in its current form. METHODS A subsample (n = 384) of community-living older women (aged 72-84 years) participating in the Kuopio Fall Prevention Study (KFPS) completed the KS form. Participants' falls were prospectively registered for 12 months with SMS messages. Their group status and form-based fall risk category were compared to the verified fall events during the KFPS intervention. Negative binomial regression and multinomial regression analyses were used. Physical performance measurements (single leg stance, leg extension strength and grip strength) were used as covariates. RESULTS During the follow-up, 43.8% of women fell at least once. Among the fallers, 76.8% had at least one self-determined injurious fall, and 26.2% had falls requiring medical attention. According to KS, 7.6% of the women had low fall risk, 75.0% moderate, 15.4% substantial, and only 2.1% high fall risk. Women in the "moderate fall risk" group had 1.47-fold (95% CI 0.74-2.91; nonsignificant), in "substantial fall risk" 4.00-fold (1.93-8.3; p < 0.001) and in "high fall risk" 3.00-fold (0.97-9.22; nonsignificant) higher risk of falls compared to the "low fall risk" group. Performance in physical tests did not account for future falls. CONCLUSIONS The KS form proved to be a feasible tool for self-administered fall risk assessment with moderate predictive ability. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02665169, date of first registration 27/01/2016.
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Affiliation(s)
- Tommi Vilpunaho
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Saija Karinkanta
- The UKK Institute for Health Promotion Research, Tampere, Finland
- The Social Insurance Institution of Finland, Research Unit, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Juho Kopra
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland
- Department of Orthopaedics, 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), Yliopistonranta 1B, P.O. Box 1627, 70211, 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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Mazidi M, Davies IG, Penson P, Rikkonen T, Isanejad M. Lifetime serum concentration of 25-hydroxyvitamin D 25(OH) is associated with hand grip strengths: insight from a Mendelian randomisation. Age Ageing 2022; 51:6565794. [PMID: 35397158 PMCID: PMC9122526 DOI: 10.1093/ageing/afac079] [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] [Received: 07/29/2021] [Indexed: 11/26/2022] Open
Abstract
Clinical trials have suggested that increased 25-hydroxyvitamin D (25(OH)D) has positive effect on hand grip strength. This Mendelian randomisation (MR) was implemented using summary-level data from the largest genome-wide association studies on vitamin D (n = 73,699) and hand grip strength. Inverse variance weighted method (IVW) was used to estimate the causal estimates. Weighted median (WM)-based method, MR-Egger and leave-one-out were applied as sensitivity analysis. Results showed that genetically higher-serum 25(OH)D levels had a positive effect on both right hand grip (IVW = Beta: 0.038, P = 0.030) and left hand grip (IVW = Beta: 0.034, P = 0.036). There was a low likelihood (statistically insignificant) of heterogeneity and pleiotropy, and the observed associations were not driven by single single-nucleotide polymorphisms. Furthermore, MR pleiotropy residual sum and outlier did not highlight any outliers. In conclusion, our results highlighted the causal and beneficial effect of serum 25(OH) D on right- and left-hand grip strengths.
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Affiliation(s)
- Mohsen Mazidi
- King’s College London, Department of Twin Research & Genetic Epidemiology, South Wing St Thomas', London, UK
| | - Ian G Davies
- School of Sports and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Peter Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Toni Rikkonen
- Institute of Life Course and Medical Sciences, Department of Musculoskeletal and Ageing Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Masoud Isanejad
- Institute of Life Course and Medical Sciences, Department of Musculoskeletal and Ageing Sciences, University of Liverpool, Liverpool L7 8TX, UK
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Moilanen A, Kopra J, Kröger H, Sund R, Rikkonen T, Sirola J. Characteristics of Long-Term Femoral Neck Bone Loss in Postmenopausal Women: A 25-Year Follow-Up. J Bone Miner Res 2022; 37:173-178. [PMID: 34668233 PMCID: PMC9298425 DOI: 10.1002/jbmr.4444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to monitor long-term changes in bone mineral density (BMD) after menopause and factors affecting BMD. The study population consisted of a random sample of 3222 women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study, of which 62.1% were postmenopausal at the beginning of the study. This group of women underwent dual-energy X-ray absorptiometry (DXA) measurements at the femoral neck every 5 years from baseline (in 1989) up to 25-year follow-up. They also responded to risk-factor questionnaires at 5-year intervals. During the 25-year follow-up, the baseline cohort decreased to 686 women. The women were divided into quartiles based on their baseline BMD. Self-reported hormone replacement therapy (HRT) and corticosteroid use were divided into ever users and never users. Morbidity was assessed as the total number of self-reported diseases and BMD-affecting diseases. The mean 25-year BMD change was found to be -10.1%, p < 0.001. Higher baseline BMD was associated with higher bone loss rate; the reduction in the highest quartile BMD was 11.1% and in the lowest quartile 7.4% (p = 0.0031). Lower baseline body mass index (BMI) and a greater increase in BMI were found to protect against postmenopausal bone loss (p < 0.001). The lowest bone loss quartile included 15.2% more HRT users than the highest bone loss quartile (p = 0.004). The number of diseases/bone-affecting diseases, use of vitamin D/calcium supplementation, use of corticosteroids, smoking or alcohol use had no statistical significance for annual bone loss rate. This study presents hitherto the longest (25-year) BMD follow-up in postmenopausal women. The linear femoral neck bone loss of 10% was less than previously assumed. A 5-year BMD change appeared to predict long-term bone loss in postmenopausal women. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Anna Moilanen
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Juho Kopra
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Salo S, Hurri H, Rikkonen T, Sund R, Kröger H, Sirola J. Association between severe lumbar disc degeneration and self-reported occupational physical loading. J Occup Health 2022; 64:e12316. [PMID: 35084078 PMCID: PMC8793002 DOI: 10.1002/1348-9585.12316] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/25/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Occupational physical loading has been reported to be associated with intervertebral disc degeneration. However, previous literature reports inconsistent results for different vertebral levels. The aim of our study was to investigate the association between lumbar disc degeneration (LDD) at different vertebral levels and the self‐reported physical loading of occupation. Methods The study population consisted of 1,022 postmenopausal women and was based on the prospective Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort. The severity of LDD was graded from T2‐weighted MRI images using the five‐grade Pfirrmann classification. Five intervertebral levels (L1–L2 to L5–S1) were studied (total 5110 discs). The self‐rated occupational physical loading contained four groups: sedentary, light, moderate, and heavy. Results The heavy occupational physical loading group had higher odds for severe LDD at the L5–S1 vertebral level (OR 1.86, 95% CI: 1.19–2.92, p = .006) in comparison with the sedentary work group. A clear trend of increasing disc degeneration with heavier occupational loading was also observed at the L5–S1 level. Age, smoking, and higher body mass index (BMI) were associated with more severe LDD. Leisure‐time physical activity at the age of 11–17 years was associated with less severe LDD. Controlling for confounding factors did not alter the results. Conclusions There appears to be an association between occupational physical loading and severe disc degeneration at the lower lumbar spine in postmenopausal women. Individuals in occupations with heavy physical loading may have an increased risk for work‐related disability due to more severe disc degeneration.
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Affiliation(s)
- Sami Salo
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heidi Hurri
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Toni Rikkonen
- 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
| | - Heikki Kröger
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- Kuopio musculoskeletal research unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Isanejad M, Tajik B, McArdle A, Tuppurainen M, Sirola J, Kröger H, Rikkonen T, Erkkilä A. Dietary omega-3 polyunsaturated fatty acid and alpha-linolenic acid are associated with physical capacity measure but not muscle mass in older women 65-72 years. Eur J Nutr 2021; 61:1813-1821. [PMID: 34913105 PMCID: PMC9106622 DOI: 10.1007/s00394-021-02773-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022]
Abstract
Purpose The aim was to investigate the cross-sectional association of dietary omega-3 polyunsaturated fatty acids PUFA (alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)) intake with multiple physical functions, muscle mass and fat mass in older women. Method Study subjects were 554 women from the Osteoporosis Risk Factor and Prevention Fracture Prevention Study, with dietary intake assessed with 3-day food record. Body composition was measured by dual-energy X-ray absorptiometry. Physical function measures included walking speed 10 m, chair rises, one leg stance, knee extension, handgrip strength and squat. Short physical performance battery (SPPB) score was defined based on the European working group on sarcopenia criteria. Results The multivariable adjusted models showed statistically significant associations for dietary ALA with higher SPPB (β = 0.118, P = 0.024), knee extension force at baseline (β = 0.075, P = 0.037) and lower fat mass (β = − 0.081, P = 0.034), as well as longer one-leg stance (β = 0.119, P = 0.010), higher walking speed (β = 0.113, P = 0.047), and ability to squat to the ground (β = 0.110, P = 0.027) at baseline. Total dietary omega-3 PUFA was associated with better SPPB (β = 0.108, P = 0.039), one-leg stance (β = 0.102, P = 0.041) and ability to squat (β = 0.110, P = 0.028), and with walking speed (β = 0.110, P = 0.028). However, associations for dietary EPA and DHA with physical function and body composition were not significant. Conclusion Dietary omega-3 and ALA, but not EPA and DHA, were positively associated with muscle strength and function in older women. The intake of omega-3 and its subtypes was not associated with muscle mass. Longitudinal studies are needed to show whether omega-3 intake may be important for muscle function in older women.
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Affiliation(s)
- Masoud Isanejad
- Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L6 8TX, England, UK. .,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.
| | - Behnam Tajik
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Anne McArdle
- Department of Musculoskeletal and Ageing Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L6 8TX, England, UK
| | - Marjo Tuppurainen
- Department of Obstetrics and Gynaecology, Kuopio, University Hospital, Kuopio, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Arja Erkkilä
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
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Qazi SL, Koivumaa-Honkanen H, Rikkonen T, Sund R, Kröger H, Isanejad M, Sirola J. Physical capacity, subjective health, and life satisfaction in older women: a 10-year follow-up study. BMC Geriatr 2021; 21:658. [PMID: 34814850 PMCID: PMC8609741 DOI: 10.1186/s12877-021-02605-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Physical capacity and subjective wellbeing are important for healthy aging. Our aim was to study how objective/subjective physical capacity and subjective health relate to life satisfaction, in a 10-year follow-up of aging women. Methods The participants (n = 1485, mean age 67.4 years) consisted of community-dwelling older women living in Kuopio, Finland. Grip strength and one-legged stance test time were used as objective, and self-rated mobility (SRM) as subjective physical capacity measures. Self-rated health (SRH) and SRM were assessed with one-item scales and life satisfaction with a 4-item scale. Correlation and linear regression were used to analyze these relationships and correlation network analysis to visualize them. Age and BMI were included in the analysis as adjusting factors. Results All the study variables were significantly correlated with baseline and follow-up life satisfaction, except BMI, which was only associated with life satisfaction at follow-up. On both occasions, SRH and SRM were the two strongest correlates of life satisfaction, but their mutual correlation was still higher. In linear regression analyses, SRH was positively associated with both baseline and follow-up life satisfaction, but physical capacity measures became non-significant after including SRH and SRM in the model. In the partial correlation network analyses, SRH and SRM were the most central nodes, connecting every other variable. Conclusions Self-reports on health, mobility, and life satisfaction are closely intertwined and provide easily accessible health information among aging women, but the impacts of objective physical capacity measures warrant further longitudinal studies in respect to subjective wellbeing among aging people. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02605-z.
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Affiliation(s)
- Sarang Latif Qazi
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Mediteknia Building, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Heli Koivumaa-Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Mediteknia Building, P.O. Box 1627, 70211, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Mediteknia Building, P.O. Box 1627, 70211, Kuopio, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Mediteknia Building, P.O. Box 1627, 70211, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Mediteknia Building, P.O. Box 1627, 70211, Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Masoud Isanejad
- Institute of Life Course and Medical Sciences, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Mediteknia Building, P.O. Box 1627, 70211, Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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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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Pekonen SR, Kopra J, Kröger H, Rikkonen T, Sund R. Regional and gender-specific analyses give new perspectives for secular trend in hip fracture incidence. Osteoporos Int 2021; 32:1725-1733. [PMID: 33712877 PMCID: PMC8387269 DOI: 10.1007/s00198-021-05906-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/04/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
UNLABELLED In this study, we found that regional disparity in incidence of hip fractures has converged. Also, annual hip fracture risk ratios between genders have systematically diminished over time. INTRODUCTION Several studies have reported secular trends in hip fracture incidence, but knowledge about the possible causes is limited. We studied potential explanations by examining spatio-temporal epidemiology of the fractures and estimating relative risks between genders. METHODS This observational study was based on all inpatient hospital discharges in 1972-2018 in Finland. We divided the data by gender, 5-year age groups and Finnish sub-regions and estimated gender and age standardized spatio-temporal rates of hip fractures by using a Bayesian age-period-cohort model. RESULTS In 1972, women's hip fracture incidence was 1.2-1.3 times higher in western and coastal Finland compared to eastern and inland areas. Also, women had approximately 1.7 times higher average risk to get a hip fracture compared to men. Today, the hip fracture differences between the areas have converged to insignificant and the relative risk between genders has diminished to 1.2. Age-specific relative risks indicate greater hip fracture risk for younger men and older women, and the women's risk increases beyond the risk of men at age 65 which is ten years later than in the beginning of the study period. CONCLUSION Incidence of hip fracture has converged significantly between regions and genders. Especially factors related with socioeconomic development and increased frailty and longevity seem to be important. The hip fracture incidence rate ratio between women and men has systematically decreased in time, and more attention should be paid to hip fracture risk in men in the future.
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Affiliation(s)
- S.-R. Pekonen
- grid.9668.10000 0001 0726 2490School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - J. Kopra
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - H. Kröger
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- grid.410705.70000 0004 0628 207XDepartment of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - T. Rikkonen
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - R. Sund
- grid.9668.10000 0001 0726 2490Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
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12
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Nissinen T, Suoranta S, Saavalainen T, Sund R, Hurskainen O, Rikkonen T, Kröger H, Lähivaara T, Väänänen SP. Detecting pathological features and predicting fracture risk from dual-energy X-ray absorptiometry images using deep learning. Bone Rep 2021; 14:101070. [PMID: 33997147 PMCID: PMC8102403 DOI: 10.1016/j.bonr.2021.101070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/08/2022] Open
Abstract
Dual-energy X-ray absorptiometry (DXA) is the gold standard imaging method for diagnosing osteoporosis in clinical practice. The DXA images are commonly used to estimate a numerical value for bone mineral density (BMD), which decreases in osteoporosis. Low BMD is a known risk factor for osteoporotic fractures. In this study, we used deep learning to identify lumbar scoliosis and structural abnormalities that potentially affect BMD but are often neglected in lumbar spine DXA analysis. In addition, we tested the approach's ability to predict fractures using only DXA images. A dataset of 2949 images gathered by Kuopio Osteoporosis Risk Factor and Prevention Study was used to train a convolutional neural network (CNN) for classification. The model was able to classify scoliosis with an AUC of 0.96 and structural abnormalities causing unreliable BMD measurement with an AUC of 0.91. It predicted fractures occurring within 5 years from the lumbar spine DXA scan with an AUC of 0.63, meeting the predictive performance of combined BMD measurements from the lumbar spine and hip. In an independent test set of 574 clinical patients, AUC for lumbar scoliosis was 0.93 and AUC for unreliable BMD measurements was 0.94. In each classification task, neural network visualizations indicated the model's predictive strategy. We conclude that deep learning could complement the well established DXA method for osteoporosis diagnostics by analyzing incidental findings and image reliability, and improve its predictive ability in the future.
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Affiliation(s)
- Tomi Nissinen
- Department of Applied Physics, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Sanna Suoranta
- Department of Clinical Radiology, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Taavi Saavalainen
- Department of Clinical Radiology, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
| | - Ossi Hurskainen
- Department of Clinical Radiology, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Toni Rikkonen
- Institute of Clinical Medicine, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Timo Lähivaara
- Department of Applied Physics, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
| | - Sami P. Väänänen
- Department of Applied Physics, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
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Juopperi S, Sund R, Rikkonen T, Kröger H, Sirola J. Correction to: Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women. BMC Musculoskelet Disord 2021; 22:349. [PMID: 33845823 PMCID: PMC8042917 DOI: 10.1186/s12891-021-04219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Samuli Juopperi
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopedics, Traumatology and Hand surgery, Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopedics, Traumatology and Hand surgery, Kuopio University Hospital, Kuopio, Finland
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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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15
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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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16
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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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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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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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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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Imtiaz B, Tuppurainen M, Rikkonen T, Kivipelto M, Soininen H, Kröger H, Tolppanen AM. Postmenopausal hormone therapy and Alzheimer disease: A prospective cohort study. Neurology 2017; 88:1062-1068. [PMID: 28202700 PMCID: PMC5384835 DOI: 10.1212/wnl.0000000000003696] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 12/21/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore the association between postmenopausal hormone therapy (HT) and Alzheimer disease (AD). METHODS Twenty-year follow-up data from the Kuopio Osteoporosis Risk Factor and Prevention study cohort were used. Self-administered questionnaires were sent to all women aged 47-56 years, residing in Kuopio Province starting in 1989 until 2009, every 5th year. Register-based information on HT prescriptions was available since 1995. Probable AD cases, based on DSM-IV and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria, were identified from the special reimbursement register (1999-2009). The study population included 8,195 women (227 cases of incident AD). RESULTS Postmenopausal estrogen use was not associated with AD risk in register-based or self-reported data (hazard ratio/95% confidence interval 0.92/0.68-1.2, 0.99/0.75-1.3, respectively). Long-term self-reported postmenopausal HT was associated with reduced AD risk (0.53/0.31-0.91). Similar results were obtained with any dementia diagnosis in the hospital discharge register as an outcome. CONCLUSIONS Our results do not provide strong evidence for a protective association between postmenopausal HT use and AD or dementia, although we observed a reduced AD risk among those with long-term self-reported HT use.
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Affiliation(s)
- Bushra Imtiaz
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Marjo Tuppurainen
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Toni Rikkonen
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Miia Kivipelto
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Hilkka Soininen
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Heikki Kröger
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Maija Tolppanen
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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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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Abstract
The timing of the menopause transition has remained fairly constant throughout history. It represents a milestone in female health and, after passing through it, women experience increased musculoskeletal and cardiovascular morbidity. Muscle performance is an important determinant of functional capacity and quality of life among the elderly and is also involved in the maintenance of balance. Therefore, good muscle strength can prevent fragility fractures and lessen the burden of osteoporosis. Muscle strength begins to decline during the perimenopausal years and this phenomenon seems to be partly estrogen dependent. Randomized controlled trials have indicated that hormone replacement therapy may prevent a decline in muscle performance, although the exact mechanism of estrogen-dependent sarcopenia remains to be clarified. Exercises have been shown to improve postmenopausal muscle performance and hormone replacement therapy may also potentiate these beneficial effects. Improvement or maintenance of muscle strength alone, however, may not be considered as a primary indication for long-term hormone replacement therapy in view of current knowledge of its risks and benefits. Work history and educational background may be associated with postmenopausal muscle performance, which itself has unique associations with skeletal and cardiovascular diseases.
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Affiliation(s)
- Joonas Sirola
- Bone and Cartilage Research Unit, University of Kuopio, 70211 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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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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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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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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Karjalainen JP, Riekkinen O, Töyräs J, Hakulinen M, Kröger H, Rikkonen T, Salovaara K, Jurvelin JS. Multi-site bone ultrasound measurements in elderly women with and without previous hip fractures. Osteoporos Int 2012; 23:1287-95. [PMID: 21656263 DOI: 10.1007/s00198-011-1682-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 05/19/2011] [Indexed: 10/18/2022]
Abstract
UNLABELLED About 75% of patients suffering from osteoporosis are not diagnosed. This study describes a multi-site bone ultrasound method for osteoporosis diagnostics. In comparison with axial dual energy X-ray absorptiometry (DXA), the ultrasound method showed good diagnostic performance and could discriminate fracture subjects among elderly females. INTRODUCTION Axial DXA, the gold standard diagnostic method for osteoporosis, predicts fractures only moderately. At present, no reliable diagnostic methods are available at the primary health care level. Here, a multi-site ultrasound method is proposed for osteoporosis diagnostics. METHODS Thirty elderly women were examined using the ultrasound backscatter measurements in proximal femur, proximal radius, proximal and distal tibia in vivo. First, we predicted the areal bone mineral density (BMD) at femoral neck by ultrasound measurements in tibia combined with specific subject characteristics (density index, DI) and, second, we tested the ability of ultrasound backscatter measurements at proximal femur to discriminate between individuals with previously fractured hips from those without fractures. Areal BMD was determined by axial DXA. RESULTS Combined ultrasound parameters, cortical thickness at distal and proximal tibia, with age and weight of the subject, provided a significant estimate of BMD(neck) (r = 0.86, p < 0.001, n = 30). When inserted into FRAX (World Health Organization fracture risk assessment tool), the DI indicated the same treatment proposal as the BMD(neck) with 86% sensitivity and 100% specificity. The receiver operating characteristic analyses, with a combination of ultrasound parameters and patient characteristics, discriminated fracture subjects from the controls similarly as the model combining BMD(neck) and patient characteristics. CONCLUSIONS For the first time, ultrasound backscatter measurements of proximal femur were conducted in vivo. The results indicate that ultrasound parameters, combined with patient characteristics, may provide a means for osteoporosis diagnostics.
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Affiliation(s)
- J P Karjalainen
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211 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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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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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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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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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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Karjalainen J, Töyräs J, Rikkonen T, Jurvelin J, Riekkinen O. Dual-frequency ultrasound technique minimizes errors induced by soft tissue in ultrasound bone densitometry. Acta Radiol 2008; 49:1038-41. [PMID: 18728919 DOI: 10.1080/02841850802325982] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most bone ultrasound devices are designed for through-transmission measurements of the calcaneus. In principle, ultrasound backscattering measurements are possible at more typical fracture sites of the central skeleton. Unfortunately, soft tissue overlying the bones diminishes reliability of these measurements. PURPOSE To apply the single-transducer dual-frequency ultrasound (DFUS) technique to eliminate the errors induced by soft tissue on the measurements of integrated reflection coefficient (IRC) in human distal femur in vivo. MATERIAL AND METHODS Ultrasound and dual-energy X-ray absorptiometry (DXA) examinations were conducted on a bodybuilder during a 21-week training and dieting period. RESULTS Significant changes in quantity and composition of soft tissue took place during the diet. However, DXA measurements showed no significant effects on bone density measurements. The single transducer DFUS technique enabled the determination of local soft-tissue composition, as verified by comparison with the DXA (r=0.91, n=8, p<0.01). Further, the technique eliminated the soft-tissue-induced error from IRC measured for the bone. The uncorrected IRC associated significantly with the change in local soft-tissue composition (r=-0.83, n=8, p<0.05), whereas the corrected IRC values showed no significant dependence (r=-0.30, n=8, p=0.46) on local soft-tissue composition. CONCLUSION The DFUS technique may significantly enhance the accuracy of clinical ultrasound measurements of bone.
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Affiliation(s)
- J. Karjalainen
- Department of Physics, University of Kuopio, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland and Bone and Cartilage Research Unit (BCRU), Kuopio University, Kuopio, Finland
| | - J. Töyräs
- Department of Physics, University of Kuopio, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland and Bone and Cartilage Research Unit (BCRU), Kuopio University, Kuopio, Finland
| | - T. Rikkonen
- Department of Physics, University of Kuopio, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland and Bone and Cartilage Research Unit (BCRU), Kuopio University, Kuopio, Finland
| | - J.S. Jurvelin
- Department of Physics, University of Kuopio, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland and Bone and Cartilage Research Unit (BCRU), Kuopio University, Kuopio, Finland
| | - O. Riekkinen
- Department of Physics, University of Kuopio, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland and Bone and Cartilage Research Unit (BCRU), Kuopio University, Kuopio, Finland
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Sirola J, Rikkonen T, Tuppurainen M, Jurvelin JS, Alhava E, Kröger H. Grip strength may facilitate fracture prediction in perimenopausal women with normal BMD: a 15-year population-based study. Calcif Tissue Int 2008; 83:93-100. [PMID: 18641912 DOI: 10.1007/s00223-008-9155-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [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: 03/26/2008] [Accepted: 06/10/2008] [Indexed: 11/30/2022]
Abstract
The aim of the present study was to investigate the ability of grip strength measurements to predict fracture risk in perimenopausal women according to bone mineral density (BMD). A random sample of 971 perimenopausal women from the Kuopio Osteoporosis Risk Factor and Prevention study cohort was measured with dual-energy X-ray absorptiometry (DXA) at the femoral neck and grip strength with a pneumatic squeeze dynamometer in 5-year intervals from baseline (1989-1991). Fractures during the 15-year follow-up were recorded based on self-reports and validated from medical records. In the total sample and in osteopenic or osteoporotic women (T score < -1, n = 284) grip strength was not significantly associated with fracture-free survival rate (P = nonsignificant in Cox regression). In women with normal baseline BMD (N-BMD, T score > -1, n = 687) the lowest grip strength quartile had a significantly lower fracture-free survival rate in the Cox proportional hazard model (P = 0.005, hazard ratio [HR] = 2.0). In the multivariate Cox regression model, T score and grip strength were the only significant predictors of 15-year fracture-free survival in the N-BMD group and a risk index (RI) was formed according to HRs of these two variables. High RI (0-5 points) was associated with significantly lower 15-year fracture-free survival rate (P = 0.001, HR = 0.137) in the N-BMD group. In contrast, 5-year T score was no better a predictor of fractures in the baseline N-BMD group (P = 0.04, HR = 0.36). In conclusion, grip strength predicts 15-year fracture-free survival in perimenopausal women with N-BMD, while 5-year DXA does not seem to be any better a predictor of fracture risk. DXA measurements could be coupled with simple and cost-effective grip strength measurements. Controlling BMD in women with N-BMD could be abandoned.
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Affiliation(s)
- Joonas Sirola
- Bone and Cartilage Research Unit, University of Kuopio, Kuopio, 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. 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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Rikkonen T, Tuppurainen M, Kröger H, Jurvelin J, Honkanen R. Distance of walking in childhood and femoral bone density in perimenopausal women. Eur J Appl Physiol 2006; 97:509-15. [PMID: 16718507 DOI: 10.1007/s00421-006-0208-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2006] [Indexed: 10/24/2022]
Abstract
Kuopio osteoporosis risk factor and prevention (OSTPRE) study is a population-based study from Eastern Finland. At baseline in 1989-91, bone densitometry of lumbar spine and femoral neck as assessed by DXA was carried out on women aged 48-58 (n = 3,222). In 1993, menarcheal age and health habits during adolescence were inquired from a postal inquiry. In 1996, a random sample of 254 women who had been premenopausal at baseline was interviewed over phone. They were asked how many kilometers per day they had walked to school and back, in each grade of primary school. The study sample (N = 185) was formed by excluding women with menarcheal age of >14 or <11 years. Women with any reported HRT history were also excluded. The mean age of the study sample was 50.7 (1.63) years, weight 70.8 (13.1) kg, height 161.5 (5.0) cm, and mean walking distance to and fro from the school at ages from 9 to 11 years was 2.7 (1.7) km. In regression analysis, the walking distance was associated with femoral BMD (r = 0.18, P = 0.015). After adjusting for baseline age, weight and height, this association persisted (P = 0.025). When walking distance was categorized as I = 0-0.549 km, II = 0.55-1.99 km, III = 2.0-4.99 and IV = 5.0 km and more, the respective means for femoral BMDs were 0.92, 0.97, 0.98 and 1.01 g/cm(2). Statistical significance persisted after adjusting for height, weight, age, grip strength, calcium intake, smoking, place of residence, use of contraceptive pills, physical load of work and baseline physical activity (P = 0.032). A 10 year follow-up revealed no changes in bone loss rate between the groups and femoral BMD benefits persisted (repeated measures analysis = NS). Walking distance was not associated with spinal bone density. Even though walking is a low impact activity, walking before menarche may have a moderate but long-lasting positive effect on femoral peak bone density. Lack of walking and similar low impact physical activities during peak growth years may have a negative effect on peak bone mass formation.
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Affiliation(s)
- Toni Rikkonen
- Research Institute of Public Health, University of Kuopio 1627, 70211 Kuopio, Finland.
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Sirola J, Rikkonen T, Tuppurainen M, Jurvelin JS, Kröger H. Association of grip strength change with menopausal bone loss and related fractures: a population-based follow-up study. Calcif Tissue Int 2006; 78:218-26. [PMID: 16604281 DOI: 10.1007/s00223-005-0298-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [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: 12/15/2005] [Accepted: 02/07/2006] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to investigate the association between grip strength change and bone health according to menopausal status. A random sample of 971 pre- to postmenopausal women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort was measured with dual X-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN) and grip strength with pneumatic squeeze dynamometer at baseline (1989-1991), 5 years (1994-1997), and 10 years (1999-2001). Fractures were recorded based on self-reports and validated from medical records. Women were divided into two groups according to change in grip strength quartile from baseline to 5-year follow-up: not improved (n = 735) and improved (n = 236). In the total population, the greatest bone loss was observed in perimenopausal (beginning of menopause during follow-up, n = 311) women [P < 0.001 vs. premenopausal women (n = 139)], and it declined in postmenopausal (n = 521) women [P < 0.001 by analysis of covariance (ANCOVA)]. The perimenopausal bone loss rate was significantly lower in women in the improved group in comparison to the not improved group (P < 0.01) in contrast to the pre- and postmenopausal groups (P > 0.05). Accordingly, there was a greater decline in perimenopausal LS and FN T-scores in the improved group vs. the not improved group over the first 5-year follow-up interval (P < 0.05 by ANCOVA) and remained unchanged over the 10-year follow-up. In perimenopausal women, there was a trend toward higher fracture-free survival rate in the improved group (82%) vs. the not improved group (88%) after 10 years. Adjustments did not change the results. In conclusion, maintenance of grip strength is associated with menopausal bone loss and future fractures.
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Affiliation(s)
- J Sirola
- Bone and Cartilage Research Unit, University of Kuopio, Kuopio, Finland.
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Sirola J, Rikkonen T, Tuppurainen M, Honkanen R, Jurvelin JS, Kröger H. Maintenance of muscle strength may counteract weight-loss-related postmenopausal bone loss--a population-based approach. Osteoporos Int 2006; 17:775-82. [PMID: 16491321 DOI: 10.1007/s00198-005-0054-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 08/25/2005] [Accepted: 12/05/2005] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Weight loss significantly increases postmenopausal bone loss, but the effects of muscle strength change on weight-loss-associated bone loss remain unclear. The study population, 587 peri- and postmenopausal women, was a random sample of the original Osteoporosis Risk Factor and Prevention Study (OSTPRE) study cohort (n=14,220) in Kuopio, Finland. Bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN) was measured with dual x-ray absorptiometry, and grip strength was measured with a pneumatic squeeze dynamometer at baseline in 1989-1991 and at the 10-year follow-up in 1999-2001. METHODS Women were divided into three groups according to change in age-grouped grip-strength quartile in both of the measurements: "decreased" (n=133), "maintained" (n=300), and "improved" (n=154). In addition, the study sample was divided into two groups according to weight change during the follow-up: weight losers (n=156) and weight gainers (n=431). RESULTS There were no differences in the change status of grip (muscle) strength between the weight loss and weight gain groups (p>0.500, Pearson chi-square test). Women losing weight during the follow-up and within the improved grip-strength-change group had a significantly lower bone loss rate compared with those in the maintained and decreased grip-strength-change groups (p<0.01 in comparison to the decreased group). This was in contrast to women who gained weight during the follow-up (not significant between any grip-strength-change groups). Furthermore, women who lost body weight and were in the improved grip-strength-change group had a bone loss rate comparable with that of the women who gained body weight (not significant). This was in contrast to the maintained (p<0.05 between weight losers versus gainers in LS) and decreased grip-strength-change groups (p<0.01 weight losers versus gainers in LS and FN). CONCLUSION The present study suggests that maintaining muscle strength may counteract postmenopausal bone loss related to weight loss. Accordingly, exercise that improves muscle strength may be encouraged for postmenopausal women with weight loss intentions for other health reasons.
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Affiliation(s)
- J Sirola
- Bone and Cartilage Research Unit (BCRU), University of Kuopio, Mediteknia Building, P.O. Box 1627, 70211, and Department of Obstetrics and Gynaecology, Kuopio University Hospital, Finland.
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Sirola J, Rikkonen T, Kröger H, Honkanen R, Tuppurainen M, Airaksinen O, Saarikoski S. Factors related to postmenopausal muscle performance: a cross-sectional population-based study. Eur J Appl Physiol 2004; 93:102-7. [PMID: 15316789 DOI: 10.1007/s00421-004-1173-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2004] [Indexed: 10/26/2022]
Abstract
The aim of the present study was to investigate cross-sectionally the association of postmenopausal muscle strength with simple performance tests. A random sample of 1,166 naturally postmenopausal women (born 1932-1941) was selected from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort. Grip and quadriceps strength were measured with strain gauge dynamometers and reported in both absolute values (KPa and kg) and per kilogram of body mass (N cm(-2) kg(-1) and N kg(-1)). In addition, two performance tests, 'ability to stand on one foot' and 'ability to squat down to touch the floor' were carried out. A five-category self-assessment of overall health ('very good', 'good', 'moderate', 'bad', and 'very bad') was obtained by postal questionnaire. The women that were able to stand on one foot and able to squat down to touch the floor had greater grip and quadriceps strength than their counterparts ( P<0.001 and P<0.03 in ANOVA, respectively). In addition, self-assessed health had a strong positive association with muscle strength in the grip and leg extensor muscles in ANOVA ( P<0.001 between 'very good' and 'moderate' or poorer state of health) and regression model ( P<0.001). Adjustment for age, duration of menopause, body mass, height, physical activity level, use of HRT, and number of diseases and medications did not change any of the main effects. Also, there were no differences in results between absolute measurement values and values reported per kilogram of body mass. According to the present study, a simple performance test may be useful in the prediction of postmenopausal muscle strength. Furthermore, self-assessed state of health is strongly associated with muscle strength in postmenopausal women.
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Affiliation(s)
- Joonas Sirola
- TULES Research Centre, University of Kuopio, Kuopio, Finland.
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