January 2021: New NOREPOS publication about mortality risk in hip fracture patients living alone

Photo: pixabay

A paper by Cecilie Dahl and coauthors was published in the Journal of Bone and Mineral Research (JBMR). Hip fracture is associated with excess mortality many years after the fracture, and the authors found a higher post- fracture mortality in people (50-79 years at fracture) who were living alone, compared to hip fracture patients who were living with a partner. The differences in mortality became larger with time since fracture. Older male hip fracture patients had the highest absolute mortality, but the relative mortality in those living alone versus those living with a partner was highest in the group of younger male hip fracture patients (50-60 years) who had no registered comorbid disease. Living alone is also a risk factor for higher mortality in the general population; however, hip fracture patients living alone had an even higher mortality compared to people of the same age, gender who were living alone and had not experienced a hip fracture.

November 2020: New NOREPOS publication about geographic difference in hip fracture incidence

Photo: pixabay

A paper by Cecilie Dahl and coauthors was published in Osteoporosis International. The paper further explored the geographic differences in hip fracture incidence that were first noted in Forsén and coauthors (February 2020). A somewhat higher incidence of hip fracture was found in women living far from the coast (>15 km) and high above sea level (>107 m), compared to those living closer to the coast and at lower elevation, also when taking into account age, urban/rural differences of the municipality, country of birth and season of the year. The same differences were not found in men. There were still differences in hip fracture incidence between counties of Norway when taking into account residential distance to coast and elevation.

June 2020: Digital NOREPOS meeting

Due to the SARS-CoV-2 situation, our planned two-day meeting was rescheduled to a 2-hour digital meeting on the 4th of June. The steering committee and affiliated collaborators from all study centers in NOREPOS were invited. Post Docs and Researchers Helena Kjeldgaard, Jesper Dahl and Cecilie Dahl presented progress and preliminary results for each of the work packages in the ongoing RCN funded project, Novel aspects of an old problem. The meeting also included a session about anti-osteoporosis drug use and fracture risk in the HUNT study by Mari Hoff, and methods to account for multimorbidity using prescription data in register-based studies, by Kristin Holvik.

April 2020: New NOREPOS publication about ethnic differences in risk of hip fracture in Norway

A paper by Geir Aamodt and co-authors, published in Osteoporosis International, has studied ethnic differences in hip fracture risk across counties in Norway. Hip fracture is a major public health problem, and the incidence rates vary considerably between countries. Ethnic differences in bone mineral density have been identified as a factor to explain some of the geographical differences in rates of hip fracture globally. In this Norwegian register-based study, a lower risk of hip fracture was experienced in all immigrant groups than in those born in Norway.

February 2020: New NOREPOS publication about geographic variation in hip fracture risk

A paper by Lisa Forsén and co-authors, published in Osteoporosis International, has studied the variation in hip fracture risk across counties in Norway, and whether the decline in incidence over time has varied between counties. Norway is a far-stretched Scandinavian country, with the mainland extending from 58 to 71° north, and it has substantial coast-inland, latitudinal and seasonal variations in temperature and climate. Contrary to what may be expected with regard to vitamin D exposure from sunlight, a clear pattern of a lower incidence in the coastal areas of the southwest and in the Arctic north was found, while the incidence was highest in the southeastern counties of Norway. The decline over time has not been constant across all counties; the regional differences that have earlier been prominent, have become smaller in recent years.

December 2019: NOREPOS in the news

The survival after a hip fracture is poorer in the city than on the countryside. The feature story and interview with associate professor Tone Omsland is published on the Norwegian website

December 2019: New NOREPOS dissertation

Siri Solbakken

We congratulate research fellow in NOREPOS Siri Marie Solbakken, MD, on defending her PhD thesis at the University of Oslo on the 11th December 2019. The title of the thesis is: Hip fracture incidence and mortality: The impact of season, health status and urbanization. The topic of her trial lecture was: “Benefits and drawbacks of registry research on determinants of mortality”. Tone Kristin Omsland has been the main supervisor.

Norway has one of the highest hip fracture rates in the world. Mortality is very high in hip fracture patients, and knowledge on explanatory factors is important when considering strategies to reduce the high post hip fracture mortality. The aims of this thesis were to investigate seasonal variation in hip fracture incidence and the impact of pre-fracture health status (based on body mass index (BMI), smoking status and self-perceived health) and urbanization on post hip fracture mortality.

In three large register-based cohort studies, national hip fracture data from the NOREPOS hip fracture database were combined with data from Cohort of Norway (a compilation of large population-based health surveys), the 2001 Population and Housing Census and data from the National Registry.

There was a distinct seasonal variation in hip fracture incidence by age, gender and comorbidity, with a higher risk of hip fracture in winter compared to summer. The seasonal variation was most pronounced in men and in the youngest and healthiest patients.

Information on self-perceived health, BMI and smoking status predicted excess mortality in hip fracture patients. Underweight patients who reported poor or not very good self-perceived health and daily smoking had a more than 6-fold increased mortality compared to persons without fracture. However, an excess mortality was present also in patients with the most favorable levels of these risk factors. Hip fracture patients living in urban areas had a higher mortality than their rural-dwelling counterparts, and the mortality differences were most pronounced during the first 1-2 years after hip fracture.

The findings may partly explain the high hip fracture burden in Norway, and suggest that both pre-fracture health status and fracture-related factors contribute to the excess hip fracture mortality. In addition, hip fracture mortality varied by degree of urbanization in the municipalities.

June 2018: Dissertation: Mortality and risk factors related to osteoporosis and osteoporotic fractures.

M.D. and endocrinologist Trine Elisabeth Finnes, research fellow in NOREPOS, defended her thesis: “Mortality and risk factors related to osteoporosis and osteoporotic fractures” at the Medical Faculty, University of Oslo on the 20 June 2018. The topic of her trial lecture was: “Hip Fractures: Advantages and disadvantages of epidemiologic observational studies versus randomized studies”.

Hip fractures represent one of the most serious consequences of osteoporosis, leading to loss of independence and a high excess mortality. To effectively prevent fractures, it is important to be able to identify the at-risk population. The aim of this dissertation was to investigate the risk of hip fracture at different levels of the bone formation marker procollagen type 1 aminoterminal propeptide (P1NP) and at different levels of vitamin K1 in the blood. In addition, Finnes and colleagues have investigated whether mortality after hip fractures changed from 1978 to 1996.

Data from large population-based studies in Norway in 1994-2001 were applied to investigate the risk of hip fracture according to serum P1NP levels and vitamin K levels, respectively. To study mortality, hip fracture patients identified in previous studies in Oslo were followed up for at least 10 years with regard to deaths.

There was no clear association between P1NP and hip fracture incidence. Low vitamin K1 concentrations were associated with increased fracture risk, and this relationship was most pronounced among those who also had poor vitamin D status. It cannot be inferred from this study whether vitamin K supplementation may prevent hip fractures. Mortality after hip fractures changed very little from 1978 to 1996 and was about three times higher than in the background population of corresponding age and gender. However, in the oldest (85 years and older), there was some improvement in one-year survival in 1996 compared to 1978. It is important to continue to follow this trend to assess whether follow-up of hip fracture patients is adequate.

More information at the University of Oslo (in Norwegian).

May 2018: Dissertation: Vitamin B supplementation, self-reported memory loss and fracture risk

M.D. Maria Garcia Lopez, research fellow in NOREPOS, defended her thesis: “Risk of fracture: The importance of B-vitamins and self-reported memory loss” at the Medical Faculty, University of Oslo on the 25 May 2018. The topic of her trial lecture was: “Gender differences in hip fracture epidemiology and etiology”.

The aim of this thesis was to assess the possible risk of cognitive impairment at early stages (self-perceived memory loss) on hip fracture, and if homocysteine-lowering treatment with B-vitamins had any preventive effect on fracture risk. Elderly who reported self-perceived memory loss had higher risk of hip fractures (men with 41% and women with 90% higher risk) compared to those without memory disorders. Concerning vitamin supplementation, those who received vitamin B6 had 42% higher hip risk compared to those who did not get vitamin B6. Folic acid and vitamin B12 treatment did not affect the risk of hip fractures. The dose of vitamin B6 used was far higher than what is found in the diet and is considered a pharmacological dose. However, these vitamin doses can be found in dietary supplements in different European countries or on the Internet. The vitamin B6 discovery has potential health consequences, mainly related to vitamin consumption and the need to respect the daily dosage recommendations when there is no vitamin deficit. The use of dietary supplements with high doses of vitamins can lead to unexpected adverse side effects.

More information at the University of Oslo (in Norwegian).

January 2018: New NOREPOS research project

The NOREPOS research network has received a grant from the Research Council of Norway (FRIMEDBIO) to carry out a large research project in the period 2018-2021. FRIMEDBIO funds independent research projects within medicine, health sciences and biology. In particular, the FRIMEDBIO scheme aims to promote “scientific quality at the forefront of international research” and “boldness in scientific thinking and innovation”. Our new research project is entitled: Novel aspects of an old problem. The Norwegian Epidemiologic Osteoporosis Studies. The project has three work packages affiliated at the Norwegian Institute of Public Health, the University of Bergen, and the University of Oslo, respectively. Two Post Doc positions and one Researcher position will be announced during spring 2018. More information about the project is available here.

September 2015: Anniversary paper about NOREPOS is published

On the occasion of the 10th Annual NOREPOS Workshop this year, a paper describing the history of epidemiologic osteoporosis research in Norway is published in the Norwegian Journal of Epidemiology. The topic of the current issue is the History of Epidemiology in Norway. The paper written by Anne Johanne Søgaard and Grethe S Tell is entitled: An example of a successful national research network in epidemiology – The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS).

April 2015: Date and venue set for the 10th Annual NOREPOS Workshop

The 10th Annual NOREPOS Workshop will take place in Scandic Hotel Nidelven, Trondheim, 27 – 28 October 2015. The program will be announced here.

April 2015: Seminar about geodata and fracture at the Norwegian Institute of Public Health

The Norwegian Institute of Public Health carried out an open seminar with the topic “Kan geodata knekke bruddgåten?”

View programme (in Norwegian).

October 2014: NOREPOS cohort profile published

The background paper describing the NOREPOS network and data material is now available online. Reference:

Søgaard AJ, Meyer HE, Emaus N, Grimnes G, Gjesdal CG, Forsmo S, Schei B, Tell GS. Cohort profile: Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Scand J Public Health 2014 Oct 2 [Epub ahead of print]

View full publication online at SAGE journals

September 2014: Dissertation: Vitamin K, inflammation, and osteoporosis

On 23 September, rheumatologist Ellen M Apalset defended her thesis “Vitamin K and inflammation in relation to bone mineral density and hip fractures” at the University of Bergen.

The study is based on data from the Hordaland Health Study (HUSK), which was conducted from 1997 to 1999 with 10 years follow-up of hip fractures recorded by the hospitals in the county.

Dietary vitamin K1 and K2 and blood markers of interferon-gamma mediated inflammation were examined.

Low dietary vitamin K1 diet was associated with low bone density among women but not in men. Older people (71-74 years) with a low intake of vitamin K1 had an increased risk of hip fracture. Vitamin K2 in the diet showed no association with bone density or risk of hip fracture.

Among the oldest there was an association between higher blood levels of certain inflammation markers and low bone density. In middle-aged people (47-49 years) there was no such correlation. The oldest also had a greater risk of hip fracture at higher levels of inflammation markers.

High intake of vitamin K1 is related to a healthy diet and lifestyle, and the study cannot conclude as to whether vitamin K1 protects against osteoporosis and fractures. A link between inflammation and osteoporosis has been shown also earlier, but this is the first time this part of the immune system has been studied in the context of bone density and fracture risk in a larger population study.

Read more (in Norwegian)

June 2014: New NOREPOS Dissertation

Cecilie Dahl defended her thesis 2 June 2014, entitled: “Quality of municipal drinking water and the risk of osteoporotic fractures in Norway”.

The dissertation consists of three sub-studies where Dahl studied differences in fracture risk according to drinking water quality in nationwide data. Results from the first sub-study showed that the drinking water that was slightly acidic often was less hygienic, and it was also associated with a higher incidence of forearm fractures. In the second sub-study, Dahl found that a higher magnesium content in drinking water could be protective against hip fracture, whereas a higher level of calcium was not associated with hip fractures.

In the third sub-study, the concentrations of metals such as lead, cadmium and aluminum in drinking water were examined. A higher level of the heavy metal cadmium was associated with increased risk of hip fractures in men. More lead in drinking water also appeared to be associated with increased risk of hip fractures in both genders, but a statistical association was only seen in the oldest (66-85 years).

The results show that the quality of drinking water, in particular low magnesium content, is correlated with high incidence of osteoporotic fractures in Norway. Since this is the first study of its kind in the world, we need more studies before concluding. The next step will be to examine how substances in drinking water may affect bone health.

March 2014: Date and venue set for NOREPOS workshop 2014

The 9th annual NOREPOS workshop will take place 18-19 June in Solstrand Hotel & Bad outside Bergen. The final program will be announced in May. More information

November 2013: Dissertation: Svanhild Waterloo

Cand. san. Svanhild Haugnes Waterloo will defend her thesis for the degree Ph.D. in the University of Tromsø Friday 8th November 2013. The topic is vertebral fractures in the sixth Tromsø study.

May 2013: Date and venue set for next NOREPOS workshop

This year’s NOREPOS workshop will take place 26-27 August in beautiful Malangen Brygger in Troms, approximately one hour drive from Langnes Airport in Tromsø. The program will be announced here.

NIPH website: “Risikoen for hoftebrudd faller, men fortsatt rundt 9000 brudd per år”

Read here

February 2012: Date and venue set for this year’s NOREPOS workshop

This year’s NOREPOS workshop will take place 20-21 September in Hurdalsjøen in Akershus, 30 minutes drive north of Gardermoen Airport. Please mark the dates in your calendar now! More information will be available soon.

February 2012: Norwegian data in FRAX®

We have contributed our nationwide data on hip fracture incidence to the World Health Organization’s Fracture Risk Assessment Tool. The calculation tool to estimate individual ten-year risk of fracture based on common risk factors is now adapted to Norwegian conditions. It can be found here.

Acknowledgements: Tone K. Omsland and Haakon E. Meyer on behalf of the NOREPOS collaboration

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