Skip to main content
SpringerLink
Log in

Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

We studied the nature of the relationship between bone mineral density (BMD) and the risk of death among elderly men. BMD was associated with mortality risk and was independent of adjustments for other co-morbidities. A piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020). Low BMD was associated with a substantial excess risk of death, whilst a higher than average BMD had little impact on mortality.

Introduction

Previous studies have demonstrated an association between low BMD and an increased risk of death among men and women. The aim of the present study was to examine the pattern of the risk in men and its relation to co-morbidities.

Methods

We studied the nature of the relationship between BMD and death among 3,014 elderly men drawn from the population and recruited to the MrOS study in Sweden. Baseline data included general health questionnaires, life style questionnaires and BMD measured using DXA. Men were followed for up to 6.5 years (average 4.5 years). Poisson regression was used to investigate the relationship between BMD, co-morbidities and the hazard function of death.

Results

During follow-up, 382 men died (all-cause mortality). Low BMD at all measured skeletal sites was associated with increased mortality. In multivariate analyses, the relationship between BMD and mortality was non-linear, and a piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020).

Conclusions

Low BMD is associated with a substantial excess risk of death compared to an average BMD, whereas a higher than average BMD has a more modest effect on mortality. These findings, if confirmed elsewhere, have implications for the constructing of probability-based fracture risk assessment tools.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. World Health Organisation (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO technical report series 843. WHO, Geneva

    Google Scholar 

  2. Kanis JA, on behalf of the World Health Organization Scientific Group (2008) Assessment of osteoporosis at the primary health-care level. Technical report. WHO Collaborating Centre, University of Sheffield, UK

    Google Scholar 

  3. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br Med J 312:1254–1259

    CAS  Google Scholar 

  4. Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ 3rd, O'Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194

    Article  PubMed  Google Scholar 

  5. Browner WS, Seeley DG, Vogt TM, Cummings SR (1991) Non-trauma mortality in elderly women with low bone mineral density. Study of osteoporotic fractures research group. Lancet 338:355–358

    Article  PubMed  CAS  Google Scholar 

  6. Johansson C, Black D, Johnell O, Oden A, Mellstrom D (1998) Bone mineral density is a predictor of survival. Calcif Tissue Int 63:190–196

    Article  PubMed  CAS  Google Scholar 

  7. von der Recke P, Hansen MA, Hassager C (1999) The association between low bone mass at the menopause and cardiovascular mortality. Am J Med 106:273–278

    Article  PubMed  Google Scholar 

  8. Trivedi DP, Khaw KT (2001) Bone mineral density at the hip predicts mortality in elderly men. Osteoporos Int 12:259–265

    Article  PubMed  CAS  Google Scholar 

  9. Van Der Klift M, Pols HA, Geleijnse JM, Van Der Kuip DA, Hofman A, De Laet CE (2002) Bone mineral density and mortality in elderly men and women: the Rotterdam study. Bone 30:643–648

    Article  Google Scholar 

  10. Mussolino ME, Madans JH, Gillum RF (2003) Bone mineral density and mortality in women and men: the NHANES I epidemiologic follow-up study. Ann Epidemiol 13:692–697

    Article  PubMed  Google Scholar 

  11. Pinheiro MM, Castro CM, Szejnfeld VL (2006) Low femoral bone mineral density and quantitative ultrasound are risk factors for new osteoporotic fracture and total and cardiovascular mortality: a 5-year population-based study of Brazilian elderly women. J Gerontol A Biol Sci Med Sci 61:196–203

    PubMed  Google Scholar 

  12. Mussolino ME, Gillum RF (2008) Low bone mineral density and mortality in men and women: the Third National Health and Nutrition Examination survey linked mortality file. Ann Epidemiol 18:847–850

    Article  PubMed  Google Scholar 

  13. Suzuki T, Yoshida H (2009) Low bone mineral density at femoral neck is a predictor of increased mortality in elderly Japanese women. Osteoporos Int 21:71–79

    Article  PubMed  Google Scholar 

  14. Nguyen ND, Center JR, Eisman JA, Nguyen TV (2007) Bone loss, weight loss, and weight fluctuation predict mortality risk in elderly men and women. J Bone Miner Res 22:1147–1154

    Article  PubMed  Google Scholar 

  15. Orwoll E, Blank JB, Barrett-Connor E, Cauley J, Cummings S, Ensrud K, Lewis C, Cawthon PM, Marcus R, Marshall LM, McGowan J, Phipps K, Sherman S, Stefanick ML, Stone K (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study—a large observational study of the determinants of fracture in older men. Contemp Clin Trials 26:569–585

    Article  PubMed  Google Scholar 

  16. Mellstrom D, Vandenput L, Mallmin H, Holmberg AH, Lorentzon M, Oden A, Johansson H, Orwoll ES, Labrie F, Karlsson MK, Ljunggren O, Ohlsson C (2008) Older men with low serum estradiol and high serum SHBG have an increased risk of fractures. J Bone Miner Res 23:1552–1560

    Article  PubMed  Google Scholar 

  17. Mellstrom D, Johnell O, Ljunggren O, Eriksson AL, Lorentzon M, Mallmin H, Holmberg A, Redlund-Johnell I, Orwoll E, Ohlsson C (2006) Free testosterone is an independent predictor of BMD and prevalent fractures in elderly men: MrOS Sweden. J Bone Miner Res 21:529–535

    Article  PubMed  Google Scholar 

  18. Lewis CE, Ewing SK, Taylor BC, Shikany JM, Fink HA, Ensrud KE, Barrett-Connor E, Cummings SR, Orwoll E (2007) Predictors of non-spine fracture in elderly men: the MrOS study. J Bone Miner Res 22:211–219

    Article  PubMed  Google Scholar 

  19. Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489

    Article  PubMed  CAS  Google Scholar 

  20. Lu Y, Fuerst T, Hui S, Genant HK (2001) Standardization of bone mineral density at femoral neck, trochanter and Ward's triangle. Osteoporos Int 12:438–444

    Article  PubMed  CAS  Google Scholar 

  21. Washburn RA, Smith KW, Jette AM, Janney CA (1993) The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 46:153–162

    Article  PubMed  CAS  Google Scholar 

  22. Breslow NE, Day NE (1987) Statistical methods in cancer research. Volume II—the design and analysis of cohort studies. IARC Sci Publ 82:1–406

    Google Scholar 

  23. Good P (ed) (2000) Permutation tests. Springer, New York

    Google Scholar 

  24. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473

    Article  PubMed  CAS  Google Scholar 

  25. Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E (2009) FRAX and its applications to clinical practice. Bone 44:734–743

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gibraltargatan 1C, 411 32, Gothenburg, Sweden

    H. Johansson, A. Odén, M. Lorentzon, C. Ohlsson & D. Mellström

  2. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    J. Kanis & E. McCloskey

  3. Department of Medical Sciences, University of Uppsala, Uppsala, Sweden

    Ö. Ljunggren

  4. Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden

    M. K. Karlsson

  5. Department of Orthopaedics, Malmö University Hospital, Malmö, Sweden

    M. K. Karlsson

  6. Bone and Mineral Unit, Oregon Health and Sciences University, Portland, OR, USA

    E. Orwoll

  7. Wallenberg Laboratory for Cardiovascular Research, Institute of Medicine, University of Gothenberg, Gothenberg, Sweden

    Å. Tivesten

Authors
  1. H. Johansson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Odén
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Kanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. McCloskey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Lorentzon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ö. Ljunggren
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. K. Karlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Orwoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Å. Tivesten
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C. Ohlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. D. Mellström
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Johansson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johansson, H., Odén, A., Kanis, J. et al. Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden. Osteoporos Int 22, 1411–1418 (2011). https://doi.org/10.1007/s00198-010-1331-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-010-1331-1

Keywords

Search

Navigation