The Oslo Health Study (HUBRO) and related activities

Our main activity is the osteoporosis substudy of the Oslo Health Study (HUBRO). We are also involved in other osteoporosis-related research activities, and we have monthly meetings (Osteoporoseforum).

The osteoporosis substudy of the Oslo Health Study was initiated in 2000, as the fourth NOREPOS study. In HUBRO, 3,389 Oslo citizens aged 30-76 years attended a bone mineral density measurement as part of their health examination. In addition, blood samples were drawn, anthropometric measures were performed, and the participants completed several questionnaires concerning lifestyle and background variables.

The methodology is described in detail here.

Before the Oslo Health Study, researchers in the Oslo group had published extensively on fractures in Norway based on other data sources. Many of these papers served as the basis for further studies, e.g. papers about fracture epidemiology (10, 11, 23), risk factors (3-14, 28-29, 31), and survival after hip fractures (15, 32). Investigators were also collaborating in international studies comparing BMD and fracture incidence in European countries (12, 27, 30).

The osteoporosis part of the Oslo Health Study used SXA machines borrowed from the Tromsø Study, thus ensuring similar methodology. In addition, DXA measurements were performed in elderly men who had participated in the Oslo Study 1972/73. Vitamin D and several markers of bone turnover have been measured in subgroups of HUBRO. The osteoporosis study in Oslo n=3,389 have given rise to studies on the association between BMD and ethnic background, socioeconomic status, and air pollution (1-4). Vitamin D deficiency, secondary hyperparathyroidism, and biochemical markers of bone turnover in relation to BMD have been described in several papers, in particular comparing persons with Pakistani and Norwegian background (20-21, 34). HUBRO data has been employed in international collaboration (9).

Risk factors for hip fractures in young patients (24), weight change and osteoporosis in men (35), weight loss and forearm fractures in postmenopausal women (39), and weight cycling as a risk factor for fractures in elderly men (42) have been studied by the Oslo group. The effect of change in use of hormone replacement therapy on the risk of fractures have been presented (36). In the mid-2000s, a project on use of osteoporosis drugs, BMD and fractures was initiated based on the Norwegian Prescription Database (8).

Three papers have presented results from studies about the association between distal forearm fractures/BMD and degree of urbanization (38, 40-41), and one paper has described the epidemiology of distal forearm fractures in Oslo (25).

In addition to the abovementioned projects, we have accomplished four different intervention trials. Two have tested use of hip protectors in nursing homes (5-7, 16-18), one has tested the effect of vitamin D supplementation in nursing homes on hip fracture risk (33) and one has compared two different ways of administration of vitamin D (22).

We have established a hip fracture register based on hospital records of all hip fractures among those participating in the Oslo studies 2000-2002 (n=32,600) occurring in the 7-year period following the baseline examination. These fracture data have been used to validate the national hospital-based data on hip fractures in the NOREPOS project: Hip fractures: Predictors, incidence and survival. Validation of data and precision of BMD measurements have been dealt with in other papers (19, 26, 37).

Four PhD degrees are accomplished based on data from the osteoporosis part of HUBRO (43, 45-47).

A mail-based follow-up to HUBRO, Health and environment in Oslo, was performed in 2009. This consisted of completing a four-page questionnaire. All those invited to HUBRO in 2000-01 and still living in Norway were invited (n=35,000), and the response rate was 45%. The analyses of the material will be carried out in 2010-11 and the results will be included in a larger European study with 30 other countries in 2011-12.

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Publications

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Scientific papers

1. Alver K, Meyer HE, Falch J, Søgaard AJ. Bone mineral density in ethnic Norwegians and Pakistani immigrants living in Oslo – The Oslo Health Study. Osteoporos Int 2005;16:623-30.

2. Alver K, Søgaard AJ, Falch JA, Meyer HE. The Oslo Health Study: Is bone mineral density higher in socioeconomic affluent areas? Int J Equity Health 2007 Nov 23;6:19.

3. Alver K, Meyer HE, Falch JA, Nafstad P, Søgaard AJ. Outdoor air pollution and bone mineral density in elderly men – The Oslo Health Study. Osteoporos Int 2007;18:1669-74, Epub Jul 10.

4. Alver K, Meyer HE, Falch JA, Søgaard AJ. et al. Outdoor air pollution, bone density and self-reported forearm fracture: the Oslo Health Study. Osteoporos Int 2010;21:1751-60

5. Bentzen H, Forsén L, Becker C, Bergland A. Uptake and adherence with soft- and hard-shelled hip protectors in Norwegian nursing homes: a cluster randomised trial. Osteoporos Int 2008;19:101-11

6. Bentzen H, Bergland A, Forsén L. Risk of hip fractures in soft protected, hard protected, and unprotected falls. Injury Prev 2008;14:306-10

7. Bentzen H, Bergland A, Forsén L. Diagnostic accuracy of three types of fall risk methods for predicting falls in nursing homes. Aging Clin Exp Res 2011;23:187-95

8. Devold HM, Doung GM, Tverdal A, Furu K, Meyer HE, Falch JA, Søgaard AJ. Prescription of anti-osteoporosis drugs during 2004-2007 – a nationwide register study in Norway. European Journal of Clinical Pharmacology 2010; 66:299-306

9. DIPART Group: Abrahamsen B, Masud T, Avenell A, Anderson F, Meyer HE, Cooper C, Smith H, LaCroix AZ, Torgerson D, Johansen A, Jackson R, Rejnmark L, Wactawski-Wende J, Brixen K, Mosekilde L, Robbins JA, Francis RM. Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010;340:b5463

10. Falch JA. Epidemiology of fractures of the distal forearm in Oslo, Norway. Acta Orthop Scand 1983;54:291-5.

11. Falch JA, Kaastad TS, Bøhler G, Espeland J, Sundsvold OJ. Secular increase and geographical differences in hip fracture incidence in Norway. Bone 1993;14:643-5.

12. Falch JA, Aho H, Berglund K, Düppe H, Finsen V, Hagström I, Jarvinen M, Johnell O, Kaastad TS, Lauritzen JB, et al. Hip fractures in Nordic cities: difference in incidence. Ann Chir Gynaecol 1995;84:286-290.

13. Forsén L, Bjørndal A, Bjartveit K, Edna TH, Holmen J, Jessen V, Westberg G. Interaction between current smoking, leanness, and physical inactivity in the prediction of hip fracture. J Bone Miner Res 1994;9:1671-8.

14. Forsén L, Meyer HE, Søgaard AJ, Næss S, Schei B, Edna TH. Mental distress and risk of hip fracture. Do broken hearts lead to broken bones? J Epidemiol Comm Health 1999;53:343-7.

15. Forsén L, Søgaard AJ, Meyer HE, Edna TH, Kopjar B. Survival after hip fracture. Short- and long-term excess mortality according to age and gender. Osteoporosis Int 1999:109;73-8.

16. Forsén L, Arstad C, Sandvig S, Schuller A, Røed U, Søgaard AJ. Prevention of hip fracture by external hip protectors: an intervention in 17 nursing homes in two municipalities in Norway. Scan J Publ Health 2003;31:261-6.

17. Forsén L, Sandvig S, Schuller A, Søgaard AJ. Compliance with external hip protectors in nursing homes in Norway. Injury Prevention 2004; 10:344-9.

18. Forsén L, Arstad C, Sandvig S, Schuller A, Røed U, Søgaard AJ. Risk of hip fracture in protected and unprotected falls in nursing homes in Norway. Injury Prev 2004; 10:16-20.

19. Forsén L, Berntsen GKR, Meyer HE, Tell GS, Fønnebø V. Differences in precision in bone mineral density measured by SXA and DXA. The NOREPOS Study. European Journal of Epidemiology 2008; 23:615-24

20. Holvik K, Meyer HE, Søgaard AJ, Selmer R, Haug E, Falch JA. Biochemical markers of bone turnover and their relation to forearm bone mineral density in persons with Pakistani and Norwegian background living in Oslo, Norway. The Oslo Health Study. Eur J Endocrinol 2006;155:693-9.

21. Holvik K, Meyer HE, Søgaard AJ, Haug E, Falch JA. Pakistanis living in Oslo have lower serum 1,25-dihydroxyvitamin D levels but higher serum ionized calcium levels compared with ethnic Norwegians. The Oslo Health Study. BMC Endocrine Disorders 2007;7:9.

22. Holvik K, Madar A, Meyer HE, Lofthus CM, Stene LC: A randomised comparison of increase in serum 25-hydroxyvitamin D concentration after four weeks of daily oral intake of 10 µg cholecalciferol from multivitamin tablets or fish oil capsules in healthy young adults. Br J Nutrition 2007,98:620-5

23. Kaastad TS, Meyer HE, Falch JA. Hip fracture incidence in Oslo, Norway: Differences within the city. Bone 1998;22:175-178.

24. Lofthus CM, Osnes EK, Meyer HE, Kristiansen IS, Nordsletten L, Falch JA. Young patients with hip fracture: A population-based study of bone mass and risk factors for osteoporosis. Osteoporos Int 2006;17:1666-1667.

25. Lofthus CM, Frihagen F, Meyer HE, Nordsletten L, Melhuus K, Falch JA. Epidemiology of distal forearm fractures in Oslo, Norway. Osteoporosis International 2008; 19:781-6

26. Lofthus CM, Medhus AW, Meyer HE. Database validity in assessing population trends in hip fracture rates in Canada. JAMA. 2010 Jan 13;303(2):134-5 (Letter)

27. Lunt M, Felsenberg D, Reeve J, Benevolenskaya L, Cannata J, Dequeker J, Dodenhof C, Falch JA, Masaryk P, Pols HA, Poor , Reid DM, Scheidt-Nave C, Weber K, Varlow J, Kanis JA, O’Neill TW, Silman AJ. Bone density variation and its effects on risk of vertebral deformity in men and women studied in thirteen European centers: the EVOS Study. J Bone Miner Res. 1997;12:1883-94.

28. Meyer HE, Tverdal A, Falch JA. Risk factors for hip fracture in middle aged Norwegian women and men. Am J Epidemiol 1993;137:1203 1211.

29. Meyer HE, Tverdal A, Falch JA. Changes in body weight and incidence of hip fracture among middle aged Norwegians. BMJ 1995;311:91 92

30. Meyer HE, Falch JA, O’Neill T, Tverdal A, Varlow J. Height and body mass index in Oslo, Norway, compared to other regions of Europe: do they explain differences in the incidence of hip fracture? European Vertebral Osteoporosis Study Group. Bone 1995;17:347 350

31. Meyer HE, Pedersen JI, Løken EB, Tverdal A. Dietary factors and the incidence of hip fracture in middle-aged Norwegians: A prospective study. Am J Epidemiol 1997;145:117-123

32. Meyer HE, Tverdal A, Falch JA, Pedersen JI. Factors associated with mortality after hip fracture. Osteoporos Int 2000; 11:228-32

33. Meyer HE, Smedshaug GB, Kvaavik E, Falch JA, Tverdal A, Pedersen JI. Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomised controlled trial. J Bone Min Res 2002; 17:709-15

34. Meyer HE, Falch JA, Søgaard AJ, Haug E. Vitamin D deficiency & secondary hyperparathyroidism and the association with bone mineral density in persons with Pakistani and Norwegian background living in Oslo, Norway. The Oslo Health Study. Bone 2004; 35:412-7.

35. Meyer HE, Søgaard AJ, Falch JA, Jørgensen L, Emaus N. Weight change over three decades and the risk of osteoporosis in men. The Norwegian Epidemiological Osteoporosis Studies (NOREPOS). Am J Epidemiol 2008; 168:454-60

36. Meyer HE, Lofthus CM, Søgaard AJ, Falch JA. Change in the use of hormone replacement therapy and the incidence of fracture in Oslo. Osteoporosis International 2009; 20:827-830

37. Omsland TK, Emaus N, Gjesdal CG, Falch JA, Tell GS, Forsen L, Berntsen GKR Meyer HE. In Vivo and In Vitro Comparison of Densitometers in the NOREPOS-study. Journal of Clinical Densitometry 2008; 11:279-82

38. Omsland TK, Gjesdal CG, Falch JA, Emaus N, Tell GS, Meyer HE. Regional differences in bone mineral density levels in Norway. The NOREPOS study. Osteoporosis International 2009; 20:631-8.

39. Omsland TK, Schei B, Grønskag A, Langhammer A, Forsén L, Gjesdal CG, Meyer HE. Weight Loss and Distal Forearm Fractures in Postmenopausal Women. The Nord-Trøndelag Health Study. Osteoporosis International 2009; 20:2009-16

40. Omsland TK, Ahmed LA, Grønskag A, Schei B, Emaus N, Langhammer A, Joakimsen RM, Jørgensen L, Søgaard AJ, Gjesdal CG, Meyer HE. More forearm fractures among urban than rural women – the NOREPOS study based on the Tromsø study and the HUNT study. J Bone Miner Res 2010; Nov 8 [Epub ahead of print]

41. Søgaard AJ, Gustad TK, Bjertness E, Tell GS, Schei B, Emaus, N, Meyer HE. Urban-rural differences in distal forearm fractures – Cohort Norway. Osteoporosis International 2007; 18:1063-72

42. Søgaard AJ, Meyer HE, Tonstad S. Håheim LL, Holme I. Weight cycling and risk of forearm fractures: A 28-year follow-up of men in the Oslo Study. Am J Epidemiol 2008; 167: 1005-13.

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Dissertations

43. Alver K. Epidemiology of bone health in Oslo, Norway: role of ethnic, regional and environmental factors. 2009

44. Bentzen H. Prevention of hip fractures in nursing homes: A comparative study of the adherence with and effect of soft-shelled and hard-shelled hip protectors. 2009

45. Holvik K. Vitamin D deficiency, alterations in the vitamin D endocrine system and bone mineral density in ethnic groups in Oslo, Norway. 2008

46. Lofthus CM. Epidemiology of osteoporotic fractures in Oslo, Norway. 2008

47. Omsland TK. Regional differences in bone mineral density and risk factors for fractures in Norway. 2009