Osteoporosis International

, Volume 22, Issue 5, pp 1411–1418 | Cite as

Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden

  • H. JohanssonEmail author
  • A. Odén
  • J. Kanis
  • E. McCloskey
  • M. Lorentzon
  • Ö. Ljunggren
  • M. K. Karlsson
  • E. Orwoll
  • Å. Tivesten
  • C. Ohlsson
  • D. Mellström
Original Article



We studied the nature of the relationship between bone mineral density (BMD) and the risk of death among elderly men. BMD was associated with mortality risk and was independent of adjustments for other co-morbidities. A piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020). Low BMD was associated with a substantial excess risk of death, whilst a higher than average BMD had little impact on mortality.


Previous studies have demonstrated an association between low BMD and an increased risk of death among men and women. The aim of the present study was to examine the pattern of the risk in men and its relation to co-morbidities.


We studied the nature of the relationship between BMD and death among 3,014 elderly men drawn from the population and recruited to the MrOS study in Sweden. Baseline data included general health questionnaires, life style questionnaires and BMD measured using DXA. Men were followed for up to 6.5 years (average 4.5 years). Poisson regression was used to investigate the relationship between BMD, co-morbidities and the hazard function of death.


During follow-up, 382 men died (all-cause mortality). Low BMD at all measured skeletal sites was associated with increased mortality. In multivariate analyses, the relationship between BMD and mortality was non-linear, and a piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020).


Low BMD is associated with a substantial excess risk of death compared to an average BMD, whereas a higher than average BMD has a more modest effect on mortality. These findings, if confirmed elsewhere, have implications for the constructing of probability-based fracture risk assessment tools.


BMD Co-morbidity Men Mortality MrOS Spline Poisson regression model 


Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • H. Johansson
    • 1
    Email author
  • A. Odén
    • 1
  • J. Kanis
    • 2
  • E. McCloskey
    • 2
  • M. Lorentzon
    • 1
  • Ö. Ljunggren
    • 3
  • M. K. Karlsson
    • 4
    • 5
  • E. Orwoll
    • 6
  • Å. Tivesten
    • 7
  • C. Ohlsson
    • 1
  • D. Mellström
    • 1
  1. 1.Center for Bone Research at the Sahlgrenska Academy, Institute of MedicineUniversity of GothenburgGothenburgSweden
  2. 2.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
  3. 3.Department of Medical SciencesUniversity of UppsalaUppsalaSweden
  4. 4.Clinical and Molecular Osteoporosis Research Unit, Department of Clinical SciencesLund UniversityLundSweden
  5. 5.Department of OrthopaedicsMalmö University HospitalMalmöSweden
  6. 6.Bone and Mineral UnitOregon Health and Sciences UniversityPortlandUSA
  7. 7.Wallenberg Laboratory for Cardiovascular ResearchInstitute of Medicine, University of GothenbergGothenbergSweden

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