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

Osteoporosis International volume 22, pages 1411–1418 (2011)Cite this article

Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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).

Conclusions

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.

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Conflicts of interest

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Author information

Affiliations

  1. Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gibraltargatan 1C, 411 32, Gothenburg, Sweden

    H. Johansson, A. Odén, M. Lorentzon, C. Ohlsson & D. Mellström

  2. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    J. Kanis & E. McCloskey

  3. Department of Medical Sciences, University of Uppsala, Uppsala, Sweden

    Ö. Ljunggren

  4. Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden

    M. K. Karlsson

  5. Department of Orthopaedics, Malmö University Hospital, Malmö, Sweden

    M. K. Karlsson

  6. Bone and Mineral Unit, Oregon Health and Sciences University, Portland, OR, USA

    E. Orwoll

  7. Wallenberg Laboratory for Cardiovascular Research, Institute of Medicine, University of Gothenberg, Gothenberg, Sweden

    Å. Tivesten

Authors
  1. H. Johansson
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  2. A. Odén
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  3. J. Kanis
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  4. E. McCloskey
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  5. M. Lorentzon
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  6. Ö. Ljunggren
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  7. M. K. Karlsson
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  8. E. Orwoll
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  9. Å. Tivesten
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  10. C. Ohlsson
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  11. D. Mellström
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Corresponding author

Correspondence to H. Johansson.

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Johansson, H., Odén, A., Kanis, J. et al. Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden. Osteoporos Int 22, 1411–1418 (2011). https://doi.org/10.1007/s00198-010-1331-1

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  • DOI: https://doi.org/10.1007/s00198-010-1331-1

Keywords

  • BMD
  • Co-morbidity
  • Men
  • Mortality
  • MrOS
  • Spline Poisson regression model