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Background Giant cell arteritis (GCA) is the most common systemic vasculitis in persons older than 50 years. The highest incidence rates of the disease have been reported in Scandinavian countries. Our objective was to determine the epidemiology of GCA in an expected high-incidence region during a 41-year period. Methods This is a hospital-based, retrospective, cohort study. Patients diagnosed with GCA in Bergen health area during 1972–2012 were identified through computerized hospital records (n = 1341). Clinical information was extracted from patients’ medical journals, which were reviewed by a standardized method. We excluded patients if data were unavailable (n = 253), if the reviewing rheumatologist found GCA to be an implausible diagnosis (n = 207) or if the American College of Rheumatology (ACR) 1990 classification criteria for GCA were not fulfilled (n = 89). Descriptive methods were used to characterize the sample. Incidence was analyzed by graphical methods and Poisson regression. Results A total of 792 patients were included. The average annual cumulative incidence of GCA was 16.7 (95% CI 15.5-18.0) per 100,000 of the population ≥ 50 years old. The corresponding incidence for biopsy-verified GCA was 11.2 (95% CI 10.2–12.3). The annual cumulative incidence increased with time in the period 1972–1992 (relative risk (RR) 1.1, p  < 0.001) but not in 1993–2012 (RR 1.0, p  = 0.543). The incidence was higher in women compared to men (average annual incidence 37.7 (95% CI 35.8–39.6) vs. 14.3 (95% CI 13.2–15.5), p  < 0.001) with women having a twofold to threefold higher incidence rate throughout the study period. Average annual incidence increased with age until the 7th decade of life in both sexes throughout the study period (2.8 (95% CI 2.3–3.3) for age <60, 15.5 (95% CI 14.4–16.8) for age 60–69, 34.5 (95% CI 32.8–36.4) for age 70–79 and 26.8 (95% CI 25.3-28.4) for age ≥80 years, p  < 0.001 for all age adjustments). Conclusions Our study confirms an incidence of GCA comparable to previous reports on Scandinavian populations. Our results show increasing incidence from 1972 through 1992, after which the incidence has levelled out.

Background Our objective was to determine the survival and causes of death in a large and well-characterized cohort of patients with giant cell arteritis (GCA). Methods This is a hospital-based, retrospective, observational cohort study including patients diagnosed with GCA in Western Norway during 1972–2012. Patients were identified through computerized hospital records using the International Classification of Diseases (ICD)-coding system. Medical records were reviewed. Patients were randomly assigned population controls matched on age, sex, and geography from the Central Population Registry of Norway (CPRN). Date and cause of death were obtained from the Norwegian Cause of Death Registry (NCoDR). The survival was analyzed using Kaplan-Meier methods with the Gehan-Breslow test and the causes of death using cumulative incidence and Cox models for competing risks. Results We identified 881 cases with a clinical diagnosis of GCA of which 792 fulfilled the American College of Rheumatology (ACR) 1990 classification criteria. Among those fulfilling the ACR criteria, 528 were also biopsy-verified. Cases were matched with 2577 population controls. A total of 490 (56%) GCA patients and 1517 (59%) controls died during the study period. We found no difference in the overall survival of GCA patients compared to controls, p  = 0.413. The most frequent underlying causes of death in both groups were diseases of the circulatory system followed by cancer. GCA patients had increased risk of dying of circulatory disease (HR 1.31, 95% CI 1.13–1.51, p  < 0.001) but lower risk of dying of cancer (HR 0.56, 95% CI 0.42–0.73, p  < 0.001) compared to population controls. Conclusions We found no difference in the overall survival of GCA patients compared to matched controls, but there were differences in the distribution of underlying death causes.

Summary Vitamin K2 may preserve bone strength and reduce fracture risk. In this randomised double-blind placebo-controlled trial among healthy postmenopausal Norwegian women, 1 year supplementation of vitamin K2 in the form of Natto capsules had no effect on bone loss rates. Introduction Japanese studies indicate that vitamin K2 (menaquinone-7 (MK-7)) intake may preserve bone strength, but this has not been documented in Europeans. The aim of this study was to assess the effect of MK-7 on bone mineral density (BMD) changes in postmenopausal Norwegian women. Methods Three hundred thirty-four healthy women between 50 and 60 years, 1-5 years after menopause, were recruited to a randomised double-blind placebo-controlled trial. The participants were randomly assigned into two groups, one receiving 360 µg MK-7 in the form of Natto capsules and the other the same amount of identical-looking placebo capsules containing olive oil. BMD was measured at total hip, femoral neck, lumbar spine and total body at baseline and 12 months together with serum levels of bone-specific alkaline phosphatase, Crosslaps, total osteocalcin (N-mid OC), carboxylated (cOC) and under-carboxylated osteocalcin (ucOC). Results After 12 months, there were no statistical differences in bone loss rates between the groups at the total hip or any other measurement site. Serum levels of cOC increased and ucOC decreased in the treatment versus the placebo group (p < 0.001). Conclusion MK-7 taken as Natto over 1 year reduced serum levels of ucOC but did not influence bone loss rates in early menopausal women.

Summary The previously reported decline in age-adjusted hip fracture rates in Norway during 1999–2008 continued after 2008. The annual number of hip fractures decreased in women and increased in men. Introduction Norway has among the highest hip fracture incidence rates ever reported despite previously observed declining rates from 1999 through 2008. The aim of the present study was to investigate whether this downward trend continued through 2013, and to compare gender-specific trends in 5 year age-groups during three time periods: 1999–2003, 2004–2008, and 2009–2013. Methods All hip fractures (cervical, trochanteric, and sub-trochanteric) admitted to Norwegian hospitals were retrieved. Annual age-standardized incidence rates of hip fracture per 10,000 person-years by gender were calculated for the period 1999–2013. Time trends were tested by age-adjusted Poisson regression. Results From 1999 through 2013 there were 140,136 hip fractures in persons aged 50 years and above. Age-adjusted hip fracture incidence rates declined by 20.4 % (95 % CI: 18.6–20.1) in women and 10.8 % (95 % CI: 7.8–13.8) in men, corresponding to an average annual age-adjusted decline of 1.5 % in women and 0.8 % in men. Except for the oldest men, hip fracture rates declined in all age-groups 70 years and older. The average annual number of fractures decreased in women (−0.3 %) and increased in men (+1.1 %). Conclusions During the past 15 years, hip fracture rates have declined in Norway. The forecasted growing number of older individuals might, however, cause an increase in the absolute number of fractures, with a substantial societal economic and public health burden.

Summary One third of 218 men and half of 1,576 women with low-energy distal radius fractures met the bone mineral density (BMD) criteria for osteoporosis treatment. A large proportion of patients with increased fracture risk did not have osteoporosis. Thus, all distal radius fracture patients ≥50 years should be referred to bone densitometry. Introduction Main objectives were to determine the prevalence of patients with a low-energy distal radius fracture in need of osteoporosis treatment according to existing guidelines using T-score ≤ −2.0 or ≤−2.5 standard deviation (SD) and calculate their fracture risk. Methods A total of 218 men and 1,576 women ≥50 years were included. BMD was assessed by dual energy X-ray absorptiometry (DXA) at femoral neck, total hip, and lumbar spine (L2-L4). The WHO fracture risk assessment tool (FRAX®) was applied to calculate the 10-year fracture risk. Results T-scores ≤−2.0 and ≤−2.5 SD at femoral neck was found in 37.7% and 19.6% of men and 51.1% and 31.2% of women, respectively. The risk of hip fracture was 6.2% for men and 9.0% for women. The corresponding figures for patients with T-score ≤−2.0 SD were 11.6% and 14.5% and for T-score ≤−2.5 SD 16.3% and 18.2%, respectively. A large proportion of distal radius fracture patients with a high 10-year FRAX® risk did not have osteoporosis. Conclusions Every second to every third fracture patient met the present BMD criteria for osteoporosis treatment. Because a large proportion of distal radius fracture patients did not have osteoporosis, treatment decisions should not be based on fracture risk assessment without bone densitometry. Thus, all distal radius fracture patients ≥50 years should be referred to bone densitometry, and if indicated, offered medical treatment.

Fig. 2 Fig. 2 Fig. 2 Annual cumulative incidence of giant cell arteritis (American College of Rheumatology (ACR) criteria fulfilled) in Bergen health area 1972–2012. ESR, erythrocyte sedimentation rate Table 2 The incidence of giant cell arteritis (GCA) in Bergen health area 1972–2012 a Mean annual cumulative incidence All time 1972–1992 1993–2012 Cumulative incidence 95% CI Cumulative incidence 95% CI Cumulative incidence 95% CI All patients 16.7 (15.5, 18.0) 11.2 (9.8, 12.7) 22.5 (20.5, 24.7) Sex Female 22.0 (20.6, 23.5) 13.3 (11.8, 14.9) 31.2 (28.8, 33.7) Male 10.5 (9.5, 11.5) 8.6 (7.4, 9.9) 12.4 (10.9, 14.0) Age, years < 60 2.8 (2.3, 3.3) 1.5 (1.0, 2.1) 4.1 (3.3, 5.0) 60–69 15.5 (14.4, 16.8) 10.9 (9.6, 12.4) 20.3 (18.4, 22.4) 70–79 34.5 (32.8, 36.4) 23.4 (21.4, 25.6) 46.2 (43.3, 49.2) 80+ 26.8 (25.3, 28.4) 14.3 (12.8, 16.0) 39.9 (37.2, 42.7) ESR, mm/hr ESR < 85 8.2 (7.3, 9.1) 4.5 (3.7, 5.5) 12.0 (10.6, 13.6) ESR > 85 8.4 (7.6, 9.3) 6.6 (5.5, 7.7) 10.4 (9.0, 11.8) b Relative risk (RR) according to time, sex, age and ESR 1972–1992 1993–2012 RR 95% CI p-value RR 95% CI p-value Unadjusted Time (years) 1.1 (1.1, 1.1) < 0.001 1.0 (1.0, 1.0) 0.543 Sex Time (years) 1.1 (1.1, 1.1) < 0.001 1.0 (1.0, 1.0) 0.462 Sex (Male vs. Relative risk calculated according to Poisson regression models for the two timeperiods 1972–1992 and 1993–2012 ESR Erythrocyte sedimentation rate CI Confidence interval Notes The original article can be found online at https://doi.org/10.1186/s13075-017-1479-6 Declarations Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Older hip fracture patients often have reduced muscle mass, which is associated with adverse outcomes. Dual energy X-ray absorptiometry (DXA) can determine muscle mass, but is not practical in the acute phase. We investigated bioelectrical impedance analysis (BIA) and anthropometry compared against DXA for detecting low muscle mass in hip fracture patients. This was a cross-sectional validation study at two Norwegian hospitals on 162 hip fracture patients aged ≥ 65 years. Appendicular lean mass (ALM) was determined by DXA, BIA and anthropometry 3 months after hip fracture. ALM by BIA was calculated by the Kyle, Janssen, Tengvall and Sergi equations, and ALM by anthropometry by the Heymsfield and Villani equations. The area under the receiver operating characteristic curve (AUC) was used to compare BIA and anthropometry for determining low ALM (≤5.67 kg/m2 for women and ≤7.25kg/m2 for men). Mean age was 79 years (SD 7.9), 74% were female. Mean ALM by DXA was 14.8 kg (SD 2.3) for women and 20.8 kg (SD 4.2) for men and 45% of women and 60% of men had low ALM. BIA (Kyle) in women (AUC 0.81, 95% confidence interval 0.72–0.89) and BIA (Sergi) in men (AUC 0.89, 95% CI 0.80–0.98) were best able to discriminate between low and normal ALM. Anthropometry (Heymsfield) was less accurate than BIA in women (AUC 0.64, 95% CI 0.54–0.75), and equal to BIA in men (AUC 0.72, 95% CI 0.72 0.56–0.87). BIA (Sergi, Kyle and Tengvall) and anthropometry (Heymsfield) can identify low muscle mass in hip fracture patients.

Summary The present study investigated the risk of incident hip fractures according to serum concentrations of vitamin K 1 and 25-hydroxyvitamin D in elderly Norwegians during long-term follow-up. The results showed that the combination of low concentrations of both vitamin D and K 1 provides a significant risk factor for hip fractures. Introduction This case-cohort study aims to investigate the associations between serum vitamin K 1 and hip fracture and the possible effect of 25-hydroxyvitamin D (25(OH)D) on this association. Methods The source cohort was 21,774 men and women aged 65 to 79 years who attended Norwegian community-based health studies during 1994–2001. Hip fractures were identified through hospital registers during median follow-up of 8.2 years. Vitamins were determined in serum obtained at baseline in all hip fracture cases ( n  = 1090) and in a randomly selected subcohort ( n  = 1318). Cox proportional hazards regression with quartiles of serum vitamin K 1 as explanatory variable was performed. Analyses were further performed with the following four groups as explanatory variable: I: vitamin K 1  ≥ 0.76 and 25(OH)D ≥ 50 nmol/l, II: vitamin K 1  ≥ 0.76 and 25(OH)D < 50 nmol/l, III: vitamin K 1  < 0.76 and 25(OH)D ≥ 50 nmol/l, and IV: vitamin K 1  < 0.76 and 25(OH)D < 50 nmol/l. Results Age- and sex-adjusted analyses revealed an inverse association between quartiles of vitamin K 1 and the risk of hip fracture. Further, a 50 % higher risk of hip fracture was observed in subjects with both low vitamin K 1 and 25(OH)D compared with subjects with high vitamin K 1 and 25(OH)D (HR 1.50, 95 % CI 1.18–1.90). The association remained statistically significant after adjusting for body mass index, smoking, triglycerides, and serum α-tocopherol. No increased risk was observed in the groups low in one vitamin only. Conclusion Combination of low concentrations of vitamin K 1 and 25(OH)D is associated with increased risk of hip fractures.

Summary The cytokine interferon gamma (IFN-γ) stimulates neopterin release and tryptophan degradation into kynurenines through the kynurenine pathway. High levels of neopterin were associated with increased hip fracture risk, as were some of the kynurenines, suggesting a role of IFN-γ-mediated inflammation in the processes leading to hip fracture. Introduction Low-grade systemic inflammation has been associated with bone loss and risk of fractures. Interferon gamma (IFN-γ) initiates macrophage release of neopterin and also stimulates degradation of tryptophan along the kynurenine pathway as part of cell-mediated immune activation. Plasma neopterin and the kynurenine/tryptophan ratio (KTR) are thus markers of IFN-γ-mediated inflammation. Risk of hip fracture was investigated in relation to markers of inflammation and metabolites in the kynurenine pathway (kynurenines). Methods Participants (71 to74 years, N  = 3,311) in the community-based Hordaland Health Study (HUSK) were followed for hip fractures from enrolment (1998–2000) until 31 December 2009. Plasma C-reactive protein (CRP), neopterin, KTR, and six kynurenines were investigated as predictors of hip fracture, using Cox proportional hazards regression analyses. Results A hazard ratio (HR) of 1.9 (95 % confidence interval (CI) 1.3–2.7) for hip fracture was found in the highest compared to the lowest quartile of neopterin ( p trend across quartiles <0.001). CRP and KTR were not related to hip fracture risk. Among the kynurenines, a higher risk of fracture was found in the highest compared to the lowest quartiles of anthranilic acid and 3-hydroxykynurenine. For subjects in the highest quartiles of neopterin, CRP, and KTR compared to those in no top quartiles, HR was 2.5 (95 % CI 1.6–4.0). Conclusions This may indicate a role for low-grade immune activation in the pathogenic processes leading to hip fracture.

Summary One third of 218 men and half of 1,576 women with low-energy distal radius fractures met the bone mineral density (BMD) criteria for osteoporosis treatment. A large proportion of patients with increased fracture risk did not have osteoporosis. Thus, all distal radius fracture patients ≥50 years should be referred to bone densitometry. Introduction Main objectives were to determine the prevalence of patients with a low-energy distal radius fracture in need of osteoporosis treatment according to existing guidelines using T-score ≤ −2.0 or ≤−2.5 standard deviation (SD) and calculate their fracture risk. Methods A total of 218 men and 1,576 women ≥50 years were included. BMD was assessed by dual energy X-ray absorptiometry (DXA) at femoral neck, total hip, and lumbar spine (L2–L4). The WHO fracture risk assessment tool (FRAX®) was applied to calculate the 10-year fracture risk. Results T-scores ≤−2.0 and ≤−2.5 SD at femoral neck was found in 37.7% and 19.6% of men and 51.1% and 31.2% of women, respectively. The risk of hip fracture was 6.2% for men and 9.0% for women. The corresponding figures for patients with T-score ≤−2.0 SD were 11.6% and 14.5% and for T-score ≤−2.5 SD 16.3% and 18.2%, respectively. A large proportion of distal radius fracture patients with a high 10-year FRAX® risk did not have osteoporosis. Conclusions Every second to every third fracture patient met the present BMD criteria for osteoporosis treatment. Because a large proportion of distal radius fracture patients did not have osteoporosis, treatment decisions should not be based on fracture risk assessment without bone densitometry. Thus, all distal radius fracture patients ≥50 years should be referred to bone densitometry, and if indicated, offered medical treatment.