Per Gärdsell

Predicting fractures in women by using forearm bone densitometry

SummaryIn 1,076 women the forearm bone mineral content (BMC) had been measured with single photon gamma absorptiometry (SPA) 10–16 years ago. The incidence of fractures incurred in the ensuing years (1975–1985) was recorded. The BMC had been significantly less in those women who were to have the types of fractures that are related to bone fragility but only in women measured during the first post-menopausal decades. From age 50–69, diminished BMC at the distal forearm site was associated with a threefold increase of relative risk whereas at the proximal site there was about a sixfold increase in relative risk. This association was not evident in the pppulation over 70 years of age because of a high frequency of fractures (mostly of the spine) in subjects with relatively high BMC values. Body weight and grip strength were significantly lower in the fracture group over 70 years of age

Soccer after anterior cruciate ligament injury - An incompatible combination? A national survey of incidence and risk factors and a 7-year follow-up of 310 players

All players in Swedish soccer teams are required to have insurance in the same company. From the archives of the insurance company, all 3,735 injuries reported in 1986 in 188,152 Swedish soccer players were reviewed. Of these, 937 were knee injuries. All players were asked by mail to fill in a questionnaire and 83 percent replied. The patient records from the different hospitals were requested. The anterior cruciate injuries represented one third of the reported knee injuries. The relative risk of sustaining an anterior cruciate ligament injury was increased in female players, in elite players, and in players in the forward position. The odds ratios were 1.6 (1.3-2.1), 3.3 (1.7-6.1) and 1.8 (1.4-2.5), respectively. The injuries occurred at a younger age in females than in males. 50 percent of the injured players were treated with anterior cruciate ligament surgery, predominantly as a reconstructive procedure, with use of a patellar tendon transplant. 30 (20) percent of the players with anterior cruciate ligament injury were active in soccer after 3 (7) years, compared to 80 (50) percent of an injured control population of soccer players. None of the elite players was active at the same level after 7 years. A comparison of anterior cruciate ligament-injured players, whether treated by surgical reconstruction or not, revealed no difference with regard to the proportion of players still playing soccer after 7 years.

The Prevalence of Gonarthrosis and Its Relation to Meniscectomy in Former Soccer Players

The prevalence of radiographic signs of gonarthrosis and its relation to knee injuries were studied in 286 former soccer players—215 nonelite and 71 elite players—and were compared with 572 age-matched controls with a mean age of 55 years. The prevalence of gonarthrosis among the nonelite players was 4.2%, among the elite players 15.5%, and among the controls 1.6%. Seven of the soccer players had known anterior cruciate ligament injuries, and 40 had had meniscec tomies. Of the 32 nonelite players with knee injuries, 4 (13%) had gonarthrosis, and of the 183 without known knee injuries 5 (3%) had gonarthrosis. Among the elite players, the prevalence of gonarthrosis in knees without diagnosed injuries was 11 %. We conclude that soccer, especially at an advanced level, is associated with an increased risk for gonarthrosis. After excluding subjects with known knee injuries, there was no difference be tween nonelite players and controls, but we found a higher rate of gonarthrosis among the elite players.

The predictive value of bone loss for fragility fractures in women: A longitudinal study over 15 years

SummaryFifteen 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.

Prevalence of coxarthrosis in former soccer players: 286 players compared with matched controls

We compared the occurrence of coxarthrosis in 286 male former soccer players in Malmö with a mean age of 55 years with an age-matched control group. During the last decades about one fifth in both groups had been referred to hip radiography. Coxarthrosis occurred in 5.6 percent of the former soccer players and in 2.8 percent of the control group (P 0.04). Among the 71 élite soccer players the prevalence of coxarthrosis was 14 percent compared with 4.2 percent in age-matched controls and non-élite players. Elite soccer players apparently run an increased risk of developing coxarthrosis.

Predicting various fragility fractures in women by forearm bone densitometry: A follow-up study

SummaryThis 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.

A School Curriculum–Based Exercise Program Increases Bone Mineral Accrual and Bone Size in Prepubertal Girls: Two-Year Data From the Pediatric Osteoporosis Prevention (POP) Study†

This 2‐year prospective controlled exercise intervention trial in 99 girls at Tanner stage 1, evaluating a school curriculum–based training program on a population‐based level, showed that the annual gain in BMC, aBMD, and bone size was greater in the intervention group than in the controls.

Daily Physical Education in the School Curriculum in Prepubertal Girls during 1 Year is Followed by an Increase in Bone Mineral Accrual and Bone Width—Data from the Prospective Controlled Malmö Pediatric Osteoporosis Prevention Study

The aim of this study was to evaluate a general school-based 1-year exercise intervention program in a population-based cohort of girls at Tanner stage I. Fifty-three girls aged 7–9 years were included. The school curriculum-based exercise intervention program included 40 minutes/school day. Fifty healthy age-matched girls assigned to the general school curriculum of 60 minutes physical activity/week served as controls. Bone mineral content (BMC, g) and areal bone mineral density (aBMD, g/cm2) were measured with dual X-ray absorptiometry (DXA) of the total body (TB), lumbar spine (L2–L4 vertebrae), third lumbar vertebra (L3), femoral neck (FN), and leg. Volumetric bone mineral density (g/cm3) and bone width were calculated at L3 and FN. Total lean body mass and total fat mass were estimated from the TB scan. No differences at baseline were found in age, anthropometrics, or bone parameters when the groups were compared. The annual gain in BMC was 4.7 percentage points higher in the lumbar spine and 9.5 percentage points higher in L3 in cases than in controls (both P < 0.001). The annual gain in aBMD was 2.8 percentage points higher in the lumbar spine and 3.1 percentage points higher in L3 in cases than in controls (both P < 0.001). The annual gain in bone width was 2.9 percentage points higher in L3 in cases than in controls (P < 0.001). A general school-based exercise program in girls aged 7–9 years enhances the accrual of BMC and aBMD and increases bone width.

The predictive value of forearm bone mineral content measurements in men

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.

The predictive value of fracture, disease, and falling tendency for fragility fractures in women.

SummaryIn 1,076 women who had been interviewed from 1970 to 1976 with regard to previous fracture and disease, all fragility fractures that occurred from 1975 to 1985 were recorded. Hip and vertebral fractures were good predictors of future fragility fractures but mainly in younger women (<70 years) and this was also the case for fracture of the distal end of the forearm in the age group 40–59. Later in life, falling tendency became the important predictor.