Risk factors for fractures - a link between metabolic bone disease and cardiovascular disease

Introduction: Fractures and cardiovascular disease (CVD) are a burden to society, as they result in high morbidity and mortality in both men and women. Aim: The aim was to study prospectively modifiable risk factors for fractures in the general population and to possibly identify a link between metabolic bone disease and CVD. Methods: Three population-based cohorts of both men and women were studied, with a follow-up time ranging from 13 to 30 years. Two methods of bone assessment, Quantitative Ultrasound (QUS) and Dual energy X-ray Absorptiometry (DXA), were compared during 7 years. Lifestyle factors, serum hormones and lipids, QUS and pharmacological treatment were studied in relation to future fractures, which were X-ray verified. Results: A 30-year follow-up study of 7495 men, aged 46-56 years at baseline, showed that a high degree of physical activity during leisure time but not at work, high occupational class and high body mass index (BMI) were protective against hip fractures; whereas smoking, tall stature, age, interim stroke and dementia increased the risk. A 20-year follow-up of 1396 men and women, aged 25-64 at baseline, showed that previous fracture, smoking, coffee consumption and lower BMI each increased the risk of fracture, independently of age and sex. The gradient of risk for serum total cholesterol to predict fracture increased over time. A 13-year follow-up of 1616 men and women, aged 25-64 at baseline, showed that stroke, high age, female sex and physical inactivity during leisure time predicted fracture independently of other factors. Low QUS and use of tranquilizers predicted fracture in both genders. QUS correlated well with DXA. Secular trends were seen when men and women aged 35-64 in 1995 were compared with subjects of similar age in 2008, i.e., 13 years apart. The fracture incidence increased, with a higher proportion of vertebral fractures among postmenopausal women in 2008. Lower HRT use, lower serum oestradiol, and greater fall risk exposure due to more physical activity during leisure time in 2008, may explain the results. Serum total and free testosterone were lower in men in 2008 but the fracture incidence was unchanged. Serum total cholesterol and triglycerides were lower in men and women in 2008 compared with subjects of similar age in 1995. Conclusions: Physical inactivity, smoking, high cholesterol and stroke were independent modifiable risk factors of fracture, indicative of a link between metabolic bone disease and CVD. Secular trends were seen in sex hormones and blood lipids in both genders, and in women, secular trends were also seen with regard to fracture type and incidence. Keywords: Risk factors, general population, physical activity, sex hormones, cholesterol, stroke, fracture. ISBN: 978-91-628-8350-8 http:// hdl.handle.net/2077/25492 Göteborg 2011 [email protected]

Pituitary dysfunction in granulomatosis with polyangiitis

Purpose: Granulomatosis with polyangiitis (GPA) is a multisystem disease, characterized by necrotizing small-vessel vasculitis, which mainly affects the respiratory tract and the kidneys. Pituitary involvement in GPA is rare, present in about 1% of all cases of GPA. To date, only case reports or small case series have been published. Herein we report clinical features, imaging findings, treatment and outcomes in three patients with GPA-related pituitary dysfunction (PD). Methods: A retrospective analysis of three cases of GPA-related PD was conducted, followed by systematic review of the English medical literature using PubMed. Results: The three cases include three women aged between 32 and 37 years. PD was the presenting feature in one and two developed PD in the course of the disease. All patients had a pituitary lesion on MRI. Conventional treatment with high doses of glucocorticoids and cyclophosphamide led to resolution or improvement of the MRI abnormalities, whereas it was not effective in restoring PD. A systematic review identified 51 additional patients, showing that GPA can lead to partial or global PD, either at onset or, during the course of the disease. Secondary hypogonadism is the predominant manifestation, followed by diabetes insipidus (DI). Sellar mass with central cystic lesion is the most frequent radiological finding. Conclusion: GPA should be carefully considered in patients with a sellar mass and unusual clinical presentation with DI and systemic disease. Although conventional induction-remission treatment improves systemic symptoms and radiological pituitary abnormalities, hormonal deficiencies persist in most of the patients. Therefore, follow-up should include both imaging and pituitary function assessment

High serum total cholesterol is a long-term cause of osteoporotic fracture.

Risk factors for osteoporotic fractures were evaluated in 1,396 men and women for a period of 20 years. Serum total cholesterol was found to be an independent osteoporotic fracture risk factor whose predictive power improves with time. The purpose of this study was to evaluate long-term risk factors for osteoporotic fracture. A population random sample of men and women aged 25-64 years (the Gothenburg WHO MONICA project, N = 1,396, 53% women) was studied prospectively. The 1985 baseline examination recorded physical activity at work and during leisure time, psychological stress, smoking habits, coffee consumption, BMI, waist/hip ratio, blood pressure, total, HDL and LDL cholesterol, triglycerides, and fibrinogen. Osteoporotic fractures over a period of 20 years were retrieved from the Gothenburg hospital registers. Poisson regression was used to analyze the predictive power for osteoporotic fracture of each risk factor. A total number of 258 osteoporotic fractures occurred in 143 participants (10.2%). As expected, we found that previous fracture, smoking, coffee consumption, and lower BMI each increase the risk for osteoporotic fracture independently of age and sex. More unexpectedly, we found that the gradient of risk of serum total cholesterol to predict osteoporotic fracture significantly increases over time (p = 0.0377). Serum total cholesterol is an independent osteoporotic fracture risk factor whose predictive power improves with time. High serum total cholesterol is a long-term cause of osteoporotic fracture

Male risk factors for hip fracture-a 30-year follow-up study in 7,495 men.

Risk factors for hip fracture were studied in 7,495 randomly selected men during 30 years; 451 men had a hip fracture. High degree of leisure-time, but not work-related, physical activity, high occupational class, and high body mass index (BMI) protected against hip fracture. Smoking, tall stature, interim stroke, and dementia increased the risk. PURPOSE: The purpose was to prospectively study risk factors for hip fracture in men. METHODS: We studied midlife determinants of future hip fractures in 7,495 randomly selected men aged 46-56 years in Gothenburg, Sweden. The subjects were investigated in 1970-1973 and followed for over 30 years. Questionnaires were used regarding lifestyle factors, psychological stress, occupational class, and previous myocardial infarction, stroke, and diabetes mellitus. Alcohol problems were assessed with the aid of registers. Using the Swedish hospital discharge register, data were collected on intercurrent stroke and dementia diagnoses and on first hip fractures (X-ray-verified). RESULTS: Four hundred fifty-one men (6%) had a hip fracture. Age, tall stature, low occupational class, tobacco smoking, alcoholic intemperance, and interim stroke or dementia were independently associated with the risk of hip fracture. There were inverse associations with leisure-time physical activity, BMI, and coffee consumption. The gradient of risk for one standard deviation of multivariable risk decreased with time since measurement yet was a good alternative to dual energy X-ray absorptiometry measurements. CONCLUSIONS: High degree of leisure-time physical activity, high occupational class, and high BMI protected against hip fracture. However, work-related physical activity was not protective. Smoking, tall stature, and interim stroke or dementia increased the risk

High serum total cholesterol is a long-term cause of osteoporotic fracture.

Risk factors for osteoporotic fractures were evaluated in 1,396 men and women for a period of 20 years. Serum total cholesterol was found to be an independent osteoporotic fracture risk factor whose predictive power improves with time. The purpose of this study was to evaluate long-term risk factors for osteoporotic fracture. A population random sample of men and women aged 25-64 years (the Gothenburg WHO MONICA project, N = 1,396, 53% women) was studied prospectively. The 1985 baseline examination recorded physical activity at work and during leisure time, psychological stress, smoking habits, coffee consumption, BMI, waist/hip ratio, blood pressure, total, HDL and LDL cholesterol, triglycerides, and fibrinogen. Osteoporotic fractures over a period of 20 years were retrieved from the Gothenburg hospital registers. Poisson regression was used to analyze the predictive power for osteoporotic fracture of each risk factor. A total number of 258 osteoporotic fractures occurred in 143 participants (10.2%). As expected, we found that previous fracture, smoking, coffee consumption, and lower BMI each increase the risk for osteoporotic fracture independently of age and sex. More unexpectedly, we found that the gradient of risk of serum total cholesterol to predict osteoporotic fracture significantly increases over time (p = 0.0377). Serum total cholesterol is an independent osteoporotic fracture risk factor whose predictive power improves with time. High serum total cholesterol is a long-term cause of osteoporotic fracture

Anthropometric and social background data, degree of physical activity, number of medications and data on those who used at least one prescription drug in people with obesity (BASUN) and the reference population from the WHO-MONICA study, Gothenburg, Sweden.

Anthropometric and social background data, degree of physical activity, number of medications and data on those who used at least one prescription drug in people with obesity (BASUN) and the reference population from the WHO-MONICA study, Gothenburg, Sweden.</p

Number of subjects with missing data for each studied variable.

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Results of a multiple linear regression for evaluation of association between health-related quality of life indicated by the Rand-36 instrument and BMI category (BASUN population with obesity) for the Mental health and Physical Component Score (PCS) domains.

The model is adjusted for age and number of medication (Meds) and results presented as beta coefficients with 95% confidence intervals.</p