Physical capability, physical activity, and their association with femoral bone mineral density in adults aged 40 years and older: The Tromsø study 2015–2016

Summary: Since muscles can influence bone growth and vice versa, we examined if level of physical activity and physical capability tests can predict areal bone mineral density (aBMD). Both high activity level and good test performance were associated with higher aBMD, especially in women. Introduction: Muscle influences bone formation and vice versa. Tests of physical capability and level of physical activity reflect various muscle qualities. We assessed the associations between total hip aBMD and physical activity as well as a range of standardized physical capability tests in an adult general population. Methods: A total of 3 533 women and men aged 40-84 years, participating in the population-based cross-sectional Tromsø study in Norway in 2015-2016, were included. Linear regression was used to assess associations between aBMD and physical activity and the physical capability tests grip strength, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), and standing balance. Non-linear associations were examined in cubic spline models. Standardized regression coefficients were calculated to compare effect sizes across physical capability measures. Results: In fully adjusted models, higher physical activity was positively associated with total hip aBMD in both sexes compared to a sedentary lifestyle. All tests of physical capability were associated with aBMD in women, SPPB showing the strongest association although effect sizes were too small to indicate clinically significant differences (1 point increase corresponded to an aBMD increase of 0.009 g/cm2, CI = 0.005 to 0.012). In men, SPPB and its subtests were associated with aBMD with chair rises showing the strongest association (1 s increase in execution time corresponded to an aBMD decrease of 0.005 g/cm2, CI = 0.008 to 0.002). Conclusion: Physical activity was associated with aBMD, and tests of physical capability can account for some of the aBMD variations in adults aged 40 years and older, especially in women

Can bone mineral density loss in the non-weight bearing distal forearm predict mortality?

Abstract Purpose Low bone mineral density (BMD) is associated with increased risk of fractures and mortality. We investigated if rate of BMD loss in the distal forearm over seven years predicted mortality. Methods 1725 postmenopausal women and 1879 men aged 50–74 who participated in the longitudinal Tromsø Study waves 4 (1994–95) and 5 (2001−2002) were included. Cox regression models adjusted for lifestyle- and health related variables were used to assess associations between BMD change over seven years and subsequent mortality during up to 17 years of follow-up in participants with normal and low BMD at baseline. Results Baseline BMD decreased and seven-year bone loss increased with increasing age. Overall, mortality rates were higher among those with low versus normal BMD (38 vs 19 per 1000 py in women, 56 vs 34 in men) and at higher bone loss rates (rate ratio high:low = 1.2 in women, 1.7 in men). BMD change was associated with increased mortality only in men with normal baseline BMD. In this group, men with a BMD loss of >4% had significantly higher mortality (HR 1.50, 95% CI 1.21, 1.87) than men with increased or unchanged BMD. BMD change was not significantly associated with increased mortality in women or in men with low BMD at baseline. Conclusions BMD loss in the distal forearm was associated with increased mortality in men with normal BMD at baseline, but not in women. We found no clear association between BMD loss and mortality in those with low BMD at baseline

Can bone mineral density loss in the non-weight bearing distal forearm predict mortality?

Purpose: Low bone mineral density (BMD) is associated with increased risk of fractures and mortality. We investigated if rate of BMD loss in the distal forearm over seven years predicted mortality. Methods: 1725 postmenopausal women and 1879 men aged 50–74 who participated in the longitudinal Tromsø Study waves 4 (1994–95) and 5 (2001−2002) were included. Cox regression models adjusted for lifestyle- and health related variables were used to assess associations between BMD change over seven years and subsequent mortality during up to 17 years of follow-up in participants with normal and low BMD at baseline. Results: Baseline BMD decreased and seven-year bone loss increased with increasing age. Overall, mortality rates were higher among those with low versus normal BMD (38 vs 19 per 1000 py in women, 56 vs 34 in men) and at higher bone loss rates (rate ratio high:low = 1.2 in women, 1.7 in men). BMD change was associated with increased mortality only in men with normal baseline BMD. In this group, men with a BMD loss of >4% had significantly higher mortality (HR 1.50, 95% CI 1.21, 1.87) than men with increased or unchanged BMD. BMD change was not significantly associated with increased mortality in women or in men with low BMD at baseline. Conclusions: BMD loss in the distal forearm was associated with increased mortality in men with normal BMD at baseline, but not in women. We found no clear association between BMD loss and mortality in those with low BMD at baseline

Osteoporosis and osteopenia in the distal forearm predicts all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromsø Study

Mini-abstract: Low bone mineral density (BMD) gives an increased risk of fractures, which can lead to premature death. Can BMD of the wrist predict mortality? BMD consistent with osteopenia and osteoporosis gave a significantly increased risk of death for both men and women in a general population in Tromsø, Norway. Summary: Low bone mineral density (BMD) gives an increased risk of fractures, which can lead to premature death. Can BMD of the wrist predict mortality?BMD consistent With osteopenia and osteoporosis gave a significantly increased risk of death for both men and women in a general population in Tromsø, Norway. Purpose: To investigate if bone mineral density (BMD) levels of the distal forearm, consistent with osteopenia and osteoporosis, can predict mortality and if grip strength is an effect modifier. Methods: The study population constituted 6565 participants aged 50–79 years at baseline in the Tromsø Study wave conducted in 1994–1995. Forearm BMD measured by SXA was categorized as "normal", "osteopenia", or "osteoporosis" following WHO’s definition. Cox regression with all-cause mortality as the outcome over 22 years of follow-up was performed for men and women separately, adjusting for health-related factors, as well as BMD by grip strength interaction. A secondary analysis with a 15-year follow-up also adjusted for hip fractures and osteoporotic fractures. Results: During follow-up, 3176 of participants died (47%). Those categorized as osteoporotic had higher mortality hazard ratio (HR) compared to those with normal BMD; men HR=1.37 (95% confidence interval (CI) 1.19, 1.58) and women HR=1.32 (1.14,1.53)were adjusted for age, body mass index, physical activity, smoking habits, education, health status, chronic diseases, and grip strength. Corresponding HRs for osteopenia were men HR=1.13 (1.00, 1.27) and women HR=1.17 (1.01, 1.35). Further adjustments for fractures did only marginally attenuate the results, and HRs were still significant. There was no grip strength by BMD interaction. Conclusion: Men and women with low distal forearm BMD values, consistent with osteoporosis or osteopenia, had an increased mortality compared to normal BMD participants. High grip strength did not modify this association, and the association remained after adjustment for a range of health-related factors

Osteoporosis and osteopenia in the distal forearm predicts all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromsø Study

Introduction: To investigate if bone mineral density (BMD) levels of the distal forearm, consistent with osteopenia and osteoporosis, can predict mortality and if grip strength is an effect modifier. Methods: The study population constituted 6565 participants aged 50–79 years at baseline in the Tromsø Study wave 4 conducted in 1994–1995. Forearm BMD measured by SXA was categorized as “normal,” “osteopenia,” or “osteoporosis” following WHO’s definition. Cox regression with all-cause mortality as the outcome over 22 years of follow-up was performed for men and women separately, adjusting for health-related factors, as well as BMD by grip strength interaction. A secondary analysis with a 15-year follow-up also adjusted for hip fractures and osteoporotic fractures. Results: During follow-up, 3176 of participants died (47%). Those categorized as osteoporotic had higher mortality hazard ratio (HR) compared to those with normal BMD; men HR = 1.37 (95% confidence interval (CI) 1.19, 1.58) and women HR = 1.32 (1.14, 1.53) were adjusted for age, body mass index, physical activity, smoking habits, education, health status, chronic diseases, and grip strength. Corresponding HRs for osteopenia were men HR = 1.13 (1.00, 1.27) and women HR = 1.17 (1.01, 1.35). Further adjustments for fractures did only marginally attenuate the results, and HRs were still significant. There was no grip strength by BMD interaction. Conclusion: Men and women with low distal forearm BMD values, consistent with osteoporosis or osteopenia, had an increased mortality compared to normal BMD participants. High grip strength did not modify this association, and the association remained after adjustment for a range of health-related factors

Physical capability, physical activity, and their association with femoral bone mineral density in adults aged 40 years and older: The Tromsø study 2015–2016

Since muscles can influence bone growth and vice versa, we examined if level of physical activity and physical capability tests can predict areal bone mineral density (aBMD). Both high activity level and good test performance were associated with higher aBMD, especially in women. Introduction: Muscle influences bone formation and vice versa. Tests of physical capability and level of physical activity reflect various muscle qualities. We assessed the associations between total hip aBMD and physical activity as well as a range of standardized physical capability tests in an adult general population. Methods: A total of 3 533 women and men aged 40-84 years, participating in the population-based cross-sectional Tromsø study in Norway in 2015-2016, were included. Linear regression was used to assess associations between aBMD and physical activity and the physical capability tests grip strength, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), and standing balance. Non-linear associations were examined in cubic spline models. Standardized regression coefficients were calculated to compare effect sizes across physical capability measures. Results: In fully adjusted models, higher physical activity was positively associated with total hip aBMD in both sexes compared to a sedentary lifestyle. All tests of physical capability were associated with aBMD in women, SPPB showing the strongest association although effect sizes were too small to indicate clinically significant differences (1 point increase corresponded to an aBMD increase of 0.009 g/cm2, CI = 0.005 to 0.012). In men, SPPB and its subtests were associated with aBMD with chair rises showing the strongest association (1 s increase in execution time corresponded to an aBMD decrease of 0.005 g/cm2, CI = 0.008 to 0.002). Conclusion: Physical activity was associated with aBMD, and tests of physical capability can account for some of the aBMD variations in adults aged 40 years and older, especially in women