Abstract
Summary
Large regional differences in hip fracture rates within Norway have previously been shown. However, regional differences in hip bone mineral density (BMD) have not yet been assessed. In this study including 10,504 hip scans, there were significant regional differences in BMD. Further studies to address reasons for the regional differences in hip fracture risk are warranted.
Introduction
Bone mineral density (BMD) at the hip is an important determinant of hip fracture. While regional differences in Norwegian hip fracture rates have previously been shown, no comparative studies of hip BMD have been conducted.
Methods
Total hip BMD was measured by DXA in two population-based studies across Norway during 1997–2002. Valid hip scans with in vivo calibration were obtained from 5127 subjects in Tromsø (age 30–89 years) and 5377 subjects in Bergen (age 47–50 and 71–75 years).
Results
Women ≥60 years in Tromsø had 0.052 g/cm2 higher age-adjusted BMD than women in Bergen, whereas BMD among women <60 years was similar in Tromsø and Bergen. Age-adjusted total hip BMD was 0.035 g/cm2 lower in men ≥60 years in Bergen compared with Tromsø, and the corresponding figure for men <60 years was 0.028 g/cm2. While adjustment for body mass index explained some, but not all of the differences, smoking, physical activity, diabetes prevalence, self-perceived health, intake of alcohol and estrogen use did not.
Conclusions
Regional differences in BMD at the hip were found in Norway. Reasons for this and potential impact on hip fracture rates should be explored in further studies.
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Falch JA, Ilebekk A, Slungaard U (1985) Epidemiology of hip fractures in Norway. Acta Orthop Scand 56:12–16
Lofthus CM, Osnes EK, Falch JA et al (2001) Epidemiology of hip fractures in Oslo, Norway. Bone 29:413–418
Finsen VV (2004) Hip fracture incidence in central Norway: a followup study. Clinical orthopaedics and related research:173–178
Bulajic-Kopjar M, Wiik J, Nordhagen R (1998) Regional differences in the incidence of femoral neck fractures in Norway. Tidsskr Nor Laegeforen 118:30–33
Finsen V, Benum P (1987) Changing incidence of hip fractures in rural and urban areas of central Norway. Clin Orthop Relat Res:104–110
Falch JA, Kaastad TS, Bohler G et al (1993) Secular increase and geographical differences in hip fracture incidence in Norway. Bone 14:643–645
Sanders KM, Nicholson GC, Ugoni AM, Seeman E, Pasco JA, Kotowicz MA (2002) Fracture rates lower in rural than urban communities: the Geelong Osteoporosis Study. J Epidemiol Commun Health 56:466–470
Mannius S, Mellstrom D, Oden A, Rundgren A, Zetterberg C (1987) Incidence of hip fracture in western Sweden 1974–1982. Comparison of rural and urban populations. Acta Orthop Scand 58:38–42
Sernbo I, Johnell O, Andersson T (1988) Differences in the incidence of hip fracture. Comparison of an urban and a rural population in southern Sweden. Acta Orthop Scand 59:382–385
Chevalley T, Herrmann FR, Delmi M et al (2002) Evaluation of the age-adjusted incidence of hip fractures between urban and rural areas: the difference is not related to the prevalence of institutions for the elderly. Osteoporos Int 13:113–118
Madhok R, Melton LJ III, Atkinson EJ et al (1993) Urban vs rural increase in hip fracture incidence. Age and sex of 901 cases 1980–89 in Olmsted County, U.S.A. Acta Orthop Scand 64:543–548
Sogaard AJ, Gustad TK, Bjertness E et al (2007) Urban-rural differences in distal forearm fractures: Cohort Norway. Osteoporos Int 18:1063–1072
Sanders KM, Nicholson GC, Ugoni AM et al (2002) Fracture rates lower in rural than urban communities: the Geelong Osteoporosis Study. J Epidemiol Community Health 56:466–470
Jonsson B, Gardsell P, Johnell O et al (1992) Differences in fracture pattern between an urban and a rural population: a comparative population-based study in southern Sweden. Osteoporos Int 2:269–273
Blake GM, Fogelman I (2007) The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J 83:509–517
Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259
Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194
Meyer HE, Berntsen GK, Sogaard AJ et al (2004) Higher bone mineral density in rural compared with urban dwellers: the NOREPOS study. Am J Epidemiol 160:1039–1046
Kolta S, Ravaud P, Fechtenbaum J et al (1999) Accuracy and precision of 62 bone densitometers using a European Spine Phantom. Osteoporos Int 10:14–19
Lunt M, Felsenberg D, Adams J et al (1997) Population-based geographic variations in DXA bone density in Europe: the EVOS Study. European Vertebral Osteoporosis. Osteoporos Int 7:175–189
Shepherd JA, Lu Y, Wilson K et al (2006) Cross-calibration and minimum precision standards for dual-energy X-ray absorptiometry: the 2005 ISCD Official Positions. J Clin Densitom 9:31–36
Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501
The Tromsø Study. University of Tromsø. http://tromsoundersokelsen.no
Gjesdal CG, Aanderud SJ, Haga HJ et al (2004) Femoral and whole-body bone mineral density in middle-aged and older Norwegian men and women: suitability of the reference values. Osteoporos Int 15:525–534
Statistics Norway. http://www.ssb.no
Omsland TK, Emaus N, Gjesdal CG et al (2008) In Vivo and In Vitro Comparison of Densitometers in the NOREPOS Study. J Clin Densitom 11:276–282
Naess O, Sogaard AJ, Arnesen E et al (2007) Cohort Profile: Cohort of Norway (CONOR). Int J Epidemiol
Binkley N, Kiebzak GM, Lewiecki EM et al (2005) Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res 20:195–201
Wasmuth HH, Reikeras O, Roald HE (1992) Hip fractures in Troms and Oslo in 1989. Risk development 1978–89. Tidsskr Nor Laegeforen 112:190–193
Hove LM, Fjeldsgaard K, Reitan R et al (1995) Fractures of the distal radius in a Norwegian city. Scand J Plast Reconstr Surg Hand Surg 29:263–267
Falch JA (1983) Epidemiology of fractures of the distal forearm in Oslo, Norway. Acta Orthop Scand 54:291–295
Compston JE (1995) Bone density: BMC, BMD, or corrected BMD? Bone 16:5–7
Berntsen GK, Fonnebo V, Tollan A et al (2001) Forearm bone mineral density by age in 7,620 men and women: the Tromso study, a population-based study. Am J Epidemiol 153:465–473
Brustad M, Alsaker E, Engelsen O et al (2004) Vitamin D status of middle-aged women at 65–71 degrees N in relation to dietary intake and exposure to ultraviolet radiation. Pub Health Nutr 7:327–335
Acknowledgments
This study was supported by a grant from the Research Council of Norway and the Norwegian Osteoporosis Foundation.
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The NOREPOS Core Research Group: Nina Emaus, Guri Grimnes (Tromsø), Haakon E. Meyer, Anne Johanne Søgaard (Oslo), Berit Schei, Siri Forsmo (Nord-Trøndelag), and Grethe S. Tell, Clara Gram Gjesdal (Bergen).
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Omsland, T.K., Gjesdal, C.G., Emaus, N. et al. Regional differences in hip bone mineral density levels in Norway: the NOREPOS study. Osteoporos Int 20, 631–638 (2009). https://doi.org/10.1007/s00198-008-0699-7
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DOI: https://doi.org/10.1007/s00198-008-0699-7