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Osteoporosis International

, Volume 29, Issue 11, pp 2447–2456 | Cite as

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

  • A. V. HaugerEmail author
  • A. Bergland
  • K. Holvik
  • A. Ståhle
  • N. Emaus
  • B. H. Strand
Original Article

Abstract

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.

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.

Keywords

Bone mineral density Grip strength Hip fracture Mortality Osteoporosis Osteopenia 

Notes

Funding

No external funding has been received to finance this project. The manuscript will be part of Annette V. Hauger’s Ph.d thesis and is internally funded by Oslo Metropolitan University.

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
    Cooper C, Cole Z, Holroyd C, Earl S, Harvey N, Dennison E, Melton L, Cummings S, Kanis J (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288CrossRefGoogle Scholar
  2. 2.
    Cauley JA (2013) Public health impact of osteoporosis. J Gerontol A Biomed Sci Med Sci 68:1243–1251CrossRefGoogle Scholar
  3. 3.
    Pietschmann P, Rauner M, Sipos W, Kerschan-Schindl K (2009) Osteoporosis: an age-related and gender-specific disease–a mini-review. Gerontology 55:3–12CrossRefGoogle Scholar
  4. 4.
    Omsland TK, Emaus N, Tell GS, Magnus JH, Ahmed LA, Holvik K, Center J, Forsmo S, Gjesdal CG, Schei B (2014) Mortality following the first hip fracture in Norwegian women and men (1999–2008). A NOREPOS study. Bone 63:81–86CrossRefGoogle Scholar
  5. 5.
    Bor A, Matuz M, Gyimesi N, Biczók Z, Soós G, Doró P (2015) Gender inequalities in the treatment of osteoporosis. Maturitas 80:162–169CrossRefGoogle Scholar
  6. 6.
    Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int 4:368–381CrossRefGoogle Scholar
  7. 7.
    Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRefGoogle Scholar
  8. 8.
    Kanis J, Johnell O, Oden A, Sernbo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 11:669–674CrossRefGoogle Scholar
  9. 9.
    Omsland T, Magnus J (2014) Forecasting the burden of future postmenopausal hip fractures. Osteoporos Int 25:2493–2496CrossRefGoogle Scholar
  10. 10.
    Qu X, Huang X, Jin F, Wang H, Hao Y, Tang T, Dai K (2013) Bone mineral density and all-cause, cardiovascular and stroke mortality: a meta-analysis of prospective cohort studies. Int J Cardiol 166:385–393CrossRefGoogle Scholar
  11. 11.
    Lenchik L, Register TC, Hsu F-C, Xu J, Smith SC, Carr JJ, Freedman BI, Bowden DW (2017) Bone mineral density of the radius predicts all-cause mortality in patients with type 2 diabetes: diabetes heart study. J Clin DensitomGoogle Scholar
  12. 12.
    Fry PS, Debats DL (2006) Sources of life strengths as predictors of late-life mortality and survivorship. Int J Aging Hum Dev 62:303–334CrossRefGoogle Scholar
  13. 13.
    Frith PA (2005) Impact of smoking, diabetes and hypertension on survival in the elderly: the Dubbo study. Med J Aust 182:495PubMedGoogle Scholar
  14. 14.
    Brown DC, Hayward MD, Montez JK, Hummer RA, Chiu C-T, Hidajat MM (2012) The significance of education for mortality compression in the United States. Demography 49:819–840CrossRefGoogle Scholar
  15. 15.
    Wong PK, Christie JJ, Wark JD (2007) The effects of smoking on bone health. Clin Sci 113:233–241CrossRefGoogle Scholar
  16. 16.
    Loprinzi PD, Addoh O (2017) Accelerometer-determined physical activity and all-cause mortality in a National Prospective Cohort Study of Adults Post-Acute Stroke. Am J Health Promot 0890117117720061Google Scholar
  17. 17.
    Zahra A, Lee E-W, L-y S, Park J-H (2015) Cardiovascular disease and diabetes mortality, and their relation to socio-economical, environmental, and health behavioural factors in worldwide view. Public Health 129:385–395CrossRefGoogle Scholar
  18. 18.
    Ebmeier S, Thayabaran D, Braithwaite I, Bénamara C, Weatherall M, Beasley R (2017) Trends in international asthma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993–2012). Lancet 390:935–945CrossRefGoogle Scholar
  19. 19.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel J-P, Rolland Y, Schneider SM (2010) Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423CrossRefGoogle Scholar
  20. 20.
    Strand BH, Cooper R, Bergland A, Jørgensen L, Schirmer H, Skirbekk V, Emaus N (2016) The association of grip strength from midlife onwards with all-cause and cause-specific mortality over 17 years of follow-up in the Tromsø Study. J Epidemiol Community Health 70:1214–1221CrossRefGoogle Scholar
  21. 21.
    Sayer AA, Syddall HE, Martin HJ, Dennison EM, Anderson FH, Cooper C (2006) Falls, sarcopenia, and growth in early life: findings from the Hertfordshire cohort study. Am J Epidemiol 164:665–671CrossRefGoogle Scholar
  22. 22.
    Syddall HE, Martin HJ, Harwood RH, Cooper C, Sayer AA (2009) The SF-36: a simple, effective measure of mobility-disability for epidemiological studies. JNHA J Nutr Health Aging 13:57–62CrossRefGoogle Scholar
  23. 23.
    Rantanen T, Masaki K, He Q, Ross GW, Willcox BJ, White L (2012) Midlife muscle strength and human longevity up to age 100 years: a 44-year prospective study among a decedent cohort. Age 34:563–570CrossRefGoogle Scholar
  24. 24.
    Leboime A, Confavreux CB, Mehsen N, Paccou J, David C, Roux C (2010) Osteoporosis and mortality. Joint Bone Spine 77:S107–S112CrossRefGoogle Scholar
  25. 25.
    Barrett-Connor E, Sajjan S, Siris E, Miller P, Chen Y-T, Markson L (2008) Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 19:607–613CrossRefGoogle Scholar
  26. 26.
    Ahmed LA, Center JR, Bjørnerem Å, Bluic D, Joakimsen RM, Jørgensen L, Meyer HE, Nguyen ND, Nguyen TV, Omsland TK (2013) Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Tromsø study. J Bone Miner Res 28:2214–2221CrossRefGoogle Scholar
  27. 27.
    Abdelmohsen AM (2017) Comparison of central and peripheral bone mineral density measurements in postmenopausal women. J Chiropr Med 16:199–203CrossRefGoogle Scholar
  28. 28.
    Eftekhar-Sadat B, Ghavami M, Toopchizadeh V, Ghahvechi Akbari M (2016) Wrist bone mineral density utility in diagnosing hip osteoporosis in postmenopausal women. Ther Adv Endocrinol Metab 7:207–211CrossRefGoogle Scholar
  29. 29.
    Grey A, Bolland M (2013) The effect of treatments for osteoporosis on mortality. Osteoporosis International 1-6Google Scholar
  30. 30.
    Miyake H, Kanazawa I, Sugimoto T (2018) Association of bone mineral density, bone turnover markers, and vertebral fractures with all-cause mortality in type 2 diabetes mellitus. Calcif Tissue Int 102:1–13CrossRefGoogle Scholar
  31. 31.
    Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njølstad I (2011) Cohort profile: the Tromsø Study. Int J Epidemiol 41:961–967CrossRefGoogle Scholar
  32. 32.
    Berntsen GKR, Fønnebø V, Tollan A, Søgaard AJ, Magnus JH (2001) Forearm bone mineral density by age in 7,620 men and women the Tromsø Study, a population-based study. Am J Epidemiol 153Google Scholar
  33. 33.
    Berntsen GKR, Fønnebø V, Tollan A, Søgaard AJ, Joakimsen RM, Magnus JH (2000) The Tromsø Study: determinants of precision in bone densitometry. J Clin Epidemiol 53:1104–1112CrossRefGoogle Scholar
  34. 34.
    Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay M (2008) A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act 5:56CrossRefGoogle Scholar
  35. 35.
    Gorber SC, Tremblay M, Moher D, Gorber B (2007) A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev 8:307–326CrossRefGoogle Scholar
  36. 36.
    Hassan E (2006) Recall bias can be a threat to retrospective and prospective research designs. Internet J Epidemiol 3:339–412Google Scholar
  37. 37.
    Van de Mortel TF (2008) Faking it: social desirability response bias in self-report research. Aust J Adv Nurs 25:40Google Scholar
  38. 38.
    Norwegian Cause of Death Registry (2017) Dødsårsakregisteret - Statistikkbank. Norwegian Institute of Public Health http://statistikkbank.fhi.no/dar/. Accessed 28 June 2018
  39. 39.
    Marcovitz PA, Tran HH, Franklin BA, O’Neill WW, Yerkey M, Boura J, Kleerekoper M, Dickinson CZ (2005) Usefulness of bone mineral density to predict significant coronary artery disease. Am J Cardiol 96:1059–1063CrossRefGoogle Scholar
  40. 40.
    von der Recke P, Hansen MA, Hassager C (1999) The association between low bone mass at the menopause and cardiovascular mortality. Am J Med 106:273–278CrossRefGoogle Scholar
  41. 41.
    McClung MR (2005) Osteopenia: to treat or not to treat? Ann Intern Med 142:796–797CrossRefGoogle Scholar
  42. 42.
    Seeman E (2004) Treatment of osteoporosis-why, whom, when and how to treat. Indian J Endocrinol Metab 6:60Google Scholar
  43. 43.
    Järvinen TL, Sievänen H, Khan KM, Heinonen A, Kannus P (2008) Shifting the focus in fracture prevention from osteoporosis to falls. Bmj 336:124–126CrossRefGoogle Scholar
  44. 44.
    Devold H, Søgaard A, Tverdal A, Falch J, Furu K, Meyer H (2013) Hip fracture and other predictors of anti-osteoporosis drug use in Norway. Osteoporos Int 24:1225–1233CrossRefGoogle Scholar
  45. 45.
    Schousboe JT, Ensrud KE, Nyman JA, Melton LJ, Kane RL (2005) Universal bone densitometry screening combined with alendronate therapy for those diagnosed with osteoporosis is highly cost-effective for elderly women. J Am Geriatr Soc 53:1697–1704CrossRefGoogle Scholar
  46. 46.
    Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR, Group SoOFR (1992) Risk factors for fractures of the distal forearm and proximal humerus. Am J Epidemiol 135:477–489Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  1. 1.Department of Physiotherapy, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
  2. 2.Norwegian Institute of Public HealthOsloNorway
  3. 3.Department of Neurobiology, Care Sciences and Society, Division of PhysiotherapyKarolinska InstitutetHuddingeSweden
  4. 4.Function Area Occupational Therapy & Physiotherapy, Allied Health Professionals FunctionKarolinska University HospitalStockholmSweden
  5. 5.Department of Health and Care Sciences, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
  6. 6.Norwegian National Advisory Unit on Aging and HealthVestfold Hospital TrustTønsbergNorway
  7. 7.Faculty of MedicineUniversity of OsloOsloNorway

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