Search

Background: It is not known whether the recently described break in the trend in hip fracture incidence in many settings applies in both women and men, depends on changes in bone mineral density (BMD) or changes in other risk factors, or whether it is apparent in both urban and rural settings., Methods: We evaluated changes in annual hip fracture incidence from 1987 to 2002 in Swedish men aged ≥60 years in one urban (n = 25,491) and one rural population (n = 16,432) and also secular differences in BMD, measured by single-photon absorptiometry at the distal radius and multiple other risk factors for hip fracture in a population-based sub-sample of the urban and the rural men aged 60-80 years in 1988/89 (n = 202 vs. 121) and in 1998/99 (n = 79 vs. 69)., Results: No statistically significant changes in the annual age-adjusted hip fracture incidence per 10,000 were apparent from 1987 to 2002 in urban (0.38 per year, 95% CI -0.12 to 0.88) or rural men (-0.05 per year, 95% CI -0.63 to 0.53). BMD was similar in 1988/89 and 1998/99 when examining both urban (-19.6 mg/cm(2), 95% CI -42.6 to 3.5) and rural (-23.0 mg/cm(2), 95% CI -52.1 to 6.1) men., Conclusions: Since no secular change in age-adjusted hip fracture incidence was found during the study period, a levelling off in hip fracture incidence is present also in Swedish men. Because BMD on a group level was similar in 1988/89 and 1998/99, changes in other risk factors ought to be either of minor importance or counteracted by changes in different risk factors.

Background and Purpose: Although the incidence of hip fracture during the past 50 years has increased, a break in this trend has been reported in the last decade. Whether this change is attributable to changes in bone mineral density (BMD) or whether it varies between urban and rural regions is unknown., Methods: We evaluated changes in annual hip fracture incidence in women aged > or = 50 years in one urban population (n = 51,757) and one rural population (n = 26,446) from 1987 to 2002. We also examined secular differences in BMD (mg/cm(2)), evaluated by single-photon absorptiometry at the distal radius, prevalence of osteoporosis, and several other risk factors for hip fracture in one population-based sample of urban women and one sample of rural women aged 50-80 years at two time points: 1988/89 (n = 257 and n = 180, respectively) and 1998/99 (n = 171 and n = 118, respectively)., Results: No statistically significant changes were evident in annual age-adjusted hip fracture incidence per 10(4) when analyzing all women (-0.01 per year (95% CI: -0.37, 0.35)), rural women (-0.38 per year (-1.05, 0.28)), or urban women (0.19 per year (-0.28, 0.67)). BMD (expressed as T-score) was similar in 1988/99 and 1998/99 when analyzing all women (-0.09 (-0.26, 0.09)), urban women (-0.04 (-0.27, 0.19)), or rural women (-0.15 (-0.42, 0.13)) women., Interpretation: Since no changes in age-adjusted hip fracture incidence and no differences in BMD were found during the study period, changes evident in the other risk factors for hip fracture that we investigated (such as gait velocity and balance) are either of minor importance or are counteracted by changes in other risk factors.

Fragility fractures are correlated to reduced bone size and/or reduced volumetric bone density (vBMD). These region-specific deficits may originate from reduced mineral accrual and/or reduced skeletal growth during the first 2 decades of life. Before pathological development can be defined, normal skeletal growth must be described. To evaluate growth of bone size, accrual of bone mineral content (BMC), areal bone mineral density (aBMD) and vBMD in a population-based cohort, 44 boys and 42 girls were followed by annual measurements from the age of 12 to 16 (attendance rates 90-100%). Segmental bone length, bone width, BMC, aBMD and vBMD were measured by dual-energy X-ray absorptiometry (DXA). Data were compared with predicted adult peak, as determined in 36 men aged 27.7+/-4.6 years and 44 women aged 26.8+/-4.9 years. Growth in width of the femoral neck precedes accrual of BMC in the femoral neck in both genders up to age 15. The girls were at all ages closer to their predicted adult peak in both bone width and BMC compared with the boys except in the femoral neck. As femoral neck vBMD had reached its predicted adult peak already at 12 years in both genders, the increase in femoral neck BMC and femoral neck aBMD from age 12 to 16 was most likely to be explained by the increase in bone size. In boys the peak velocity growth was recorded at ~14 years for BMC, height, width and lean mass. Growth from the age of 12 to 16 seems to build a bigger but not a denser skeleton in the femoral neck.

This study evaluates the effect on the skeleton of physical activity from age 9 to 16. In 42 girls and 44 boys, bone mass and bone size were evaluated longitudinally by dual-energy X-ray absorptiometry (DXA) from ages 13 to 16. Physical activity from ages 9 to 13 was cross-sectionally evaluated at baseline (age 13). Girls with high physical activity from ages 9 to 13 at baseline had higher femoral neck bone mineral content (FN BMC; g) (P = 0.07), higher FN areal bone mineral density (FN aBMD; g/cm2), and higher FN volumetric BMD (FN vBMD; g/cm3) (both P < 0.05) compared with girls of low activity. FN width (cm) and head aBMD (an unloaded region) showed no differences when comparing the two groups. Three years of further high and low activity (from ages 13 to 16) did not yield any increased differences between the two groups. Boys with high physical activity from ages 9 to 13, had at baseline higher FN BMC, FN aBMD, and FN width (all P < 0.05) compared with boys with low activity. FN vBMD and head aBMD showed no differences when comparing the two groups. Three years of further high and low activity did not yield any increased differences between the two groups. We conclude that exercise may yield skeletal benefits before age 13, and that 3 years of continued high or low level activity up to age 16 did not yield any increased differences in bone size or bone mass in either girls or boys.

Medial tibial stress syndrome, a common condition of uncertain origin found in athletes, is characterized by pain in the distal posteromedial aspect of the tibia during exercise, with or without increased scintigraphic uptake in the affected region. To determine whether medial tibial stress syndrome with increased scintigraphic uptake is associated with a change in tibial bone mineral density confined to the site of the increased uptake, we measured bone mineral density (in grams per square centimeter) in 18 adult male athletes with long-standing medial tibial stress syndrome and compared the measurements with those of 16 age- and sex-matched control subjects and with those of 18 athletes without medial tibial stress syndrome who had a comparable training regimen. Tibial bone mineral density in the region corresponding to the pain was 15%+/-9% lower in the patients than in control subjects and 23%+/-8% lower than in the athletic control subjects (both significant differences). Bone mineral densities in most other regions of the body were higher than in the control subjects but lower than in the athletic controls at the corresponding sites. In summary, medial tibial stress syndrome is associated with low regional bone mineral density.

Background: Earlier studies have shown that physical exercise and a higher workload increase muscle strength and improve gait and balance at all ages for both sexes. Published studies have, so far, failed to investigate the functional performance of elderly individuals concerning their long-term physical activity and variables of daily living., Objective: To compare elderly women who participate in long-term, moderate exercise programmes with two age-matched groups of women from an urban and a rural community., Methods: All participants answered a questionnaire about health, social circumstances and fractures. We measured the vibration threshold of the lower extremities, bone mineral density of the distal radius and functional performance such as muscle strength, balance and gait., Results: The elderly, active groups performed significantly better in all functional tests and had sustained fewer fractures than the urban control group. When the comparison was made with the rural control group the differences were less obvious. The active group rated their health as better than both the control groups., Conclusion: Elderly women, who continue with moderate exercise programmes over many years, sustain fewer fractures and have better muscle strength, balance, gait and health ratings than women in general. Whether this is the result of the exercise or inherited characters, remains to be proved., (Copyright 2001 S. Karger AG, Basel.)

On the basis of cross-sectional studies in elite athletes and longitudinal studies, physical activity in growing children has been suggested to enhance bone mineral acquisition and prevent osteoporosis later in life. The level of exercise in most of these studies is not applicable in a population on a day-to-day basis. The aim of this study was to determine whether moderate increased exercise within the school curriculum from age 12 to 16 years would have anabolic bone effects. In a population-based setting of 40 boys and 40 girls the school curriculum was enhanced to physical education 4 times per week for 3-4 years. Controls were 82 boys and 66 girls who had had physical education twice a week over a corresponding period. Both cases and controls were measured at age 16 years. Bone mineral content (BMC), areal bone mineral density (aBMD), bone size (femoral neck width) and volumetric BMD (vBMD) were measured in total body, spine and femoral neck (FN) by dual-energy X-ray absorptiometry. Data are presented as mean +/- SD. BMC (8 +/- 15%, p = 0.04), aBMD (9 +/- 13%, p = 0.002) and vBMD (9 +/- 15%, p = 0.001) were all higher in FN in the male intervention group compared with controls. FN bone size was no higher in the intervention group than in the controls. In girls, no differences were found when comparing the intervention group with controls. The results remained after adjusting for confounding factors such as weight, height, milk intake and activity after school. In summary, we report that increased bone mass can be achieved in a population-based cohort of boys (but not in girls) by moderate increased physical activity within the school curriculum from age 12 to 16 years. We speculate that the same results can be seen in girls if intervention starts at an earlier age. We conclude that increasing the physical education content of the Swedish school curriculum may improve bone mass in at least peripubertal boys.

Patients with fragility fractures have low bone mineral density (BMD)--this statement is supported mainly by data on women. In this study, including only men, the objectives were to determine whether a decline in BMD alone or in combination with data on male sex hormones and skinfold thickness could be of value in predicting forthcoming fractures. We also wanted to find out whether high consumers of alcohol can be identified by measuring BMDs and male sex hormones. A prospective, population-based study was performed in the city of Malmö, Sweden. 242 men were randomly selected; all were of Scandinavian ethnic background, and were aged 50, 60, 70, and 80 years. Forearm BMD, testosterone, sex-hormone-binding globulin (SHBG), and skinfold thickness were analyzed. In addition, alcohol consumption and carbohydrate-deficient transferrin (CDT)--a marker of alcohol abuse--were analyzed. The study group was followed prospectively for 7 years and all fractures sustained were recorded. Prospectively, for a 1 SD decrease in forearm BMD, the Cox proportional hazard model gave a relative risk (RR) of 1.75 with a 95% confidence interval of 1.08-2.83 for a forthcoming fracture and 3.88 (1.30-11.57) for a hip fracture. For a 1 SD change in skinfold thickness, measured on the dorsum of the hand, a RR of 1.69 (0.99-2.87) for a forthcoming fracture was found and the corresponding value for hip fracture was 2.34 (1.10-5.00). Testosterone and SHBG did not enhance fracture prediction. Abusers of alcohol had, retrospectively, significantly more fractures. Individuals with alcohol consumption rates in the highest quartile had significantly higher CDT levels, but we were unable to identify high consumers of alcohol by analyzing BMD or sex hormones. In this study we found that forearm BMD and skinfold thickness could be used in predicting forthcoming fractures in men.

We performed ultrasound measurements (QUS) of the calcaneus in a population-based setting on 280 healthy children, aged 11-16 years, from a small urban area in southern Sweden. The results are compared with dual-energy X-ray absorptiometry (DXA) measurements in the total body, the lumbar spine and the hip, as well as single-energy X-ray absorptiometry (SXA) of the forearm. Normative data and correlations between the three different techniques were determined. We found significant correlations between QUS and age (r = 0.34-0.54), height (r = 0.13-0.56) and weight (r = 0.30-0.60), and between QUS and bone mineral density (BMD) measurements (r = 0.44-0.70). Boys increased all their bone mineral variables with age, whereas girls showed a decreasing trend from age 15 years. QUS had a significantly higher increase in standardized value with age than Ward's triangle BMD, but a significantly lower increase in standardized value with age than distal radius (cortical site) BMD. At other BMD sites we did not find any significant differences compared with QUS regarding changes with age. The measurements obtained by QUS, DXA and SXA, respectively, were divided into, quartiles. Of all subjects in the lowest quartile for QUS measurements, only 34-50% were also in the lowest quartiles for DXA and SXA measurements. In conclusion, QUS measurements of the calcaneus in children show similar results as for adult regarding the correlation with DXA and SXA; they also have a significant correlation with anthropometric data. QUS did not identify the same individuals with low bone mass as the X-ray techniques.

We performed, in a cross-sectional study, dual energy X-ray absorptiometry (DXA) among 15-16-year-old boys (n 58) and girls (n 44) living in an urban area and among boys (n 82) and girls (n 66) of the same age from a rural area. We measured bone mineral density (BMD) of the total body, the lumbar spine and the hip. In the rural population, we found significantly higher BMD levels in the lumbar spine (14% for the boys and 12% for the girls) and the total body (6.9% for the boys and 3.4% for the girls). We detected no significant differences in the hip BMD. Adolescents in rural areas seem to develop a higher peak bone mass and thereby presumably have a lower risk of developing fragility fractures.

In this population-based study, the relationship between childhood weight and height, and adolescent bone mass and muscle strength have been studied in 39 girls and 48 boys. Total body and femoral neck bone mass measurements (bone mineral content, BMC and bone mineral density, BMD) were made by dual X-ray absorptiometry. Quadriceps muscle strength was measured. Mean age at the time of measurement was 15.1 years for girls and boys. Results were individually linked to data on childhood (birth to 6 years of age) weight and height, taken from community health records. Childhood weight was found to be predictive of adolescent total body BMC (TBMC). However, this was not the case when correlating childhood weight and total body BMD (TBMD), suggesting that growth determines the size of the skeleton, whereas the density within that bone envelope is to a greater extent governed by other factors. Further, in a multiple regression model we found that the combined effect of childhood weight and height was significantly correlated with adolescent quadriceps muscle strength.

The aim of this population-based study was to find out whether differences in levels of physical activity have an influence on bone mass quantity and whether quadriceps muscle strength is a reliable determinant of bone mass. Included were 175 men and 157 women, aged 15-42 years. Bone mineral density (BMD) was measured at various sites by dual X-ray absorptiometry (DXA) and single photon absorptiometry (SPA). Muscle strength was assessed using an isokinetic muscle force meter. A questionnaire was used to estimate the level of physical activity. We found a positive correlation between physical activity and BMD for boys at the distal forearm and for girls at the trochanter (age group 15-16 years). Active men (age group 21-42 years) had up to 9% higher BMD levels at the hip than those who were less active. Quadriceps muscle torque was not an independent predictor of BMD. Our data suggest that a higher level of physical activity-within the limits of a "normal life style"-may have a positive effect on BMD in the proximal femur of young adults, which in turn may lessen the subsequent risk of fracture.

Objective: To study the effects of participation rate in sampling on "normative" bone mass data., Design: This was a comparison between two randomly selected samples from the same population. The participation rates in the two samples were 61.9% and 83.6%. Measurements were made of bone mass at different skeletal sites and of muscle strength, as well as an assessment of physical activity., Setting: Malmö, Sweden., Subjects: There were 230 subjects (117 men, 113 women), aged 21 to 42 years., Results: Many subjects participated in both studies (163). Those who took part only in the study with the higher participation rate (67) almost invariably had higher values for bone mass density at the sites measured (up to 7.6% for men) than participants in the study with the lower participation rate. No differences in muscle strength were recorded., Conclusion: A high degree of compliance is important to achieve a reliable result in determining normal values in population based studies.

The purpose of this study was to examine the bone mineral densities (BMD) of female junior and senior football (soccer) players with different training regimens and histories, female former football players, and their respective controls. Active junior (age 13-17 years, n = 62) and senior (age 18-28 years, n = 34) players, representing three teams with different levels of performance and training, were compared reciprocally and with matched controls (n = 90). Former players (age 34-84 years, n = 25) who had ended their careers on average 9.7 years previously and their matched controls (n = 57) were also studied. Body composition and total body, lumbar spine and proximal femur BMD were measured with dual-energy X-ray absorptiometry. Former players and their controls were asked in a questionnaire to specify their current level of physical activity. In a control for differences in age, weight and body mass index, football players had significantly greater BMD than controls at all sites measured. This difference appeared to be site-specific, with greater differences in BMD at the proximal femur sites (10.5-11.1%) than at the lumbar spine (4.8%) or for the total body (3.5%). Further, differences were greater for senior than for junior players. However, no BMD differences were found between teams representing different levels of performance and training. Female former football players had retained their proximal femur and total-body BMD advantage over controls. In conclusion, training in female football, which is an impact-loading activity, has a site-specific, positive effect on bone formation that is not increased over a certain level of physical activity. The BMD advantage attained appears to be preserved to some extent after the termination of the athlete's active career, which may have a positive effect on future fracture risk.

We have in a population-based setting evaluated biochemical markers of bone metabolism in 328 women, aged 40-80 years, and related it to contents of bone mineral measurements and the retrospective and prospective presence of fracture. The participants were recruited from the city population files. Serum samples for analysis of osteocalcin (Oc), procollagen I carboxy-terminal extension peptide (PICP), and carboxy-terminal telopeptide of type I collagen (ICTP) were taken, and forearm bone mineral content (BMC) was measured by single photon absorptiometry (SPA). Fracture history was recorded, and the information was verified and supplemented from both radiologic and orthopedic files. Five years later the registration of fractures was repeated. At the initial investigation, Oc was 23% lower in women who had sustained a fracture (n = 37) within 6 years before measurement (6.3 +/- 3.6 microgram/l vs 8.2 +/- 4.2 microgram/l (p = 0.006)), after adjusting for age and BMC difference. PICP and ICTP were not different from values in the women without fracture. However, in women aged 70-80 years with a fracture sustained during the previous 6 years, PICP was lower (128 +/- 32 microgram/l vs 144 +/- 34 microgram/l, p = 0.046). Oc and ICTP were significantly correlated to age and BMC (Oc-age r = 0.36, Oc-BMC r = -0.31, ICTP-age r = 0.44, ICTP-BMC r = -0.24). The correlations of PICP were weaker. Prospectively, logistic regression gave an odds ratio (OR) of 1.8 (p = 0.015) for a low PICP and fracture susceptibility, at a change of 1 SD, independent of age and BMC. In the age bracket 70-80, the odds ratio was 2.4 (p = 0.036). The odds ratio for ICTP, independent of age and BMC, was 1.9 (P = 0.043) for 1 SD decrease and subsequent fracture risk. We concluded that women who had sustained at least one recent fracture had an altered bone turnover with decreased bone formation but an unaltered resorption. Women with retrospectively registered fractures also sustained subsequent fractures. A decrease from the mean of the collagen markers PICP and ICTP was associated with an increased risk for future fracture. Utilizing these biochemical markers of bone metabolism in a female population, PICP and ICTP had a similar influence on the risk of future fracture as forearm BMC (OR = 1.6, p = 0.03).

This is a follow-up of a previous study on the predictive power of bone mineral measurements; two more observation years have been added. A group of women (n = 1076) had their forearm bone mineral content (BMC) measured from 1970-1976. All fractures that occurred in 1975-1987 (13 years) were recorded. Four hundred sixty-nine fragility fractures occurred during the collection period. Again, it was found that BMC at the distal end of the forearm is a good predictor of future fracture before the age of 70. The measurement at the proximal site (forearm shafts), however, in contrast to our previous study, has a capacity of predicting fracture also in the age group 70-80. BMC measurements were good predictors of vertebral crush fractures and trochanteric hip fracture but lesser predictors of fractures of the distal end of the forearm. In age groups 40-70, BMC was a stronger predictor of fracture than age, and the risk associated with a 1 SD decrease of BMC 6 was 3.2 for a hip fracture as compared with those without any fragility fracture, even when adjusted for age. In addition to BMC, low body weight was a fracture predictor. Body weight 5 kg below age-adjusted mean increased the risk of a trochanteric hip fracture by 30%. The data are used in hypothetical calculations of the effects of screening.

The bone mineral mass was measured in 324 residents of the city of Malmö, Sweden, by dual energy roentgen absorptiometry (DEXA) using the Lunar DPX equipment--total body, hip, and lumbar vertebrae. The bone mineral content of the wrist was also measured with single photon absorptiometry (SPA) in 88 of the individuals. Weight, height, and vertebral height, as well as body fat, lean body mass, menarcheal age, menopausal age, and hand grip strength were determined. Measurements were compared with reference bone mineral content values from the United States, Japan, and France--also hip fracture incidence was compared. All bone mineral values decreased with age. A good correlation was found between the DEXA technique of total body bone mineral and the forearm SPA values. The bone mineral content was correlated with lean body mass and weight. The Malmö bone mineral content was on the same level as in the United States, but higher than in Japan and France. The comparatively high risk of fragility fractures in the Scandinavian countries compared with most other settings cannot be explained by low bone mass.

One thousand one hundred ninety-two subjects who had the bone mineral content (BMC) of their forearm measured during the period spanning 1970-1976 were followed to 1985. At that time, 489 had died. Those who died had a lower BMC of the forearm at the time of the measurement than did the survivors. However, the difference was significant only in men aged 50-69 years. In men, deviation below normal BMC was an indicator of a shorter than average life expectancy, whereas above average values were not important in this respect.

A higher incidence of fragility fractures in urban than in rural populations has been described. The present study included 954 randomly selected men and women between the ages of 40 to 80 years living in the cities of Malmö, an urban population, and Sjöbo, a typical agricultural community. Lean body mass (LBM) was estimated with a bioelectrical impedance method; bone mineral content (BMC) of the forearm was evaluated by single photon absorptiometry, and strength of the quadriceps, and hamstring muscles of the right knee, and hand grip were measured. The age-related difference in LBM between the ages of 50 to 80 were 7.8 kg in men and 2.9 kg in women. Urban men aged 60 and 70, and women aged 50 and 70 had a 1.8 to 3.7 kg lower LBM than rural subjects. One hundred women (17%) and 28 men (11%) had experienced fragility fractures. Women aged 70 with fragility fractures had 3.1 kg lower LBM than women without fractures, and the age-dependent difference in LBM was greater in the urban and rural women with fracture, than in women without fracture. LBM showed a higher correlation to BMC, in the range of 0.20-0.28, than the correlation between body weight and BMC. Quadriceps muscle strength was lower in the elderly age groups in both sexes, and a 40% decline was seen both in those from the highest and lowest quartiles of LBM. Use of LBM instead of body weight showed higher correlations to flexion strength of the knee and hand grip.(ABSTRACT TRUNCATED AT 250 WORDS)

Altogether 426 women had their forearm bone mineral content (BMC) measured with single photon absorptiometry (SPA): one group in the early 1970s, another about 18 years later. Both groups represented purportedly healthy subjects. A third group of 328 women, measured at the same time as the second group, was from the same population but chosen by random selection (the population-based group). In the two sets of non-population-based women there was a small percentage reduction in the cortical forearm bone mass in the recent measurement as compared with the earlier measurement. This was significant only in women below 70 years of age. The forearm BMC, both cortical and trabecular, was less in all age groups of women randomly selected from the same population as the healthy control sample. This difference emphasizes the importance of selecting normative data from a population-based sample.

Thirty-six women aged 60, 70 or 80 years who had fractured one of their distal radii (Colles' fracture) 0 to 35 (median 10) years earlier were examined in this population-based study. Single photon measurements (SPA) were performed on both arms 1 cm and 6 cm proximal to the styloid process of the ulna. All women were questioned about earlier wrist fractures and which, if any, side had been affected. Information about the type and site of the fracture was also gathered from the hospital records. The bone mineral content (BMC) was found to be increased by almost 20% in the once-fractured radius at the distal measuring site (1 cm) when compared with the unaffected side. This difference did not seem to diminish with time. At the proximal measuring site there was no difference between the once-fractured and the non-fractured side. There was a progressive loss of bone mineral in the once-fractured arm during the first years after the fracture however. This appeared to be reversed after about 10 years to a relative gain, even though the correlation was weak. Six of the 36 women could not remember which side had been fractured and five could not remember having had such a fracture at all. Determination of osteoporosis by measuring forearm BMC with single photon densitometry is therefore of limited value in some women of the oldest age groups.

Fifteen years after their forearm bone mineral content was measured, 366 women were measured again with the same single photon technique. 96 of the women had sustained one or more fragility fractures during that period. The initial bone mineral content was less in those women who were to have fractures. The rate of loss over the years did not differ between fracture and non-fracture women--the initial bone mass was the better predictor. Peak bone mass in the women in this study occurred before the age of 40.

Several previous studies have reported regional differences in the incidence of hip fractures. A population-based study was performed in the city of Malmö (urban population) and in the municipality of Sjöbo (rural population), 60 km apart. A total of 961 men and women, randomly selected and of Scandinavian ethnic background, participated in the study. Bone mineral content (BMC) of the forearm was measured with single-photon absorptiometry (SPA). Women and men in the city had significantly lower BMC compared with the rural population. The differences were even more pronounced when comparing a true urban population (lived their entire life in a city) with a true rural population (never lived in a city). The differences in BMC between Malmö and Sjöbo were more obvious in men. These data suggest that differences in bone mass between an urban and a rural population could to some extent explain differences in fracture incidence.

Six hundred and fifty-four men had their bone mineral content (BMC) measured with single photon absorptiometry during 1970-1976. All roentgenograms 1975-1985 (11 years) were registered and thus all falls requiring roentgen examinations. BMC was found to be of predictive value in ages below 70-80 with regard to future fragility fractures. Other characteristics were more falls, less grip strength, and weight. A history of previous vertebral fracture and cerebral disorder were also predictive. Men with only nonfragility fractures showed no differences compared to the nonfracture population.

In order to explain the higher prevalence of fractures in urban compared with rural areas, 782 residents in the city of Malmö, Sweden and 486 inhabitants from the nearby rural municipality of Sjöbo were invited to participate in a sex- and age-matched cross-sectional study on life-style differences; 73 and 80% respectively responded. Responders answered a questionnaire on medical and social background and were interviewed on past and present physical activity. The men and women of the rural area were found to be significantly more active physically at work and during spare time. Housing was larger in the rural area. For women, these differences are decreasing in the younger age groups. Bone mass was found to be correlated to heavier work load for men. Other life-style variable such as dairy calcium intake, coffee drinking, estrogen medication, and morbidity, could not explain this difference. Higher prevalence of fractures in the city could therefore be explained by physically less active life-style. [ABSTRACT FROM AUTHOR]

A placebo-controlled, double-blind study was carried out over 4 months to evaluate two doses of synthetic human calcitonin (0.25 and 0.125 mg) given s.c. three times per week. Enrolled were 60 women, aged 56-82 years, who had experienced a vertebral fracture due to low-energy trauma within the preceding year. During active treatment there was within the first month a dose-dependent decrease of the indices of bone resorption (fasting urinary calcium and hydroxyproline excretions), whereas only the higher dose and a treatment period of 4 months produced a reduction of bone formation (serum osteocalcin). The bone mineral content (BMC) of the nondominant forearm was unchanged. Treatment with calcitonin also had significant, dose-dependent, analgetic effects. The amelioration of pain was, in multivariate analyses, related to a reduction in parameters felt to be markers for bone resorption. In the placebo group there was a significant reduction of the BMC of the forearm but no changes of any of the biochemical markers for bone turnover and no improvement of pain. In conclusion, treatment with two low doses of calcitonin induced changes of the biochemical markers of bone turnover in a dose-dependent manner. The analgetic properties of calcitonin were also of salient clinical importance. The knowledge derived from this study could be adapted to the dosage schedule in long-term trials in osteoporosis. [ABSTRACT FROM AUTHOR]