The Hordaland Health Study (HUSK) – Osteoporosis substudy

Bergen (photo: Tomoyoshi Noguchi)

The Hordaland Health Study was conducted 1997-2000 as a population-based study, including about 26000 adult and elderly participants. Among these, ca. 7000 participants born 1925-27 and 1950-51 were invited to participate in the Osteoporosis substudy. Of these, 2237 of the oldest and 3140 of the youngest cohorts met for bone mineral density measurements. They attended a health examination including measurements of blood pressure, height and weight. Blood samples were drawn (serum, plasma and whole blood samples are stored), and the participants provided information concerning lifestyle, use of medication and background variables by self-administered questionnaires. In addition, a 169-item food frequency questionnaire was filled in, providing detailed information on dietary habits during the previous year.

More information about HUSK can be found here.

Bone mineral density (BMD) was measured using a stationary, dual x-ray densitometer (EXPERT-XL; Lunar Company Inc). In addition to hip scan of bone mineral density, whole body BMD and body composition were assessed. Women in the cohort born 1950-51 were invited to a second BMD measurement two years after the first measurement. Around 1900 of these women met for the first measurement, 1500 for the second.

Computerized discharge diagnoses records for all hospitals in Hordaland County were searched for hip fracture diagnoses. Each diagnosis was confirmed by an adequate surgical procedure code. The first fracture of proximal femoral neck occurring between study inclusion and the date of diagnosis extraction was used. The first collection of hip fracture data took place in November 2005, the second in December 2009. Due to very few hip fractures in the youngest cohort (47-49 years at inclusion), this cohort has so far not been included in the hip fracture studies.

The osteoporosis study in HUSK has given rise to studies on the association between BMD and homocystein (1), and on BMD and vitamins K1 and K2 (2). In another study, BMD in the study population versus BMD in the reference population provided by the densitometer manufacturer was investigated (3). The impact of lean mass and fat mass on BMD has also been studied (4).

The risk of hip fracture has been studied in relation to plasma homocystein, folate and vitamin B12 in one study (5) and in relation to dietary vitamins K1 and K2 in another (6).

One PhD degree has been completed based on data from the osteoporosis part of HUSK (7). A second PhD student and a post doctor are currently working with these data.

In addition to osteoporosis research within HUSK, investigators have participated in other studies on BMD and fractures with collaborators both within the NOREPOS research collaboration (8-14), as well as other, external collaborators (15,16), e.g. on BMD after jejunoileal bypass (17), and the effect of glucorticoid substitution on bone in primary adrenal insufficiency (Addison’s disease) (18). Among other studies on bone health from Bergen is the SPOR study where about 750 persons with distal radius fractures took part. Risk of fracture in relation to BMD and vitamin D-status was investigated (19-21) and resulted in a PhD degree (22).

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Publications

Last updated October 2011

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Scientific papers and dissertations

1. Gjesdal CG, Vollset SE, Ueland PM, Refsum H, Drevon CA, Gjessing HK, Tell GS. Plasma total homocysteine level and bone mineral density: the Hordaland Homocysteine Study. Arch Intern Med 2006;166(1):88-94.

2. Apalset EM, Gjesdal CG, Eide GE, Johansen A-MW, Drevon CA, Tell GS. Dietary vitamins K1, K2 and bone mineral density: the Hordaland Health Study. Arch Osteoporos 2010;DOI 10.1007/s11657-010-0036-6.

3. Gjesdal CG, Aanderud SJ, Haga HJ, Brun JG, Tell GS. Femoral and whole-body bone mineral density in middle-aged and older Norwegian men and women: suitability of the reference values. Osteoporos Int 2004;15(7):525-34.

4. Gjesdal CG, Halse JI, Eide GE, Brun JG, Tell GS. Impact of lean mass and fat mass on bone mineral density: The Hordaland Health Study. Maturitas 2008;59(2):191-200.

5. Gjesdal CG, Vollset SE, Ueland PM, Refsum H, Meyer HE, Tell GS. Plasma homocysteine, folate, and vitamin B 12 and the risk of hip fracture: the Hordaland homocysteine study. J Bone Miner Res 2007;22(5):747-56.

6. Apalset EM, Gjesdal CG, Eide GE, Tell GS. Intake of vitamin K1 and K2 and risk of hip fractures: The Hordaland Health Study. Bone 2011;49(5):990-5.

7. Gjesdal CG. Epidemiologic studies of osteoporosis in Hordaland. University of Bergen, 2007. ISBN 978-82-308-0451-3.

8. Emaus N, Gjesdal CG, Almås B, Christensen M, Grimsgaard AS, Berntsen GK, Salomonsen L, Fønnebø V. Vitamin K2 supplementation does not influence bone loss in early menopausal women: a randomised double-blind placebo-controlled trial. Osteoporos Int 2010;21(10):1731-40.

9. Forsén L, Berntsen GK, 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(9):615-24.

10. 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. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 2011;26(4):850-6.

11. Omsland TK, Gjesdal CG, Emaus N, Tell GS, Meyer HE. Regional differences in hip bone mineral density levels in Norway: the NOREPOS study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2009;20(4):631-8.

12. Omsland TK, Schei B, Grønskag AB, Langhammer A, Forsén L, Gjesdal CG, Meyer HE. Weight loss and distal forearm fractures in postmenopausal women: the Nord-Trøndelag health study, Norway. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2009;20(12):2009-16.

13. Meyer HE, Berntsen GK, Søgaard AJ, Langhammer A, Schei B, Fønnebø V, Forsmo S, Tell GS. Higher bone mineral density in rural compared with urban dwellers: the NOREPOS study. Am J Epidemiol 2004;160(11):1039-46.

14. Søgaard AJ, Gustad TK, Bjertness E, Tell GS, Schei B, Emaus N, Meyer HE. Urban-rural differences in distal forearm fractures: Cohort Norway. Osteoporos Int 2007;Mar 1.

15. Elshorbagy AK, Gjesdal CG, Nurk E, Tell GS, Ueland PM, Nygård O, Tverdal A, Vollset SE, Smith AD, Refsum H. Cysteine, homocysteine and bone mineral density: a role for body composition? Bone 2009;44(5):954-8.

16. Omland LM, Tell GS, Ofjord S, Skag A. Risk factors for low bone mineral density among a large group of Norwegian women with fractures. European Journal of Epidemiology 2000;16(3):223-9.

17. VÃ¥ge V, Gjesdal CG, Eide GE, Halse JI, Viste A. Bone mineral density in females after jejunoileal bypass: a 25-year follow-up study. Obesity surgery 2004;14(3):305-12.

18. LøvÃ¥s K, Gjesdal CG, Christensen M, Wolff AB, AlmÃ¥s B, Svartberg J, Fougner KJ, Syversen U, Bollerslev J, Falch JA, Hunt PJ, Chatterjee VK, Husebye ES. Glucocorticoid replacement therapy and pharmacogenetics in Addison’s disease: effects on bone. European journal of endocrinology / European Federation of Endocrine Societies 2009;160(6):993-1002.

19. Øyen J, Apalset EM, Gjesdal CG, Brudvik C, Lie SA, Hove LM. Vitamin D inadequacy is associated with low-energy distal radius fractures: a case-control study. Bone 2011;48(5):1140-5.

20. Øyen J, Brudvik C, Gjesdal CG, Tell GS, Lie SA, Hove LM. Osteoporosis as a risk factor for distal radial fractures: a case-control study. The Journal of bone and joint surgery. American volume 2011;93(4):348-56.

21. Øyen J, Gjesdal CG, Brudvik C, Hove LM, Apalset EM, Gulseth HC, Haugeberg G. Low-energy distal radius fractures in middle-aged and elderly men and women-the burden of osteoporosis and fracture risk : A study of 1794 consecutive patients. Osteoporos Int 2010;21(7):1257-67.

22. Øyen J. Low-energy fracture of the distal radius in middle-aged and elderly Norwegian women and men. University of Bergen 2011. ISBN 978-82-308-1706-3.