Dan Mellström

Sahlgrenska University Hospital, Goeteborg, Västra Götaland, Sweden

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Publications (257)1094.69 Total impact

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    ABSTRACT: We sought to determine whether specific characteristics of vertebral fractures in elderly men are associated with low bone mineral density (BMD) and osteoporosis. Mister osteoporosis Sweden is a population based cohort study involving 3014 men aged 69 to 81 years. Of these, 1427 had readable lateral radiographs of the thoracic and lumbar spine. Total body (TB) BMD (g/cm²) and total right hip (TH) BMD were measured by dual energy x-ray absorptiometry. The proportion of men with osteoporosis was calculated from TH BMD. There were 215 men (15.1%) with a vertebral fracture. Those with a fracture had lower TB BMD than those without (p < 0.001). Among men with a fracture, TB BMD was lower in those with more than three fractures (p = 0.02), those with biconcave fractures (p = 0.02) and those with vertebral body compression of > 42% (worst quartile) (p = 0.03). The mean odds ratio (OR) for having osteoporosis when having any type of vertebral fracture was 6.1 (95% confidence interval (CI) 3.9 to 9.5) compared with those without a fracture. A combination of more than three fractures and compression in the worst quartile had a mean OR of 114.2 (95% CI 6.7 to 1938.3) of having osteoporosis compared with those without a fracture. We recommend BMD studies to be undertaken in these subcohorts of elderly men with a vertebral fracture. Cite this article: 2015;97-B:1106-10. ©2015 The British Editorial Society of Bone & Joint Surgery.
    Bone and Joint Journal 08/2015; 97-B(8):1106-10. DOI:10.1302/0301-620X.97B8.35032
  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):529.2-530. DOI:10.1136/annrheumdis-2015-eular.1097 · 10.38 Impact Factor
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    ABSTRACT: The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population born in Sweden. Thus, the use of a FRAX® model in immigrants overestimates the risk of fracture, and the use of country of origin-specific models may be more appropriate. Age-specific fracture and mortality rates vary between countries so that FRAX tools are country-specific. In the case of immigrants, it is not known whether the model for the original or the new country is most appropriate. The aim of this study was to compare the incidence of hip fractures in foreign-born and Swedish-born individuals residing in Sweden. We studied the incidence of hip fracture in all men and women aged 50 years or more in Sweden between 1987 and 2002. The population comprised 2.8 million Swedish-born and 270,000 foreign-born individuals. Incident hip fractures occurred in 239,842 Swedish-born and 12,563 foreign-born individuals. The hip fracture incidence rose with age for both groups and was higher for women than men amongst both Swedish-born and foreign-born individuals. The hip fracture incidence for the Swedish-born cohort was approximately twice that of immigrants. For example, at the age of 70 years, the annual hip fracture incidence (per 100,000) was 450 (95 % CI 446-454) for a Swedish-born woman and 239 (95 % CI 223-257) for a foreign-born woman at the time of immigration. The hip fracture incidence rose slowly with time from immigration (0.6 % per annum, 95 % CI 0.5-0.8 %) but remained significantly lower than for Swedish-born individuals even after 40 years of residence. The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population native to Sweden. Although there was a small rise in age- and sex-specific incidence after immigration, the incidence remained markedly lower than that observed in Swedish-born individuals. Thus, the use of a FRAX model for Sweden will overestimate the risk of fracture for foreign-born individuals living in Sweden.
    Osteoporosis International 05/2015; DOI:10.1007/s00198-015-3180-4 · 4.17 Impact Factor
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    ABSTRACT: Context: Peak bone mass is an important factor for the lifetime risk of developing osteoporosis. Ways to predict bone development in young adulthood are lacking. Objective: and Main Outcome Measures: The aim of this study was to investigate whether baseline measurements of bone turnover markers (BTM) could predict bone development in early adulthood in men. Design, setting and participants: In total, 817 men (18.9±0.6 years, mean±SD, at baseline) from the population-based Gothenburg Osteoporosis and Obesity Determinants Study were included in this five-year longitudinal study. Areal BMD (aBMD) and BMC were measured using dual-energy absorptiometry (DXA), and volumetric BMD (vBMD) and cortical bone size were measured using peripheral quantitative computed tomography (pQCT). Blood samples were collected at the baseline visit, and levels of osteocalcin (OC) and NTX were analyzed. Results: OC was a positive predictor of the increase in aBMD and BMC of the total body (R(2) aBMD 6.6%; BMC 4.9%), lumbar spine (R(2) aBMD 5.4%; BMC 5.7%), and radius (R(2) aBMD 14.8%; BMC 12.8%) between 19 and 24 years (p<0.001). Men in the highest OC quartile at baseline (35.2±4.4 ng/mL, mean±SD) gained markedly more in radius cortical CSA (4.0±4.3 mm(2) vs. 1.9±2.9 mm(2)) and trabecular vBMD (11±7 mg/mm3 vs. 3±12 mg/mm(3)) than men in the lowest OC quartile at baseline (17.7±2.3 ng/mL, mean±SD) (p<0.001). Conclusion: A high OC level at the age of 19 predicts a favorable development in BMD, BMC, and bone size between 19-24 years of age.
    Journal of Clinical Endocrinology &amp Metabolism 01/2015; 100(4):jc20143947. DOI:10.1210/jc.2014-3947 · 6.31 Impact Factor
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    ABSTRACT: ContextIt is important to identify the patients at highest risk of fractures. A recent large-scale meta-analysis identified 63 autosomal SNPs associated with bone mineral density (BMD), of which 16 were also associated with fracture risk. Based on these findings two genetic risk scores (GRS63 and GRS16) were developed.Objective To determine the clinical usefulness of these GRS for the prediction of BMD, BMD change and fracture risk in elderly subjects.Design, Settings and ParticipantsTwo male (MrOS US, MrOS Sweden) and one female (SOF) large prospective cohorts of older subjects.Main Outcome MeasuresBMD, BMD change and radiographically and/or medically confirmed incident fractures (8,067 subjects, 2,185 incident non-vertebral or vertebral fractures).ResultsGRS63 was associated with BMD (≅3% of the variation explained), but not with BMD change.Both GRS63 and GRS16 were associated with fractures. After BMD-adjustment, the effect sizes for these associations were substantially reduced.Similar results were found using an unweighted GRS63 and an unweighted GRS16 compared to those found using the corresponding weighted risk scores.Only minor improvements in C-statistics (AUC) for fractures were seen when the GRSs were added to a base model (age, weight and height) and no significant improvements in C-statistics were seen when they were added to a model further adjusted for BMD. Net reclassification improvements with the addition of the GRSs to a base model were modest and substantially attenuated in BMD-adjusted models.Conclusions and RelevanceGRS63 is associated with BMD, but not BMD change, suggesting that the genetic determinants of BMD differ from those of BMD change. When BMD is known, the clinical utility of the two GRSs for fracture prediction is limited in elderly subjects. © 2014 American Society for Bone and Mineral Research
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 01/2015; 30(1). DOI:10.1002/jbmr.2314 · 6.59 Impact Factor
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    ABSTRACT: Objectives Blood haemoglobin (Hb) declines in elderly men while the adipocyte derived protein adiponectin increases with age. The association between erythropoesis and adiponectin in elderly men is incompletely known. The aim was to determine whether adipokines like adiponectin and leptin are associated with anaemia and Hb in elderly community dwelling men.Design/SettingThe Swedish-Gothenburg MrOS (Osteoporotic Fractures in Men) is a population-based study (n=1010 median age 75.3 years, range 69-81 years).Main Outcome MeasuresWe investigated the associations between adiponectin levels and Hb before and after adjusting for potential confounders (i.e. age, body composition, erythropoietin (EPO), total estradiol, leptin, cystatin C, iron- and B-vitamin status).ResultsIn these older men, age was negatively associated with Hb (r=-0.12, p<0.001) and positively associated adiponectin (r=0.13, p<0.001). In age-adjusted partial correlations, Hb correlated negatively with adiponectin (r=-0.20, p<0.001); this was still significant after multivariable adjustments for age, body composition, EPO, fasting insulin, sex hormones, leptin and ferritin. Anaemic men (66/1005) (Hb <130 g/L) had significantly higher age-adjusted mean adiponectin compared to non-anaemic men (14.0 μg/ml vs. 11.7 μg/ml, p<0.05). In multivariate analysis, adiponectin together with EPO, total estradiol, insulin, albumin, transferrin saturation, HDL-cholesterol, cystatin C, total body fat mass and free T4, but not leptin, explained 35% of the variation in Hb. These results remained after exclusion of men with diabetes.Conclusions Serum adiponectin, but not leptin, correlated negatively and independently with Hb and suggesting a possible role of adiponectin in the age-related Hb decline observed in apparently healthy elderly men.This article is protected by copyright. All rights reserved.
    Journal of Internal Medicine 12/2014; 278(1). DOI:10.1111/joim.12340 · 5.79 Impact Factor
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    ABSTRACT: Background The adrenal sex hormone dehydroepiandrosterone (DHEA), which is present in serum mainly as the sulfate DHEA-S, is the most abundant steroid hormone in human blood. Its levels decline dramatically with age. Despite the great amount of literature on vascular and metabolic actions of DHEA/-S, evidence for an association between DHEA/-S levels and cardiovascular events is contradictory. Objectives This study tested the hypothesis that serum DHEA and DHEA-S are predictors of major coronary heart disease (CHD) and/or cerebrovascular disease (CBD) events in a large cohort of elderly men. Methods We used gas and liquid chromatography-mass spectrometry to analyze baseline levels of DHEA and DHEA-S in the prospective population-based Osteoporotic Fractures in Men study in Sweden (2,416 men, ages 69 to 81 years). Complete cardiovascular clinical outcomes were available from national Swedish registers. Results During the 5-year follow-up, 302 participants experienced a CHD event, and 225 had a CBD event. Both DHEA and DHEA-S levels were inversely associated with the age-adjusted risk of a CHD event; the hazard ratios and 95% confidence intervals per SD increase were 0.82 (0.73 to 0.93) and 0.86 (0.77 to 0.97), respectively. In contrast, DHEA/-S showed no statistically significant association with the risk of CBD events. The association between DHEA and CHD risk remained significant after adjustment for traditional cardiovascular risk factors, serum total testosterone and estradiol, C-reactive protein, and renal function, and remained unchanged after exclusion of the first 2.6 years of follow-up to reduce reverse causality. Conclusions Low serum levels of DHEA and its sulfate predict an increased risk of CHD, but not CBD, events in elderly men.
    Journal of the American College of Cardiology 10/2014; 64(17):1801–1810. DOI:10.1016/j.jacc.2014.05.076 · 15.34 Impact Factor
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    ABSTRACT: Coffee, a major dietary source of caffeine, is among the most widely consumed beverages in the world and has received considerable attention regarding health risks and benefits. We conducted a genome-wide (GW) meta-analysis of predominately regular-type coffee consumption (cups per day) among up to 91 462 coffee consumers of European ancestry with top single-nucleotide polymorphisms (SNPs) followed-up in ~30 062 and 7964 coffee consumers of European and African-American ancestry, respectively. Studies from both stages were combined in a trans-ethnic meta-analysis. Confirmed loci were examined for putative functional and biological relevance. Eight loci, including six novel loci, met GW significance (log10Bayes factor (BF)>5.64) with per-allele effect sizes of 0.03-0.14 cups per day. Six are located in or near genes potentially involved in pharmacokinetics (ABCG2, AHR, POR and CYP1A2) and pharmacodynamics (BDNF and SLC6A4) of caffeine. Two map to GCKR and MLXIPL genes related to metabolic traits but lacking known roles in coffee consumption. Enhancer and promoter histone marks populate the regions of many confirmed loci and several potential regulatory SNPs are highly correlated with the lead SNP of each. SNP alleles near GCKR, MLXIPL, BDNF and CYP1A2 that were associated with higher coffee consumption have previously been associated with smoking initiation, higher adiposity and fasting insulin and glucose but lower blood pressure and favorable lipid, inflammatory and liver enzyme profiles (P<5 × 10(-8)).Our genetic findings among European and African-American adults reinforce the role of caffeine in mediating habitual coffee consumption and may point to molecular mechanisms underlying inter-individual variability in pharmacological and health effects of coffee.Molecular Psychiatry advance online publication, 7 October 2014; doi:10.1038/mp.2014.107.
    Molecular Psychiatry 10/2014; 20(5). DOI:10.1038/mp.2014.107 · 15.15 Impact Factor
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    ABSTRACT: Abstract Objective. The aim of this study was to test whether lower urinary tract symptoms (LUTS) and urinary incontinence are associated with the metabolic syndrome (MetS). The association between LUTS and benign prostatic enlargement (BPE) was also investigated. Material and methods. A cross-sectional, representative risk factor analysis of LUTS, as measured by the International Prostate Symptom Score (IPSS), and urinary incontinence was conducted. Among 950 representative individuals, aged 69-81 years, the association between clinical, anthropometric, endocrine, metabolic and inflammatory factors on the one hand, as both major and minor aspects of MetS, and LUTS and urinary incontinence, on the other hand, was analysed. The prostate gland volume was measured in a subgroup of 155 randomly selected individuals and the association between LUTS and BPE was estimated. Results. No significant association was found between LUTS or urinary incontinence and the major aspects of the MetS. However, in a multivariate analysis, serum serotonin showed an independent negative correlation with LUTS and with urinary incontinence while fasting serum glucose and serum adiponectin showed a positive correlation with LUTS. Furthermore, in a subgroup of 155 individuals, the prostate gland volume correlated positively with LUTS. Conclusions. The study did not show an association between LUTS or urinary incontinence and the major components of the MetS. However, serum serotonin showed an independent negative correlation with LUTS and with urinary incontinence while fasting serum glucose and serum adiponectin showed a positive correlation with LUTS. The data confirm the general knowledge that BPE may be one of the causative factors of LUTS.
    Scandinavian Journal of Urology 09/2014; 49(2):1-7. DOI:10.3109/21681805.2014.936495
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    ABSTRACT: The epidemiology, the fracture pattern and the clinical relevance of prevalent vertebral fractures in old men are debated wherefore we set out to clarify these issues.
    The spine journal: official journal of the North American Spine Society 09/2014; 15(2). DOI:10.1016/j.spinee.2014.09.016 · 2.80 Impact Factor
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    ABSTRACT: Previous studies have reported an association between exercises during youth and increased areal bone mineral density at old age. The primary aim of this study was to investigate if exercise during growth was independently associated with greater cortical bone size and whole bone strength in weight-bearing bone in old men. The tibia and radius were measured using both peripheral quantitative computed tomography (pQCT)(XCT-2000, Stratec) at the diaphysis and high-resolution pQCT (HR-pQCT)(XtremeCT, Scanco) at the metaphysis to obtain cortical bone geometry and finite element derived bone strength in distal tibia and radius, in 597 men, 79.9 ± 3.4 (mean ± SD) years old. A self-administered questionnaire was used to collect information about previous and current physical activity. In order to determine whether level of exercise during growth and young adulthood or level of current physical activity were independently associated with bone parameters in both tibia and radius, ANCOVA analyses were used. Adjusting for covariates and current physical activity we found that men in the group with the highest level of exercise early in life (regular exercise at competitive level) had higher tibial cortical cross-sectional area (CSA; 6.3%, p < 0.001) and periosteal circumference (PC; 1.6%, p = 0.011) at the diaphysis, and higher estimated bone strength (failure load (7.5%, p < 0.001) and stiffness (7.8%, p < 0.001)) at the metaphysis than men in the subgroup with the lowest level of exercise during growth and young adulthood. Subjects in the group with the highest level of current physical activity had smaller tibial endosteal circumference (EC, 3.6%, p = 0.012) at the diaphysis than subjects with a lower current physical activity, when adjusting for covariates and level of exercise during growth and young adulthood. These findings indicate that exercise during growth can increase the cortical bone size via periosteal expansion while exercise at old age may decrease endosteal bone loss in weight-bearing bone in old men. © 2014 American Society for Bone and Mineral Research.
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 08/2014; 29(8). DOI:10.1002/jbmr.2212 · 6.59 Impact Factor
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    ABSTRACT: Aims: Most previous prospective studies suggest that low serum insulin-like growth factor-I (IGF-I) associates with increased risk of cardiovascular disease (CVD) events while other studies suggest that high serum IGF-I associates with increased risk of CVD events. We tested the hypothesis that not only low, but also high, serum IGF-I associate with increased risk of CVD events in elderly men. Methods and Results: Serum IGF-I levels were measured in 2901 elderly men (aged 69 to 81 years) included in the prospective population-based MrOS-Sweden cohort. Data for CVD events were obtained from national Swedish registers with no loss of follow-up. During follow-up (median 5.1 yrs) 589 of the participants experienced a CVD event. The association between serum IGF-I and risk of CVD events was nonlinear, and restricted cubic spline Cox regression analysis revealed a U-shaped association between serum IGF-I levels and CVD events (p<0.01 for nonlinearity). Low as well as high serum IGF-I (quintile 1 or 5 vs. quintiles 2-4) significantly associated with increased risk for CVD events (hazard ratio (HR) = 1.25, 95% confidence interval (CI) 1.02-1.54; and HR = 1.35, 95% CI 1.10-1.66, respectively). These associations remained after adjustment for prevalent CVD and multiple risk factors. High serum IGF-I associated with increased risk of coronary heart disease (CHD) events but not with risk of cerebrovascular events. Conclusion: Both low and high serum IGF-I levels are risk markers for CVD events in elderly men. The association between high serum IGF-I and CVD events is mainly driven by CHD events.
    Journal of Clinical Endocrinology &amp Metabolism 07/2014; 99(11):jc20141575. DOI:10.1210/jc.2014-1575 · 6.31 Impact Factor
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    ABSTRACT: Cortical porosity increases with age and affects bone strength, but its association with fracture in older men is unknown. The aim of this study was to investigate whether cortical porosity is associated with prevalent fractures in older men. A subsample of 456 men aged 80.2 ± 3.5 (mean ± SD) years, with available high resolution peripheral quantitative computed tomography measurements at the tibia from the 5-year follow up exam, was drawn from the prospective MrOS Gothenburg study. Dual-energy x-ray absorptiometry was used to measure areal bone mineral density (aBMD). Data on physical activity, calcium intake, medications, diseases, and smoking were collected on questionnaires at the follow-up exam. Of 87 men (19.1%) with fracture at or after age 50 (all fracture group), 52 (11.4%) had had a self-reported fracture before the baseline exam and 35 (7.7%) had had an x-ray verified fracture between baseline and follow-up. Men in the all-fracture group and in the x-ray verified group had 15.8% (13.2 ± 4.9 vs.11.4 ± 3.8%; p < 0.001) and 21.6% (14.1 ± 5.2 vs.11.6 ± 3.9%; p < 0.01) higher cortical porosity, respectively, than men in the non-fracture group. The independent associations between bone microstructure parameters and fracture were tested using multivariate logistic regression with age, height, weight, calcium intake, smoking, physical activity, medications, and diseases as covariates. Cortical porosity was independently associated with any fracture (reported or x-ray verified; OR per SD increase: 1.49; 95% confidence interval (CI): 1.17-1.90) and with any x-ray verified fracture alone (OR: 1.73; 95% CI: 1.23-2.42). Including aBMD (spine or hip, respectively) in the multivariate logistic regression above revealed that cortical porosity was associated with any fracture (OR: 1.54; 95% CI: 1.17-2.01) and with x-ray verified fracture alone (OR: 1.49; 95% CI: 1.00-2.22). Cortical porosity was associated with prevalence of fracture even after adjustment for aBMD. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Clinical Densitometry 07/2014; 17(3):417. DOI:10.1016/j.jocd.2014.04.068 · 1.60 Impact Factor
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    ABSTRACT: Serum adiponectin is a risk factor for fracture. The predictive value attenuates with time in elderly men so that its use for the risk assessment in the long term is questionable. The study underlines the importance of testing the long-term stability of potential risk factors. Introduction High serum adiponectin is associated with an increased risk of fracture in elderly men. The aim of the present study was to determine the impact of adiponectin on the probability of fracture as a function of time. Methods The probability of osteoporotic fracture was computed in 989 elderly men from the MrOS study in Sweden. Baseline data included clinical risk factors for fracture, femoral neck BMD and serum adiponectin. Men were followed for up to 7.4 years with a mean follow up of 5.3 years (range 0.0–7.4 years). Poisson regression was used to model the hazard function for osteoporotic fracture and death to determine the 10 year probability of fracture. Results During follow up, 124 men sustained one or more osteoporotic fracture. There was a significant interaction between adiponectin and time since baseline (p = 0.026) such that the longer time since baseline, the lower the gradient of fracture risk. When using this interaction in the calculation of 10-year probability of fracture, the probabilities of osteoporotic fracture varied little over the range of adiponectin values. Conclusion Serum adiponectin is a risk factor for fracture. Nevertheless, the predictive value attenuates with time so that its use for the risk assessment in the long term is questionable. This study underlines the importance of testing the long-term stability of potential risk factors that might be used in fracture risk assessment.
    Osteoporosis International 07/2014; 25(7). DOI:10.1007/s00198-014-2654-0 · 4.17 Impact Factor
  • Journal of Clinical Densitometry 07/2014; 17(3):400. DOI:10.1016/j.jocd.2014.04.012 · 1.60 Impact Factor
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    ABSTRACT: Background Low plasma 25-hydroxyvitamin D (25[OH]D) concentration is associated with high arterial blood pressure and hypertension risk, but whether this association is causal is unknown. We used a mendelian randomisation approach to test whether 25(OH)D concentration is causally associated with blood pressure and hypertension risk. Methods In this mendelian randomisation study, we generated an allele score (25[OH]D synthesis score) based on variants of genes that affect 25(OH)D synthesis or substrate availability (CYP2R1 and DHCR7), which we used as a proxy for 25(OH)D concentration. We meta-analysed data for up to 108 173 individuals from 35 studies in the D-CarDia collaboration to investigate associations between the allele score and blood pressure measurements. We complemented these analyses with previously published summary statistics from the International Consortium on Blood Pressure (ICBP), the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, and the Global Blood Pressure Genetics (Global BPGen) consortium. Findings In phenotypic analyses (up to n=49 363), increased 25(OH)D concentration was associated with decreased systolic blood pressure (β per 10% increase, −0·12 mm Hg, 95% CI −0·20 to −0·04; p=0·003) and reduced odds of hypertension (odds ratio [OR] 0·98, 95% CI 0·97—0·99; p=0·0003), but not with decreased diastolic blood pressure (β per 10% increase, −0·02 mm Hg, −0·08 to 0·03; p=0·37). In meta-analyses in which we combined data from D-CarDia and the ICBP (n=146 581, after exclusion of overlapping studies), each 25(OH)D-increasing allele of the synthesis score was associated with a change of −0·10 mm Hg in systolic blood pressure (−0·21 to −0·0001; p=0·0498) and a change of −0·08 mm Hg in diastolic blood pressure (−0·15 to −0·02; p=0·01). When D-CarDia and consortia data for hypertension were meta-analysed together (n=142 255), the synthesis score was associated with a reduced odds of hypertension (OR per allele, 0·98, 0·96—0·99; p=0·001). In instrumental variable analysis, each 10% increase in genetically instrumented 25(OH)D concentration was associated with a change of −0·29 mm Hg in diastolic blood pressure (−0·52 to −0·07; p=0·01), a change of −0·37 mm Hg in systolic blood pressure (−0·73 to 0·003; p=0·052), and an 8·1% decreased odds of hypertension (OR 0·92, 0·87—0·97; p=0·002). Interpretation Increased plasma concentrations of 25(OH)D might reduce the risk of hypertension. This finding warrants further investigation in an independent, similarly powered study.
    The Lancet Diabetes & Endocrinology 06/2014; DOI:10.1016/S2213-8587(14)70113-5 · 9.19 Impact Factor
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    ABSTRACT: Leukocyte telomere length (LTL) is related to the aging of somatic cells. We hypothesized that LTL is inversely associated with mortality in elderly men. LTL was measured in 2744 elderly men (mean age 75.5, range 69-81 years) included in the prospective population-based MrOS-Sweden study. Mortality data were obtained from national health registers with no loss of follow-up. During the follow-up (mean 6.0years), 556 (20%) of the participants died. Using Cox proportional hazards regression, tertile of LTL did not associate with all-cause mortality [tertile 1 (shortest) or 2 (middle) vs. tertile 3 (longest); hazard ratio (HR)=1.05, 95% confidence interval (CI) 0.85-1.28 and HR=0.97, 95% CI 0.79-1.19, respectively]. Furthermore, LTL did not associate with cancer (197 events) or cardiovascular disease (CVD, 206 events) mortality (tertile 1 vs. tertile 3; HR=0.94, 95% CI 0.67-1.34 and HR=0.94, 95% CI 0.68-1.30, respectively). The lack of association between LTL and mortality remained also after adjustment for multiple covariates. Our results demonstrate that LTL is not associated with all-cause mortality or mortality due to cancer or CVD in elderly men. Further studies are needed to determine whether LTL can predict the risk of mortality in elderly women.
    Experimental gerontology 04/2014; 57. DOI:10.1016/j.exger.2014.04.013 · 3.53 Impact Factor
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    ABSTRACT: Context: Blood hemoglobin (Hb) declines with age in healthy elderly men, in whom decreasing testosterone has been regarded as part of normal ageing. However, the association between Hb and serum estradiol is incompletely known. Objective: To determine whether estradiol is associated with anemia/Hb and established determinants of Hb in elderly men without prostate cancer. Design, Setting and Participants: The MrOS (Osteoporotic Fractures in Men) is a population-based study (n=918, median age 75.3 years, range 70-81 years). Main Outcome Measures: We evaluated total estradiol in relation to Hb and adjusted for potential confounders (i.e. age, body mass index (BMI), erythropoietin (EPO), total testosterone, cystatin C, iron- and B-vitamin status). Results: Estradiol correlated negatively with age (r=-0.14, p<0.001). Hb correlated (age adjusted) positively with estradiol (r=0.21, p<0.001) and testosterone (r=0.10, p<0.01). Independent predictors for Hb in multivariate analyses were estradiol, EPO, BMI, transferrin saturation, cystatin C and free T4 but not testosterone. After exclusion of subjects with Hb <130g/L and/or testosterone <8 nmol/L (n=99), the correlation between Hb and testosterone was no longer significant, whereas the associations between Hb and estradiol remained. After adjusting for age, BMI and EPO, men with lower estradiol levels were more likely to have Hb in the lowest quartile of values [OR per SD decrease in estradiol = 1.61 (95% CI 1.34-1.93)]. Anemic subjects (Hb <130 g/L) had lower mean estradiol than non-anemic (67.4 vs 79.4 pmol/L, p<0.001). Conclusions: Estradiol correlated, positively and independently, with Hb. Decreased estradiol might partly explain the age-related Hb decline observed in healthy elderly men.
    The Journal of Clinical Endocrinology and Metabolism 04/2014; 99(7):jc20134111. DOI:10.1210/jc.2013-4111 · 6.31 Impact Factor
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    ABSTRACT: Context: The key role of serum estradiol (E2) for bone health in men is well established. The effect of serum sex steroids on bone microstructure, measured by high-resolution peripheral quantitative computed tomography (HRpQCT), remains unknown in elderly men. Objective: To examine the associations between serum sex steroids and bone microstructural parameters in older men. Methods: Trabecular and cortical bone microstructure at the tibia was measured by HRpQCT in 440 men (mean 80 years of age) participating in the population-based MrOS Sweden cohort. Serum levels of E2 and testosterone (T) were analyzed with mass spectrometry and free E2 and free T levels were calculated using law-of-mass-action equations. Results: Age-adjusted models demonstrated that E2 and free E2 but not T or free T associated significantly inversely with cortical porosity. The associations between E2 and free E2 and cortical porosity remained significant after further adjustment for height, weight, physical activity, calcium intake and smoking. Models including both serum E2 and T demonstrated that E2 (standardized beta= -0.12, P<0.05) but not T associated independently with cortical porosity. A similar independent association was found for free E2 (standardized beta= -0.12, P<0.05) but not free T. Free E2 associated significantly with trabecular bone volume fraction in age-adjusted models but this association did not remain significant after further adjustment. Conclusions: Serum E2 levels associated inversely with cortical porosity in 80-year-old men. We propose that low serum E2 may reduce cortical bone strength, at least partly by increasing cortical porosity, and, thereby, increase fracture risk in older men.
    The Journal of Clinical Endocrinology and Metabolism 04/2014; 99(7):jc20141319. DOI:10.1210/jc.2014-1319 · 6.31 Impact Factor

Publication Stats

6k Citations
1,094.69 Total Impact Points

Institutions

  • 1990–2014
    • Sahlgrenska University Hospital
      • • Department of Cardiology
      • • Department of Geriatrics
      • • Department of Urology
      • • Department of Infectious Diseases
      Goeteborg, Västra Götaland, Sweden
  • 1982–2014
    • University of Gothenburg
      • • Institute of Medicine
      • • Centre for Bone and Arthritis Research (CBAR) (1)
      • • Department of Obstetrics and Gynecology
      • • Department of Pathology
      Goeteborg, Västra Götaland, Sweden
  • 2011
    • Lund University
      • Department of Clinical Sciences, Malmö
      Lund, Skåne, Sweden
  • 2008
    • Uppsala University Hospital
      • Department of Surgical Sciences
      Uppsala, Uppsala, Sweden
  • 1993
    • Akademiska Sjukhuset
      Uppsala, Uppsala, Sweden