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  • 1.
    Cedergren, Marie
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Selbing, Anders
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Källen, Bengt A. J.
    Tornblad Institute, University of Lund, Lund, Sweden.
    Chlorination Byproducts and Nitrate in Drinking Water and Risk for Congenital Cardiac Defects2002In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 89, no 2, p. 124-130Article in journal (Refereed)
    Abstract [en]

    Drinking water disinfection byproducts have been associated with an increased risk for congenital defects including cardiac defects. Using Swedish health registers linked to information on municipal drinking water composition, individual data on drinking water characteristics were obtained for 58,669 women. Among the infants born, 753 had a cardiac defect. The risk for a cardiac defect was determined for ground water versus surface water, for different chlorination procedures, and for trihalomethane and nitrate concentrations. Ground water was associated with an increased risk for cardiac defect when crude rates were analyzed but after suitable adjustments this excess rate was found to be determined by chlorination procedures including chlorine dioxide. Chlorine dioxide appears itself as an independent risk factor for cardiac defects (adjusted odds ratio 1.61 (95%CI 1.00–2.59)). The risk for cardiac defects increased with increasing trihalomethane concentrations (P=0.0005). There was an indicated but statistically nonsignificant excess risk associated with nitrate concentration. The individual risk for congenital cardiac defect caused by chlorine dioxide and trihalomethanes is small but as a large population is exposed to public drinking water, the attributable risk for cardiac defects may not be negligible.

  • 2.
    Grahn Kronhed, Ann-Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Blomberg, Carina
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, Borås, Sweden.
    Impact of a community-based osteoporosis and fall prevention program on fracture incidence2005In: Osteoporosis international, ISSN 0937-941X, Vol. 16, no 6, p. 700-706Article in journal (Refereed)
    Abstract [en]

    Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Östergötland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.

  • 3.
    Grahn Kronhed, Ann-Charlotte
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Blomberg, Carina
    Löfman, Owe
    Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, Borås, Sweden.
    Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly.: a quasi-experimental study of behavioural modifications2006In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 18, no 3, p. 235-241Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Osteoporosis and fall fractures are increasing problems amongst the elderly. The aim of this study was to explore whether combined population-based and individual interventions directed at risk factors for osteoporosis and falls result in behavioral changes in an elderly population.

    METHODS: A quasi-experimental design was used for the study. Persons aged >or=65 years were randomly selected in the intervention and control community. An intervention program was managed from the primary health care center and delivered to the community. Health education was designed to increase awareness of risk factors for the development of osteoporosis and falling. Questionnaires about lifestyle, health, previous fractures, safety behavior and physical activity level were distributed at baseline in 1989 and at the follow-ups in 1992 and 1994 in both communities.

    RESULTS: There was a difference of 17.7% between the dual intervention (receiving both population-based and individual interventions) and the control samples regarding the self-reported use of shoe/cane spikes, and a difference of 20.5% regarding the reported "moderate level" of physical activity in 1994. There was an increase in the number of participants in the dual intervention sample who, at baseline, had not reported equipping their homes with non-slip mats and removing loose rugs but who did report these changes in 1994. The increase in the reported use of shoe/cane spikes in the dual intervention sample was observed mainly for the period 1992-1994.

    CONCLUSIONS: A public health intervention model, including both population-based and individual interventions, can contribute to behavioral changes in the prevention of falls and changed physical activity patterns amongst elderly people.

  • 4.
    Grahn Kronhed, Ann-Charlotte
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Knutsson, Inger
    Primary Health Care Laboratory, Vadstena, Sweden.
    Löfman, Ove
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Research and Development Unit, Primary Health Care, BorÅs, Sweden.
    Is calcaneal stiffness more sensitive to physical activity than forearm bone mineral density?: A population-based study of persons aged 20-79 years2004In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 32, no 5, p. 333-339Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to investigate the associations between forearm bone mineral density (BMD), calcaneal stiffness, and physical activity levels in a normal population using different non-invasive methods.

    Methods: The participants were invited to undergo bone measurements using single photon absorptiometry of the forearm and quantitative ultrasound (QUS) of the calcaneal bone, and also to complete a questionnaire. Physical activity levels were designated low, moderate, and high in the question on leisure-time activity.

    Results: There were 956 participants included in the present study. Forearm BMD in the eighth age decade was 0.40 g/cm2 (95% CI 0.33 - 0.46 g/cm2) lower than in the third decade among women and 0.28 g/cm2 (95% CI 0.18 - 0.37 g/cm2) lower among men. The differences in calcaneal stiffness between the same age decades were 22.4 (95% CI 17.5 - 27.4) among women and 15.8 (95% CI 8.0 - 23.5) among men. The correlation between forearm BMD and calcaneal stiffness was 0.58 (95% CI 0.52 - 0.64) in women and 0.34 (95% CI 0.25 - 0.42) in men. Reported moderate and high leisure-time activity levels in both genders were associated with higher calcaneal stiffness but not with forearm BMD.

    Conclusions: The QUS may be used to measure the effect of present physical activity levels on calcaneal bone at the population level. Further longitudinal studies are warranted in order to determine the most appropriate non-invasive method in population-based studies.

  • 5.
    Hallberg, Inger
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Rosenqvist, A. M
    Department of Geriatrics, Ryhovs Hospital, Jönköping, Sweden.
    Kartous, L
    Department of Geriatrics, Ryhovs Hospital, Jönköping, Sweden.
    Löfman, Owe
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Wahlström, Ola
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Toss, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Health-related quality of life after osteoporotic fractures2004In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 15, no 10, p. 834-841Article in journal (Refereed)
    Abstract [en]

    Objective: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. Methods: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55-75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. Results: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score < - 2.5 in hip or spine) had lower HRQOL than those with normal BMD. Conclusion: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.

  • 6.
    Holmberg, Håkan
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Varenhorst, Eberhard
    Department of Surgery and Urology, County Hospital, Norrköping, Sweden.
    Economic evaluation of screening for prostate cancer: a randomized populaionbased programme during a 10 year period in Sweden1998In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 45, no 2, p. 133-147Article in journal (Refereed)
    Abstract [en]

    Prostate cancer is a growing health problem representing considerable costs. Screening and early curative treatment may reduce morbidity and possibly prevent future escalating costs. However, population screening programmes are generally not well accepted at present due to uncerainty about whether screening for prostate cancer can result in reduced mortality. Evidence from large, randomized, controlled trials is still lacking. The objective of this study was to calculate clinical and economic consequences of general prostate cancer screening based on a limited screening trial in a Swedish community and a decision-tree model. A random selection of 1492 men (50–69 years) were invited to repeated screening in 1987. They have been examined every third year (four rounds). The other 7679 men in the population act as controls. The results show that the total incremental health care costs for prostate cacer will increase by 179 million SEK per year with screening compared to no-screening. The number of detected cases of localized cancer will increase by about 1000, which represents an additional cost of about 158 000 SEK per case. In conclusion, general screening for prostate cancer can be performed with a reasonable cost per detected localized cancer. Information on the long-term effect on life quality and cancer mortality is unknown.

  • 7.
    Holmqvist, Britt-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Institute of Mathematical Science and Technology, The Norwegian University of Life Sciences, Aas, Norway.
    Samuelsson, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    A low incidence of Type 1 diabetes between 1977 and 2001 in south-eastern Sweden in areas with high population density and which are more deprived2008In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 3, p. 255-260Article in journal (Refereed)
    Abstract [en]

    Aims  To explore how socioeconomic factors and population density may contribute to the geographical variation of incidence of Type 1 diabetes in children in south-eastern Sweden.

    Method  All children diagnosed with Type 1 diabetes in south-eastern Sweden during 1977–2001 were defined geographically to their place of residence and were allocated x and y coordinates in the national grid. The population at risk and socioeconomic data were aggregated in 82 000 200-m squares and geocoded likewise. A socioeconomic index was calculated using a signed χ2 method. Rural–urban gradients were defined by overlay analysis in a geographic information system.

    Results  The incidence during the past 25 years has been rising steadily, particularly in the last 6 years. The incidence was highest in areas with a high proportion of small families, of families with a high family income and better education, and this was found both at the time of diagnosis and at the time of birth. In the rural–urban analysis, the lowest incidence was found in the urban area with > 20 000 inhabitants, where there was also a higher frequency of deprivation.

    Conclusions  Our findings indicate that geographical variations in incidence rates of Type 1 diabetes in children are associated with socioeconomic factors and population density, although other contributing factors remain to be explained.

  • 8.
    Kohli, Sunil
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Sahlén, K.
    Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Linköping University, Faculty of Health Sciences.
    Sivertun, Åke
    Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Trell, Erik
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Wigertz, Ove
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Individuals living in areas with high background radon: a GIS method to identify populations at risk1997In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 53, no 2, p. 105-112Article in journal (Refereed)
    Abstract [en]

    Objective: to identify and link populations and individuals that live within high risk areas. Design: census registers and disease registers which contain data on individuals can only give aggregate statistics relating to postal code districts, town, county or state boundaries. However environmental risk factors rarely, if ever, respect these man-made boundaries. What is needed is a method to rapidly identify individuals who may live within a described area or region and to further identify the disease(s) occurring among these individuals and/or in these areas. Method: this paper describes a method for linking the standard registers available in Sweden, notably the residence-property addresses they contain and the geographical coordinate setting of these, to map the population as a point coverage. Using standard GIS methods this coverage could be linked, merged or intersected with any other map to create new subsets of population. Representation of populations down to the individual level by automatised spatialisation of available census data is in its simplicity a new informatics method which in the designated GIS medium adds a new power of resolution. Results: we demonstrate this using the radon maps provided by the local communes. The Swedish annual population registration records of 1991 for the county ofÖstergötland and the property register available at the Central Statistical Bureau of Sweden formed the main data sources. By coupling the address in the population register to the property register each individual was mapped to the centroid of a property. By intersecting the population coverage with the radon maps, the population living in high, normal or low risk areas was identified and then analysed and stratified by commune, sex and age. The resulting tables can be linked to other databases, e.g. disease registers, to visualise and analyse geographical and related patterns. The methodology can be adapted for use with any other environmental map or small area. It can also be expanded to the fourth dimension by linking likewise available migration information to generate immediately coordinate-set, accumulated exposition and similar data.

  • 9.
    Kohli, Sunil
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Sahlén, K.
    Sivertun, Åke
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Löfman, Owe
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Trell, Erik
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Wigertz, Ove
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Distance from the primary health center: a GIS method to study geographical access to health care1995In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 19, no 6, p. 425-436Article in journal (Refereed)
    Abstract [en]

    Aerial distance from the dependent Primary Health Center is a crude but objective measure of geographical accessibility to Primary Health care facilities. This report describes a method for calculation of distances between the PHC and the population it serves using the data available from the local health authorities and the Swedish Central Statistical Bureau. The Swedish annual population registration records of 1991 and the property register available with the Central Statistical Bureau of Sweden formed the main data sources. By coupling the address in the population register to the property register each individual was mapped to the centroid of a property. The location of the PHCs as well as the areas covered by each were obtained from the local health authorities and mapped. By intersecting the population coverage with the PHC coverage the population for each PHC area was identified. Subsequently the distance to the PHC was calculated for each individual (property centroid). The population maps so generated can be linked to other databases to visualize and analyze the spatial dimension of health and disease. The methodology can be adapted for use with postal code districts, census enumeration tracts, or any other small area.

  • 10.
    Löfman, Owe
    Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
    Osteoporosis in women: Epidemiological and diagnostic perspectives2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    An epidemiological study of 15.462 hip fractures in Östergötland 1940-86 showed a large incidence increase mainly due to an increase in age-specific incidence of trochanteric fractures. A trendforecast assuming the same increase in incidence as over the study period and a population forecast according to the official prognosis, predicted 70% more hip fractures in the year 2000 compared to 1985. The different forecasts models were validated for the year 1995 and showed a good correlation between estimated and observed number of fractures, but varied dependent on which fracture and prognosis model that were evaluated.

    A follow-up investigation of 11.517 hip fractures 1982-96 showed a downturn in incidence of female fractures and a continous increase for males, particularly of trochanteric fractures. A trend brake was thus seen and this continues up to 2010 according to our trendforecasts but may be counteracted by the increasing number of elderly after 2020. Gender ratio changed over time with increasing number of male fractures, more trochanteric fractures relative to cervical (c/t-ratio) and an increasing mean age of the fracture patient.

    Age specific reference values were established for bone mineral density (BMD) in forearm, lumbar spine and hip after investigation of 429 women 20-80 years, randomly sampled from the general population. Bone density was assessed from cross-sectional data for the various skeletal sites over an almost complete adult life period and these were then compared to values obtained from other studies, densitometry technologies and reference materials. Large discordances were found between the different technologies and reference materials.

    The outcome of using the T-score proposed by a WHO study group 1994 as a diagnostic cutoff principle for the diagnosis of osteoporosis (T<-2.5) and osteopenia (T<-1 - -2.5) was evaluated by calculating the resulting prevalence in a cohort of 210 women, 70 years of age. The use of different approaches in calculation of T -score and different reference samples, yielded unacceptable disparities in disease prevalence of between 9 and 72%. The differences were also heavely dependent of which and how many sites that were included in the diagnostic decision.

    We studied biochemical markers of bone turnover (alkaline phosphatase, osteocalcin, hydroxyproline and calcium excretion in the urine) in relation to age, menopause and BMD, and their ability to predict bone loss in a 5-year follow-up perspective. Markers varied inversely to BMD, increased markedly at menopause and predicted bone loss over the next 5 years up to 75% at individual level, (AUC of an ROC analysis).

    A case. finding strategy using low-energy index fractures in forearm, spine, hip or humerus was performed to detect subjects with osteoporosis. 303 consecutive women 55-75 years with a recent fracture were examined with densitometry and a risk profile questionnaire. The lowest BMD was found in spine and hip fracture patients. Odds ratio for osteoporosis was at least 8 for a patient with a prior hip fracture. The number of previous fractures correlated inversely with bone density (Z-score). Despite 92% of the fracture patients (many with a multiple fracture history) had a low bone mass (t-score<1), only 15% had been treated for osteoporosis before the index fracture.

    List of papers
    1. Increased Hip-Fracture Incidence in the County of Östergötland, Sweden, 1940–1986, with Forecasts up to the Year 2000: An Epidemiological Study
    Open this publication in new window or tab >>Increased Hip-Fracture Incidence in the County of Östergötland, Sweden, 1940–1986, with Forecasts up to the Year 2000: An Epidemiological Study
    Show others...
    1991 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 20, no 4, p. 1018-1024Article in journal (Refereed) Published
    Abstract [en]

    The incidence of hip fractures in the county of Östergōtland in Sweden has increased dramatically from 1940 to 1986, mainly due to an increase in age-specific incidence of trochanteric fractures. The increase is most pronounced in people over 80 but is present even in age groups down to 50 years. If the age-specific incidence rates continue to increase, and the population of the elderly grows in accordance with the forecast, there will be 70% more hip fractures in the year 2000 than in 1985.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81307 (URN)10.1093/ije/20.4.1018 (DOI)
    Available from: 2012-09-11 Created: 2012-09-11 Last updated: 2017-12-07Bibliographically approved
    2. Changes in Hip Fracture Epidemiology: Redistribution Between Ages, Genders and Fracture Types
    Open this publication in new window or tab >>Changes in Hip Fracture Epidemiology: Redistribution Between Ages, Genders and Fracture Types
    2002 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 13, no 1, p. 18-25Article in journal (Refereed) Published
    Abstract [en]

    After several reports of increasing hip fracture incidence some studies have suggested a trend-break. In a previous study of hip fractures we forecast a 70% increase in the total number of fractures from 1985 up to year 2000. We therefore studied the incidence trend for the last 15 years and supply a new prognosis up to year 2010. We recorded all incident hip fractures treated in the county of Östergötland, Sweden (≈ 400 000 inhabitants) 1982–96. A total of 11 517 hip fractures in men and women aged 50 years and above were included in the study after cross-validation between a computerized register of radiologic investigations and the hospital records. The projected number of fractures up to year 2010 was estimated by a Poisson regression model, considering both age and year of fracture in every single year 1982–96 for the respective fracture type and gender, and applied to the projected population. The annual number of hip fractures increased by 39% in men and 25% in women during the study period. Amongst men, the age-adjusted incidence of cervical fractures increased from 188 to 220/100 000 and of trochanteric fractures from 138 to 170/100 000. In women the incidence of cervical fractures decreased from 462/100 000 to 418/100 000 and of trochanteric fractures from 407/100 000 to 361/100 000. Cervical/trochanteric fracture incidence rate ratio leveled off, and also the female/male fracture rate ratio declined. A prognosis assuming that the incidence development will continue as during 1982–96, and a population in agreement with the forecast, predicts that the total age- and sex-adjusted number of hip fractures will decrease by 11% up to year 2010 compared with 1996. In women and men, however, a decrease of 19% and an increase of 7% respectively were projected. If the age- and sex-specific incidence remains at the same level as at the end of the study period, no significant change in the total numbers will occur. A trend-break was thus found in hip fracture incidence for women but not for men. Whether this is due to therapeutic and/or preventive measures in women is unknown. According to the most probable scenario a substantial increase in male trochanteric fractures (36%) is expected up to 2010, while all other hip fractures in both genders will decrease by 4–32% resulting in a total reduction of 11%.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25209 (URN)10.1007/s198-002-8333-x (DOI)9648 (Local ID)9648 (Archive number)9648 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    3. Bone mineral density in normal Swedish women
    Open this publication in new window or tab >>Bone mineral density in normal Swedish women
    Show others...
    1997 (English)In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 20, no 2, p. 167-174Article in journal (Refereed) Published
    Abstract [en]

    We examined 429 women, aged 20–80 years, randomly selected from the population register to establish normal values for bone mineral density (BMD) in Swedish women. BMD of the spine and hip was measured by dual-energy X-ray absorptiometry (DEXA; Hologic QDR 1000) and in the forearm by single photon absorptiometry (SPA; Molsgaard ND-1100). The recalled age of menarche was negatively correlated to BMD at all ages. There was no significant change in BMD from 20–49 years at any site except a slight decline at Ward's triangle. Bone loss was rapid at all sites during the first decade after menopause. Thereafter, BMD declined slowly in the trochanter and total hip but more rapidly in the forearm, femoral neck, and Ward's triangle. BMD in the spine even increased in the eighth decade probably due to osteoarthritis. The average change in forearm BMD during the 15 perimenopausal years comprising mean age for menopause ± 2 SD (43–57 years) was −0.4% per year in premenopausal females and −1.6% per year in postmenopausal females. The corresponding annual percental change was, for the spine, +0.2 and −1.7; neck, −0.7 and −1.7; trochanter, +0.5 and −1.5; and Ward's triangle, −0.1% and −2.2%, respectively. Our normal values for lumbar spine BMD prior to menopause did not differ from published values or the manufacturer's normal values; however, our spine BMD values for the first decade after menopause were significantly lower (≈10%) than in other studies. Our femoral neck BMD values for younger women were, like those of several other groups, significantly lower than the manufacturer's normal values, but our sample of young women in this study was small. The prevalence of osteoporosis, if defined as t score < −2.5 is highly dependent on the sampling of the reference population of young adult women, and also on the choice of skeletal site. Further studies on bone mineral density in healthy young adult women are needed.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81309 (URN)10.1016/S8756-3282(96)00345-6 (DOI)
    Available from: 2012-09-11 Created: 2012-09-11 Last updated: 2017-12-07Bibliographically approved
    4. Bone Mineral Density in Diagnosis of Osteoporosis: Reference Population, Definition of Peak Bone Mass, and Measured Site Determine Prevalence
    Open this publication in new window or tab >>Bone Mineral Density in Diagnosis of Osteoporosis: Reference Population, Definition of Peak Bone Mass, and Measured Site Determine Prevalence
    2000 (English)In: Journal of clinical densitometry, ISSN 1094-6950, E-ISSN 1559-0747, Vol. 3, no 2, p. 177-186Article in journal (Refereed) Published
    Abstract [en]

    A population-based study was performed in order to compare different definitions of peak bone mass, and to apply the corresponding T-scores for different skeletal sites to a cohort of 70-yr-old women for studying the prevalence of osteoporosis. Bone mineral density (BMD) of the hip, lumbar spine, and forearm was measured by dual X-ray absorptiometry (Hologic 4500) in 296 women ages 16–31 yr and 210 women age 70 yr. Peak bone mass occurred in women in their early 20s at the proximal femur and at 28 and 31 yr at the spine and forearm, respectively. BMD cutoff levels were compared to machine-specific cutoff values for the different sites. When applied to our cohort of 70-yr-old women, the prevalence of osteoporosis at the total hip was 9–25%, depending on which peak bone mass the T-score of – 2.5 was based. The prevalence in the spine was 28–33% and in the forearm 45–67%. Osteoporosis in at least one of the three measured sites was documented in 49–72% of the population sample. Our results show that the use of T-score to define osteoporosis results in a highly different prevalence rate in a given population depending on the reference population and the skeletal sites chosen for measurement.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25205 (URN)10.1385/JCD:3:2:177 (DOI)9644 (Local ID)9644 (Archive number)9644 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    5. Bone mineral density instead of T-score?
    Open this publication in new window or tab >>Bone mineral density instead of T-score?
    2001 (English)In: Journal of clinical densitometry, ISSN 1094-6950, E-ISSN 1559-0747, Vol. 4, no 1, p. 75-77Article in journal, Letter (Refereed) Published
    Abstract [en]

    No abstract available.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25208 (URN)10.1016/S1094-6950(06)60152-2 (DOI)9647 (Local ID)9647 (Archive number)9647 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    6. Common biochemical markers of bone turnover predict future bone loss: A 5-year follow-up study
    Open this publication in new window or tab >>Common biochemical markers of bone turnover predict future bone loss: A 5-year follow-up study
    2005 (English)In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 356, no 1-2, p. 67-75Article in journal (Refereed) Published
    Abstract [en]

    Background

    Bone mineral density (BMD) is used to follow gain or loss of bone mass but cannot detect changes within a short period of time. Biochemical markers of bone turnover may be of value for prediction of individual bone loss.

    Methods

    We studied the relation between common inexpensive markers of bone turnover (serum alkaline phosphatase (ALP), osteocalcin (OC), urinary hydroxyproline (OHPr), and calcium (Ca)), BMD, age, and menopause in a combined cross-sectional and longitudinal design comprising 429 pre- and postmenopausal randomly selected women aged 21–79 years (mean 50 years). A follow-up was initiated after 5 years (including 192 of these women), which focused on changes in bone mass and the ability of these four common markers of bone turnover (sampled at baseline) to predict future bone loss.

    Results

    A marked increase was observed for all markers at the beginning of menopause. During the postmenopausal period ALP and Ca decreased to near premenopausal levels, while OC and OHPr remained high even 15 years after menopause. We also found inverse correlations at baseline between the bone markers and BMD, independent of the selected marker or skeletal site, r=−0.14 to −0.46, P<0.05. The correlations between ALP, OC, OHPr, and subsequent bone loss over 5 years, was significant for arm, r=−0.23 to −0.36, P<0.01. Baseline levels of all bone markers correlated significantly at group level with the 5-year follow-up of BMD for all sites. The ability of markers to predict individual bone loss was estimated by a multivariate regression model, which included baseline BMD, age, and body mass index as independent variables. ROC analysis showed a validity of approximately 76% for the forearm model, but was lower for the hip (55%) and lumbar spine (65%).

    Conclusions

    These data show that the common inexpensive biochemical markers of bone turnover ALP, OC, OHPr, and Ca were related to the current bone mass and, moreover, provides information about future bone loss at the individual level. Future investigations should include an evaluation of the clinical relevance of markers of bone turnover in relation to fracture risk.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-29375 (URN)10.1016/j.cccn.2004.12.014 (DOI)14707 (Local ID)14707 (Archive number)14707 (OAI)
    Note

    On the day of the defence day the status of this article was a manuscript.

    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
    7. Women with low energy fracture: Case for investigation?
    Open this publication in new window or tab >>Women with low energy fracture: Case for investigation?
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The combined use of bone mineral density, fracture history and other risk markers for fracture is advocated for identifying subjects with high fracture risk. An incident fracture is suggested as an accurate indication for osteoporosis investigation, but there are still insufficient data for grading the priority between ages and types of fractures. We therefore decided to examine a consecutive series of 55-75 year old women with an incident fracture for evaluating a standardized clinical routine program and for studying the covariance between fracture history, bone mineral density and other risk markers.

    Materila and methods: We invited 600 consecutive women 55-75 years old with an incident newly diagnosed fracture in distal radius forearm, proximal humerus, vertebra or hip. External drop-out was 33%. Of the 400 responders 31 had a high-energy trauma, 62 were on treatment against osteoporosis and 4 were living in other counties and were therefore excluded. The remaining 303 subjects entered the study. A questionnaire on previous fractures and risk factors was enclosed with the invitation to the osteoporosis unit. At a single visit a short history was assessed and physical examination performed as well as a few laboratory investigations. Bone mineral density was measured at the hip, lumbar spine and forearm by DXA (Hologic QDR 4500A).

    Results: The fracture spectrum was: distal radius 56.4 %, proximal humerus 12.2%, vertebra 18.2% and hip 13.2%. 49% had had at least one previous fracture, 19% at least two previous and 6.3% three or more previous fractures before the recent one. As few spine X-rays were performed, the true prevalence of vertebral fracture is unknown. Patients with fracture in vertebra or hip had lower BMD and more previous fractures than patients with forearm or humerus fracture. The number of previous fractures was inversely correlated to BMD of the hip and forearm, while BMD of the spine had a biphasic relationship.

    The Odds ratio of having either osteopenia and osteoporosis were >20 for patients with hip fracture and 75 for the spine (mean values), whereas the OR of the forearm fracture group was slightly above 10, table 6. The OR were as expected dependent of cut-off limit used. Mean value for the OR was in the hip fracture group 8.2 and 9.2 for !-score -2.5 and -2.0 respectively at the lower end of the confidence interval. For the spine and the forearm, the corresponding odds ratios were 16-17 and 7-9 respectively.

    Conclussion: Vertebral fracture was the strongest and distal radius the weakest predictor of low BMD. The number of previous fractures is a helpful information for finding the most osteoporotic patients. Only 15 % had been treated for osteoporosis before the index fracture. Osteoporosis investigation therefore seems warranted in every woman 55-75 years old with a recent low-energy fracture in distal radius, proximal humerus, spine or hip, with highest priority to those in spine or hip and those with multiple previous fractures.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81343 (URN)
    Available from: 2012-09-12 Created: 2012-09-12 Last updated: 2012-09-12Bibliographically approved
  • 11.
    Löfman, Owe
    et al.
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Berglund, K.
    Department of Community Medicine, County Council of Uppsala, Uppsala.
    Larsson, Lasse
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Changes in Hip Fracture Epidemiology: Redistribution Between Ages, Genders and Fracture Types2002In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 13, no 1, p. 18-25Article in journal (Refereed)
    Abstract [en]

    After several reports of increasing hip fracture incidence some studies have suggested a trend-break. In a previous study of hip fractures we forecast a 70% increase in the total number of fractures from 1985 up to year 2000. We therefore studied the incidence trend for the last 15 years and supply a new prognosis up to year 2010. We recorded all incident hip fractures treated in the county of Östergötland, Sweden (≈ 400 000 inhabitants) 1982–96. A total of 11 517 hip fractures in men and women aged 50 years and above were included in the study after cross-validation between a computerized register of radiologic investigations and the hospital records. The projected number of fractures up to year 2010 was estimated by a Poisson regression model, considering both age and year of fracture in every single year 1982–96 for the respective fracture type and gender, and applied to the projected population. The annual number of hip fractures increased by 39% in men and 25% in women during the study period. Amongst men, the age-adjusted incidence of cervical fractures increased from 188 to 220/100 000 and of trochanteric fractures from 138 to 170/100 000. In women the incidence of cervical fractures decreased from 462/100 000 to 418/100 000 and of trochanteric fractures from 407/100 000 to 361/100 000. Cervical/trochanteric fracture incidence rate ratio leveled off, and also the female/male fracture rate ratio declined. A prognosis assuming that the incidence development will continue as during 1982–96, and a population in agreement with the forecast, predicts that the total age- and sex-adjusted number of hip fractures will decrease by 11% up to year 2010 compared with 1996. In women and men, however, a decrease of 19% and an increase of 7% respectively were projected. If the age- and sex-specific incidence remains at the same level as at the end of the study period, no significant change in the total numbers will occur. A trend-break was thus found in hip fracture incidence for women but not for men. Whether this is due to therapeutic and/or preventive measures in women is unknown. According to the most probable scenario a substantial increase in male trochanteric fractures (36%) is expected up to 2010, while all other hip fractures in both genders will decrease by 4–32% resulting in a total reduction of 11%.

  • 12.
    Löfman, Owe
    et al.
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Hallberg, Inger
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Berglund, Kenneth
    Community Medicine, County Council of Uppsala, Uppsala, Sweden.
    Wahlström, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Kartous, Lisa
    Div of Geriatric Medicine, Ryhov Hospital, County council of Jönköping.
    Larsson, Lasse
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Women with low energy fracture: Case for investigation?Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The combined use of bone mineral density, fracture history and other risk markers for fracture is advocated for identifying subjects with high fracture risk. An incident fracture is suggested as an accurate indication for osteoporosis investigation, but there are still insufficient data for grading the priority between ages and types of fractures. We therefore decided to examine a consecutive series of 55-75 year old women with an incident fracture for evaluating a standardized clinical routine program and for studying the covariance between fracture history, bone mineral density and other risk markers.

    Materila and methods: We invited 600 consecutive women 55-75 years old with an incident newly diagnosed fracture in distal radius forearm, proximal humerus, vertebra or hip. External drop-out was 33%. Of the 400 responders 31 had a high-energy trauma, 62 were on treatment against osteoporosis and 4 were living in other counties and were therefore excluded. The remaining 303 subjects entered the study. A questionnaire on previous fractures and risk factors was enclosed with the invitation to the osteoporosis unit. At a single visit a short history was assessed and physical examination performed as well as a few laboratory investigations. Bone mineral density was measured at the hip, lumbar spine and forearm by DXA (Hologic QDR 4500A).

    Results: The fracture spectrum was: distal radius 56.4 %, proximal humerus 12.2%, vertebra 18.2% and hip 13.2%. 49% had had at least one previous fracture, 19% at least two previous and 6.3% three or more previous fractures before the recent one. As few spine X-rays were performed, the true prevalence of vertebral fracture is unknown. Patients with fracture in vertebra or hip had lower BMD and more previous fractures than patients with forearm or humerus fracture. The number of previous fractures was inversely correlated to BMD of the hip and forearm, while BMD of the spine had a biphasic relationship.

    The Odds ratio of having either osteopenia and osteoporosis were >20 for patients with hip fracture and 75 for the spine (mean values), whereas the OR of the forearm fracture group was slightly above 10, table 6. The OR were as expected dependent of cut-off limit used. Mean value for the OR was in the hip fracture group 8.2 and 9.2 for !-score -2.5 and -2.0 respectively at the lower end of the confidence interval. For the spine and the forearm, the corresponding odds ratios were 16-17 and 7-9 respectively.

    Conclussion: Vertebral fracture was the strongest and distal radius the weakest predictor of low BMD. The number of previous fractures is a helpful information for finding the most osteoporotic patients. Only 15 % had been treated for osteoporosis before the index fracture. Osteoporosis investigation therefore seems warranted in every woman 55-75 years old with a recent low-energy fracture in distal radius, proximal humerus, spine or hip, with highest priority to those in spine or hip and those with multiple previous fractures.

  • 13.
    Löfman, Owe
    et al.
    Linköping University, Department of Biomedicine and Surgery, Division of clinical chemistry. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Hallberg, Inger
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Berglund, Kenneth
    Community Medicine, County Council of Uppsala, Uppsala, Sweden.
    Wahlström, Ola
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Kartous, Lisa
    Department of Geriatrics, Ryhov Hospital, Jönköping, Sweden.
    Rosenqvist, Anna-Maria
    Department of Geriatrics, Ryhov Hospital, Jönköping, Sweden.
    Larsson, Lasse
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Toss, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Women with low-energy fracture should be investigated for osteoporosis2007In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, no 6, p. 813-821Article in journal (Refereed)
    Abstract [en]

    Introduction: Treatment of osteoporosis is becoming more effective, but methods to identify patients who are most suitable for investigation and treatment are still being debated. Should any type of fracture have higher priority for investigation of osteoporosis than any other? Is the number of previous fractures useful information? Material and methods: We investigated 303 consecutive women patients between 55 and 75 years of age who had a newly diagnosed low-energy fracture. They answered a questionnaire on previous fractures which also dealt with risk factors. Bone mineral density (BMD) was measured at the hip, lumbar spine, and forearm. Results: The distribution of fracture location was: distal forearm 56%, proximal humerus 12%, vertebra 18%, and hip 13%, all with similar age. Half of the subjects had had at least one previous fracture before the index fracture, 19% had had two previous fractures, and 6% had had three or more previous fractures. Patients with vertebral or hip fracture had lower BMD and had had more previous fractures than patients with forearm or humerus fractures. There was an inverse correlation between number of fractures and BMD. Osteoporosis was present in one-third of patients with forearm fracture, in one-half of those with hip or humerus fracture, and in two-thirds of those with vertebral fracture. Interpretation: Vertebral fractures were the strongest marker of low BMD and forearm fractures the weakest. The number of previous fractures is helpful information for finding the most osteoporotic patient in terms of severity. Investigation of osteoporosis therefore seems warranted in every woman between the ages of 55 and 75 with a recent low-energy fracture, with highest priority being given to those with vertebral, hip, or multiple fractures. Copyright© Taylor & Francis 2007. all rights reserved.

  • 14.
    Löfman, Owe
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society.
    Larsson, L
    Toss, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Future changes in hip fracture epidemiology - Redistribution between ages, genders and fracture types.2000In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 15, p. F316-Conference paper (Other academic)
  • 15.
    Löfman, Owe
    et al.
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Larsson, Lasse
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Ross, I.
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Berglund, K.
    Department for Community Medicine and Public Health, County Council, Jönköping, Sweden.
    Bone mineral density in normal Swedish women1997In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 20, no 2, p. 167-174Article in journal (Refereed)
    Abstract [en]

    We examined 429 women, aged 20–80 years, randomly selected from the population register to establish normal values for bone mineral density (BMD) in Swedish women. BMD of the spine and hip was measured by dual-energy X-ray absorptiometry (DEXA; Hologic QDR 1000) and in the forearm by single photon absorptiometry (SPA; Molsgaard ND-1100). The recalled age of menarche was negatively correlated to BMD at all ages. There was no significant change in BMD from 20–49 years at any site except a slight decline at Ward's triangle. Bone loss was rapid at all sites during the first decade after menopause. Thereafter, BMD declined slowly in the trochanter and total hip but more rapidly in the forearm, femoral neck, and Ward's triangle. BMD in the spine even increased in the eighth decade probably due to osteoarthritis. The average change in forearm BMD during the 15 perimenopausal years comprising mean age for menopause ± 2 SD (43–57 years) was −0.4% per year in premenopausal females and −1.6% per year in postmenopausal females. The corresponding annual percental change was, for the spine, +0.2 and −1.7; neck, −0.7 and −1.7; trochanter, +0.5 and −1.5; and Ward's triangle, −0.1% and −2.2%, respectively. Our normal values for lumbar spine BMD prior to menopause did not differ from published values or the manufacturer's normal values; however, our spine BMD values for the first decade after menopause were significantly lower (≈10%) than in other studies. Our femoral neck BMD values for younger women were, like those of several other groups, significantly lower than the manufacturer's normal values, but our sample of young women in this study was small. The prevalence of osteoporosis, if defined as t score < −2.5 is highly dependent on the sampling of the reference population of young adult women, and also on the choice of skeletal site. Further studies on bone mineral density in healthy young adult women are needed.

  • 16.
    Löfman, Owe
    et al.
    Linköping University, Faculty of Health Sciences.
    Larsson, Lasse
    Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Faculty of Health Sciences.
    Bone mineral density instead of T-score?2001In: Journal of clinical densitometry, ISSN 1094-6950, E-ISSN 1559-0747, Vol. 4, no 1, p. 75-77Article in journal (Refereed)
    Abstract [en]

    No abstract available.

  • 17.
    Löfman, Owe
    et al.
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Magnusson, Per
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Larsson, Lasse
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Common biochemical markers of bone turnover predict future bone loss: A 5-year follow-up study2005In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 356, no 1-2, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Background

    Bone mineral density (BMD) is used to follow gain or loss of bone mass but cannot detect changes within a short period of time. Biochemical markers of bone turnover may be of value for prediction of individual bone loss.

    Methods

    We studied the relation between common inexpensive markers of bone turnover (serum alkaline phosphatase (ALP), osteocalcin (OC), urinary hydroxyproline (OHPr), and calcium (Ca)), BMD, age, and menopause in a combined cross-sectional and longitudinal design comprising 429 pre- and postmenopausal randomly selected women aged 21–79 years (mean 50 years). A follow-up was initiated after 5 years (including 192 of these women), which focused on changes in bone mass and the ability of these four common markers of bone turnover (sampled at baseline) to predict future bone loss.

    Results

    A marked increase was observed for all markers at the beginning of menopause. During the postmenopausal period ALP and Ca decreased to near premenopausal levels, while OC and OHPr remained high even 15 years after menopause. We also found inverse correlations at baseline between the bone markers and BMD, independent of the selected marker or skeletal site, r=−0.14 to −0.46, P<0.05. The correlations between ALP, OC, OHPr, and subsequent bone loss over 5 years, was significant for arm, r=−0.23 to −0.36, P<0.01. Baseline levels of all bone markers correlated significantly at group level with the 5-year follow-up of BMD for all sites. The ability of markers to predict individual bone loss was estimated by a multivariate regression model, which included baseline BMD, age, and body mass index as independent variables. ROC analysis showed a validity of approximately 76% for the forearm model, but was lower for the hip (55%) and lumbar spine (65%).

    Conclusions

    These data show that the common inexpensive biochemical markers of bone turnover ALP, OC, OHPr, and Ca were related to the current bone mass and, moreover, provides information about future bone loss at the individual level. Future investigations should include an evaluation of the clinical relevance of markers of bone turnover in relation to fracture risk.

  • 18.
    Löfman, Owe
    et al.
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Larsson, Lasse
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Bone Mineral Density in Diagnosis of Osteoporosis: Reference Population, Definition of Peak Bone Mass, and Measured Site Determine Prevalence2000In: Journal of clinical densitometry, ISSN 1094-6950, E-ISSN 1559-0747, Vol. 3, no 2, p. 177-186Article in journal (Refereed)
    Abstract [en]

    A population-based study was performed in order to compare different definitions of peak bone mass, and to apply the corresponding T-scores for different skeletal sites to a cohort of 70-yr-old women for studying the prevalence of osteoporosis. Bone mineral density (BMD) of the hip, lumbar spine, and forearm was measured by dual X-ray absorptiometry (Hologic 4500) in 296 women ages 16–31 yr and 210 women age 70 yr. Peak bone mass occurred in women in their early 20s at the proximal femur and at 28 and 31 yr at the spine and forearm, respectively. BMD cutoff levels were compared to machine-specific cutoff values for the different sites. When applied to our cohort of 70-yr-old women, the prevalence of osteoporosis at the total hip was 9–25%, depending on which peak bone mass the T-score of – 2.5 was based. The prevalence in the spine was 28–33% and in the forearm 45–67%. Osteoporosis in at least one of the three measured sites was documented in 49–72% of the population sample. Our results show that the use of T-score to define osteoporosis results in a highly different prevalence rate in a given population depending on the reference population and the skeletal sites chosen for measurement.

  • 19.
    Nilsson, Rudmar
    et al.
    Kommunhälsan, Linköping, Sweden.
    Löfman, Owe
    Östergötlands Läns Landsting.
    Berglund, Kenneth
    Östergötlands Läns Landsting.
    Larsson, Lasse
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Increased Hip-Fracture Incidence in the County of Östergötland, Sweden, 1940–1986, with Forecasts up to the Year 2000: An Epidemiological Study1991In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 20, no 4, p. 1018-1024Article in journal (Refereed)
    Abstract [en]

    The incidence of hip fractures in the county of Östergōtland in Sweden has increased dramatically from 1940 to 1986, mainly due to an increase in age-specific incidence of trochanteric fractures. The increase is most pronounced in people over 80 but is present even in age groups down to 50 years. If the age-specific incidence rates continue to increase, and the population of the elderly grows in accordance with the forecast, there will be 70% more hip fractures in the year 2000 than in 1985.

  • 20.
    Samuelsson, Ulf
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Nordfeldt, Sam
    Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Seasonal variation in the diagnosis of type 1 diabetes in south-east Sweden2007In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 76, no 1, p. 75-81Article in journal (Refereed)
    Abstract [en]

    With the aim to survey the seasonal pattern of diagnosis of type 1 diabetes we included all 1903 children <16 years of age and who had been diagnosed with type 1 diabetes between 1977 and 2001 in the south-east of Sweden. To investigate the seasonal pattern a mixture of two cosine functions was included in a logistic regression model.

    There was a clear seasonal variation over the years (p < 0.001). Children in the oldest age group (11–15 years) showed the most obvious seasonal variation (p < 0.001). Children with a short duration of symptoms had about the same seasonal variation as children with a long duration. Both children with and without an infection 3 months prior to diagnosis showed significant seasonal variation (p < 0.001) although the seasonal pattern differed between the two groups (p < 0.001). As the incidence of diabetes increased during the 25 years the study period was divided into periods of 5 years and it was only during the two last periods that significant seasonal variation occurred.

    There is a clear seasonal variation in diagnosis of type 1 diagnosis in children and the results suggest that children with a less aggressive disease process at diagnosis were most responsible for this variation. Children with and without prior infection showed a different seasonal pattern.

  • 21.
    Samuelsson, Ulf
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Geographical mapping of type 1 diabetes in children and adolescents in south east Sweden2004In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 58, no 5, p. 388-392Article in journal (Refereed)
    Abstract [en]

    Study objective: As earlier studies have shown space-time clusters at onset of type 1 diabetes in the south east region of Sweden we investigated if there also has been any geographical clusters of diabetes in this region.

    Design: The place of residence (coordinates) at the time of diagnosis were geocoded in a geographical information system (GIS). All children diagnosed with type 1 diabetes up to 16 years of age at diagnosis between 1977–1995 were included. The population at risk was obtained directly from the population registry for the respective years and geographical area levels.

    Setting: South east region of Sweden containing 5 counties, 49 municipalities, and 525 parishes.

    Main results: A significant geographical variation in incidence rate were found between the municipalities (p<0.001) but not between the counties. The variation became somewhat weaker when excluding the six largest municipalities (p<0.02). In municipalities with increased risk (>35.1/100 000) the major contribution comes from children in age group 6–10 years of age at diagnosis. There were no obvious differences between the age groups in municipalities with decreased risk (<20.1/100 000). Boys and girls had about the same degree of geographical variation.

    Conclusions: Apart from chance, the most probable explanation for the geographical variation in the risk for children and adolescents to develop type 1 diabetes between the municipalities in the region is that local environmental factors play a part in the process leading to the disease.

  • 22.
    Sandblom, Gabriel
    et al.
    Department of Surgery, Uppsala Akademiska Hospital, Akademiska Sjukhuset, Uppsala, Sweden.
    Varenhorst, Eberhard
    Linköping University, Department of Biomedicine and Surgery, Urology. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Rosell, Johan
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Clinical consequences of screening for prostate cancer: 15 Years follow-up of a randomised controlled trial in Sweden2004In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 46, no 6, p. 717-723Article in journal (Refereed)
    Abstract [en]

    Objective:

    To test the feasibility of a population-based prostate cancer screening programme in general practice and explore the outcome after a 15-year follow-up period.

    Methods:

    From the total population of men aged 50–69 years in Norrköping (n = 9026) every sixth man (n = 1494) was randomly selected to be screened for prostate cancer every third year over a 12-year period. The remaining 7532 men were treated as controls. In 1987 and 1990 only digital rectal examination (DRE) was performed, in1993 and 1996 DRE was combined with a test for Prostate-Specific Antigen (PSA). TNM categories, grade of malignancy, management and cause of death were recorded in the South-East Region Prostate Cancer Register.

    Results:

    There were 85 (5.7%) cancers detected in the screened group (SG), 42 of these in the interval between screenings, and 292 (3.8%) in the unscreened group (UG). In the SG 48 (56.5%) of the tumours and in the UG 78 (26.7%) were localised at diagnosis (p < 0.001). In the SG 21 (25%) and in the UG 41 (14%) received curative treatment. There was no significant difference in total or prostate cancer-specific survival between the groups.

    Conclusions:

    Although PSA had not been introduced in the clinical practice at the start of the study, we were still able to show that it is possible to perform a long-term population-based randomised controlled study with standardised management and that screening in general practice is an efficient way of detecting prostate cancer whilst it is localised. Complete data on stage, treatment and mortality for both groups was obtained from a validated cancer register, which is a fundamental prerequisite when assessing screening programmes.

  • 23.
    Waller, John
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Eriksson, Olle
    Linköping University, Department of Mathematics. Linköping University, The Institute of Technology.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Grahn Kronhed, Ann-Charlotte
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    Larsson, Lasse
    Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Toss, Göran
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Linköping University, Department of Neuroscience and Locomotion. Linköping University, Faculty of Health Sciences.
    Knowledge of osteoporosis in a Swedish municipality: a prospective study2002In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 34, no 4, p. 485-491Article in journal (Refereed)
    Abstract [en]

    Background. As a part of the Vadstena Osteoporosis Prevention Project, the knowledge of osteoporosis was examined before the intervention program started, after 5 and 10 years.

    Methods. At baseline (in 1989) 15% of the population in two Swedish municipalities was randomly invited to the study. The participants in the study group were invited for examination by forearm bone densitometry and a questionnaire concerning lifestyle and risk factors for osteoporosis and also knowledge of osteoporosis, while the subjects in the control group were examined only by questionnaire. Follow-ups were made in 1994 and in 1999. Meanwhile education about osteoporosis was given to the study group, to the public, and to various professionals in the study community.

    Results. There was a difference in the level of knowledge between the groups prior to the intervention. The rate of increment did not differ significantly between the groups for the study period. Previous participants had 0.58 higher score than new participants in the study group in 1994 (P = 0.031) and 0.76 higher score in 1999 (P < 0.001) regarding the total number of correct answers. The women in the study group had 0.63 higher score than the men in 1994 (P = 0.016) and 1.03 higher score in 1999 (P < 0.001) regarding the total number of correct answers.

    Conclusion. There was no significant effect of a general intervention program concerning the knowledge of osteoporosis in participants in the intervention area compared to the control area.

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