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  • 1. Benetou, V
    et al.
    Orfanos, P
    Pettersson-Kymmer, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Kariologi.
    Berrino, F
    Tumino, R
    Borch, K B
    Lund, E
    Peeters, P H M
    Grote, V
    Li, K
    Altzibar, J M
    Key, T
    Boeing, H
    von Ruesten, A
    Norat, T
    Wark, P A
    Riboli, E
    Trichopoulou, A
    Mediterranean diet and incidence of hip fractures in a European cohort2013Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 24, nr 5, s. 1587-1598Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men. INTRODUCTION: Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries. METHODS: A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders. RESULTS: Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI) = 0.89-0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR = 0.86; 95 % CI = 0.79-0.94) and high fruit (HR = 0.89; 95 % CI = 0.82-0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR = 1.18; 95 % CI = 1.06-1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate = 1.74; 95 % CI = 1.32-2.31) was also a risk factor. CONCLUSIONS: In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.

  • 2.
    Bergström, Ulrica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Jonsson, H
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Olofsson, B
    Pettersson, U
    Svensson, O
    Serial fractures - age and fracture site important predictors for a second fracture: results from 13-years population based dataManuskript (Annet vitenskapelig)
  • 3.
    Englund, Undis
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nilsson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Pettersson Kymmer, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk farmakologi.
    Active commuting reduces the risk of wrist fractures in middle-aged women: the UFO study2013Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 24, nr 2, s. 533-540Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus.

    INTRODUCTION: Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture.

    METHODS: The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years.

    RESULTS: Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk.

    CONCLUSION: This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.

  • 4.
    Farhang, Mehdy
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Mukka, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Sayed-Noor, Arkan S.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    The trend of radiological severity of hip fractures over a 30 years period: a cohort study2019Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 20, nr 1, artikkel-id 358Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Despite advances in operative techniques and preoperative care, proximal femur fractures (PFF) still represent a great public health problem. Displacement and fracture stability have been assumed as important determinants of treatment modality and outcome in such fractures. Purpose of this study was to determine whether the radiological severity of PFF fractures has increased over time.

    METHODS: In a cohort study, the plain radiographs of all patients with PFF aged over 50 years who were admitted to Umeå University Hospital in 1981/82, 2002 and 2012 were recruited to examine the types of fractures.

    RESULTS: The ratio of undisplaced to displaced femoral neck (FN) fractures was 30 to 70% in 1981/82, 28 to 72% in 2002 and 25 to 75% in 2012. The ratio of stable to unstable intertrochanteric (IT) fractures was 64 to 36% in 1981/82, 68 to 32% in 2002 and 75 to 25% in 2012. The ratio of simple to comminute subtrochanteric fractures was 35 to 65% in 1981/82, 16 to 84% in 2002 and 12 to 88% in 2012. In both FN and IT fractures we found no statistical difference among these 3 study periods, p = 0.67 and p = 0.40. In subtrochanteric fractures we saw a tendency towards more comminute subtrochanteric fractures (1981/82 to 2012), p = 0.09.

    CONCLUSIONS: We found no significant increment in the radiological severity of FN and IT over a 30 years' period. However, there was tendency towards an increase in comminute subtrochanteric fractures.

  • 5.
    Ferry, Tomas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hedström, Erik M
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Zeisig, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Epidemiology of acute knee injuries seen at the Emergency Department at Umeå University Hospital, Sweden, during 15 years2014Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 22, nr 5, s. 1149-1155Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To describe the incidence and injury distribution of knee injuries in the general population of a European setting. METHODS: Retrospective study of all knee injuries registered at the Emergency Department at Umeå University Hospital, Sweden, during 1995-2009 in relation to age, sex, diagnosis, location and activity at the time of injury, mechanism of injury, and treatment and/or follow-up plan. RESULTS: During 1995-2009, 12,663 knee injuries were registered, 8 % of all injuries. The incidence of knee injuries resulting in a visit to the Emergency Department was six cases per 1,000 person years. One-third of all injuries occurred during sports. And 30 % were 15-24 years. More men than women were injured during sporting activities and women were mostly injured during transportation. CONCLUSION: Knee injuries in a general population are common and the injury distribution varies with age and sex. Sports activities and young age were prominent features of the injured population. LEVEL OF EVIDENCE: IV.

  • 6. Gordins, Vladislavs
    et al.
    Hovelius, Lennart
    Sandström, Björn
    Rahme, Hans
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Risk of arthropathy after the Bristow-Latarjet repair: a radiologic and clinical thirty-three to thirty-five years of follow-up of thirty-one shoulders2015Inngår i: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 24, nr 5, s. 691-699Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Transfer of the coracoid (Bristow-Latarjet [B-L]) is used to stabilize anterior shoulder instability. We report the long-term results of our first 31 operations with this method.

    MATERIALS AND METHODS: Thirty-six patients (mean age, 26.7 years) had a B-L repair from 1977 to 1979. Five patients died, and during 2012 to 2013, the remaining 31 shoulders had a follow-up with questionnaire, physical examination, Western Ontario Shoulder Instability Index, Subjective Shoulder Value, Subjective Assessment of Shoulder Function, subjective assessment of loss of motion, and radiologic imaging.

    RESULTS: One patient required revision surgery because of recurrence and another because of repeat dislocation. Six patients reported subluxations. Eighteen patients (58%) were very satisfied, and 13 (42%) were satisfied. The mean Western Ontario Shoulder Instability Index score (100 possible) was 85, and the median score was 93. According to Samilson-Prieto classification of arthropathy of the shoulder, 39% were classified as normal, 27% as mild, 23% as moderate, and 11% as severe. The classification of arthropathy varied with observers and radiologic views. Age younger than 22 years at the primary dislocation meant less arthropathy at follow-up (P = .045).

    CONCLUSION: The degree of arthropathy 33 to 35 years after the B-L repair seems to follow the natural history of shoulder dislocation with respect to arthropathic joint degeneration. Postoperative restriction of external rotation does not increase later arthropathy.

  • 7.
    Hedström, Erik M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Michno, Piotr
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Injuries in children and adolescents: analysis of 41,330 injury related visits to an emergency department in northern Sweden2012Inngår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 43, nr 9, s. 1403-1408Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: We present an overview of the injuries seen at the emergency department of a regional hospital in northern Sweden and the variations in the injury pattern with age, sex and time. Methods: Data consisting of all injuries sustained by those 0–19 years of age seen at the emergency department of Umeå University Hospital between 1998 and 2008 (41,330 injury events) were analysed with respect to injury type, mechanism, activity, age and sex. Rates were calculated using population data from Statistics Sweden. Results: The rate of injury related visits to the emergency department was 110/1000 person years. The most common causes of visits to the emergency department were minor injuries such as contusions, abrasions and open wounds. 12% of the injuries resulted in admission to a ward. Variations in type of injury, mechanism and activity at injury were noted, in particular with age, but also with sex. We noted a 31% rate increase of visits to the hospital's emergency department between 1998 and 2008, rate ratio 1.31 (1.27–1.38). There was no significant increase in the rate of injuries resulting in hospitalisation. Conclusions: Our results give an estimate of the rate of all injuries and subsets of injuries resulting in visits to the only hospital emergency department within a well defined catchment area. It was not possible to determine whether the increased rate of visits to the ED was due to an increase in the actual rate of injuries within the catchment area. The variations seen in different age groups reflect the hazards associated with different periods in growth and the ability to cope with these. The results point to areas where improved preventive measures may be implemented or where further research may be of value

  • 8.
    Hedström, Erik M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Michno, Piotr
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Epidemiology of fractures in children and adolescents2010Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 81, nr 1, s. 148-153Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose Fractures are most common in youth and in the elderly, with differences in incidence over time and between regions. We present the fracture pattern in a population of youths 19 years of age, who were seen at Umeå University Hospital, Sweden.

    Material and methods All injuries seen at the hospital have been recorded in a database since 1993. The data include variables such as age, sex, date, type of injury, mechanism of injury, and treatment. For the period 1993–2007, there were 10,203 injury events that had resulted in at least 1 fracture.

    Results The incidence for the whole period was 201/104 person years. The incidence increased by 13% during the period 1998–2007, when we were able to control for registration errors. The most common fracture site was the distal forearm. The most common type of injury mechanism was falling. The peak incidence occurred at 11–12 years in girls and at 13–14 years in boys, with a male-to-female incidence ratio of 1.5. We found variations in mechanisms and activities at injury with age, and over time.

    Interpretation Fractures are caused by a combination of intrinsic and extrinsic factors that vary with age. We believe the increase in incidence is partly explained by changes in children's activity patterns over time. Further research may help to identify preventive measures to reduce the number of fractures, in particular those involving hospital care, surgical treatment, and—most importantly—long-term impairment.

    Read More: http://informahealthcare.com/doi/abs/10.3109/17453671003628780

  • 9.
    Hedström, Erik M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Michno, Piotr
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Epidemiology of fractures in children and adolescents: Increased incidence over the past decade: a population-based study from northrn Sweden2010Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 81, nr 1, s. 148-153Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose Fractures are most common in youth and in the elderly, with differences in incidence over time and between regions. We present the fracture pattern in a population of youths <= 19 years of age, who were seen at Umeå University Hospital, Sweden. Material and methods All injuries seen at the hospital have been recorded in a database since 1993. The data include variables such as age, sex, date, type of injury, mechanism of injury, and treatment. For the period 1993-2007, there were 10,203 injury events that had resulted in at least 1 fracture. Results The incidence for the whole period was 201/10<sup>4</sup> person years. The incidence increased by 13% during the period 1998-2007, when we were able to control for registration errors. The most common fracture site was the distal forearm. The most common type of injury mechanism was falling. The peak incidence occurred at 11-12 years in girls and at 13-14 years in boys, with a male-to-female incidence ratio of 1.5. We found variations in mechanisms and activities at injury with age, and over time. Interpretation Fractures are caused by a combination of intrinsic and extrinsic factors that vary with age. We believe the increase in incidence is partly explained by changes in children's activity patterns over time. Further research may help to identify preventive measures to reduce the number of fractures, in particular those involving hospital care, surgical treatment, and-most importantly-long-term impairment.

  • 10.
    Pettersson-Kymmer, Ulrika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Lacroix, Andrea
    Eriksson, Joel
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Melin, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Wibom, Carl
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Vandenput, Liesbeth
    Rajaraman, Preetha
    Hartge, Patricia
    Chanock, Stephen
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Duggan, David
    Kooperberg, Charles
    Handelman, Samuel
    Aragaki, Aaron
    Nethander, Maria
    Uitterlinden, Andre
    Rivadeneira, Fernando
    Jackson, Rebecca
    Ohlsson, Claes
    Genome-wide association study meta-analysis identifies the SOAT1/AXDND1 locus to be associated with hip and forearm fracture risk2013Inngår i: Bone Abstracts, 2013, Vol. 1Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Hip and forearm fractures are the two clinically most important non-vertebral fractures. Twin studies have demonstrated a high heritability of these fractures and the heritable component of fracture risk is largely independent of BMD. To identify common genetic variants associated with hip and forearm fractures, we performed a genome-wide association study (GWAS ~ 2.5 million SNPs) meta-analysis of two large fracture data sets within the well-characterized UFO cohort (UFO-hip; 1014 hip fractures and 862 controls, and UFO-forearm; 1060 forearm fractures and 1055 controls). All fractures were confirmed through radiographic reports. Replication was performed in the Women’s Health Initiative (WHI) cohort (1845 hip fractures verified by medical records and 2120 controls). We identified one SNP within the SOAT1/AXDND1 locus (1q25.2) that was associated with fracture risk at genome wide significance (OR per allele=1.33; P=3.1×10−8) in the UFO discovery meta-analysis. This SNP was associated with fracture risk both in the WHI replication cohort (OR 1.16, P=2.1×10−3) and in the combined analyses comprising 7956 subjects (3919 cases and 4037 controls; OR=1.24, P=5.6×10−10). However, it was not associated with BMD or biochemical bone markers, suggesting that its association with fractures is BMD-independent. A genetic score (GS), including information from 63 SNPs earlier shown to be reproducibly associated with BMD, was significantly associated with both hip (P=7.9×10−4) and forearm (P=8.6×10−5) fractures. Models including both the SNP in the SOAT1/AXDND1 locus and the GS demonstrated that the impact of the SNP in the SOAT1/AXDND1 locus on fracture risk was independent of the BMD-associated GS. In summary, both a BMD-associated GS and a non-BMD associated genetic variant in the SOAT1/AXDND1 locus are associated with hip and forearm fractures.

  • 11.
    Pohl, Petra
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Nordin, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lundquist, Anders
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years: a prospective long-term follow-up study2014Inngår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 14, nr 1, s. 120-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls.

    METHODS: Community-dwelling individuals 75-93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, ≥2 non-injurious falls, and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls.

    RESULTS: During the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40-5.50) compared to those with no falls. No other group showed an increased risk.

    CONCLUSIONS: In community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall.

  • 12.
    Rantapää-Dahlqvist, Solbritt
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wiberg, K.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi. Östersunds Reumatikersjukhus, Östersund, Sweden.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Öhman, M.-L.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Increased incidence of low-energy fractures in RA patients from northern Sweden2014Inngår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 43, nr Suppl. 127, Meeting Abstract: PP154, s. 43-44Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Periarticular bone loss is an early sign of joint involvement in rheumatoid arthritis (RA) (1). Patients with RA also have an increased generalized bone loss with development of osteoporosis. Osteoporosis and related fractures constitute an important extra-articular complication in RA. Osteoporosis per se is a known risk factor for fracture in the general population. In addition to general background factors (e.g. old age, low body mass, female gender, immobility) treatment with glucocorticoids and disease activity increase the risk of fractures in osteoporotic patients with RA (1, 2). However, the incidence of fracture is not well explored. The aim of this study was to estimate the incidence of low-energy fractures in RA patients identified within a population-based register of fractures in northern Sweden.

    Method: The register of patients with RA (1987 ACR criteria), consecutively included since 1995 (n = 1178), was co-analysed with the Umeå register of injury data base with regard to low-energy fractures. This data base was constructed in 1993 and covers six districts with a population of 118 000 at-risk adults. All individuals admitted to the emergency ward with fractures are included consecutively. The individuals in this study were followed until fracture or to 1 January 2011. The standard incidence ratio (SIR) was calculated. SIR calculations were performed using the method of indirect standardization relative to the standard population of the geographic origin as the RA patients. Confidence intervals were obtained by treating the observed number of events as Poisson variables with expectation equal to the expected number.

    Results: Among the RA patients, 329 individuals (246 females and 83 males) were identified with a fracture. The corresponding figures among the controls were 14 102 females and 13 313 males with fractures. The odds ratio (OR) for a fracture in the RA patients was 1.38 (95% CI 1.21–1.57) in females and 1.85 (95% CI 1.46–2.32) in males. Stratification for age showed an increased SIR in the individuals aged > 65 years: OR 1.41 (95% CI 1.20–1.64) in females and OR 1.97 (95% CI 1.48–2.57) inmales. The highest SIR was for hip fracture (females OR 2.51, 95% CI 1.21–4.61 and males OR 3.95, 95% CI 1.28–9.23), with a similar mean age for cases and controls (72–75 years). The duration of time from diagnosis of RA to the first fracture was, during the follow-up, mean (SD) 18.7 (14.0) years in females and 14.4 (11.7) years in males. The RA patients had a similar frequency of fractures indoors as outdoors compared with controls, who had a significantly higher frequency of fractures outdoors.

    Conclusions: RA is associated with a higher incidence of fractures. Stratification for age showed increased SIR in those above 65 years of age. The highest SIR was for hip fractures in both females and males.

  • 13.
    Röding, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lysholm, Jack
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Trauma recidivism at an emergency department of a Swedish medical center2016Inngår i: Injury Epidemiology, ISSN 0176-3733, E-ISSN 2197-1714, Vol. 3, artikkel-id 22Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: To inform targeted prevention, we studied patterns of trauma recidivism and whether a first injury predicts the risk for a recurrent injury.

    METHODS: In a population-based study of 98,502 adult injury events 1999-2012, at the emergency department of Umeå University Hospital, Sweden, we compared non-recidivists with recidivists in terms of patients' sex, age, type of injury and severity of the injury.

    RESULTS: Thirty-six percent of all patients suffered recurrent injuries, which were associated with a higher proportion of inpatient care and more hospital days. Young men and elderly women were at the highest risk for trauma recidivism. At 20 to 24 years, men had a 2.4 (CI 95 % 2.3-2.5) higher risk than women, a 90 years old woman had almost a 10-fold higher risk for another moderate/severe injury than a 20 years old one. A fracture were associated with a hazard ratio of 1.28 (CI 95 % 1.15-1.42) among men younger than 65 years and 1.31 (CI 95 % 1.12-1.54) for men older than 65 years for a subsequent moderate/severe injury. For women younger than 65 years a fracture was associated with a hazard ratio of 1.44 (CI 95 % 1.28-1.62) for a subsequent moderate/severe injury. A sprain carries a higher risk for a new moderate/severe injury for both men and women and in both age groups; the hazard ratio was 1.13 (CI 95 % 1.00-1.26) for men younger than 65 years, 1.42 (CI 95 % 1.01-1.99) for men older than 65 years, 1.19 (CI 95 % 1.05-1.35) for women younger than 65 years and 1.26 (CI 95 % 1.02-1.56) for women older than 65 years. A higher degree of injury severity was associated with a higher risk for a new moderate/severe injury.

    CONCLUSION: Trauma recidivism is common and represents a large proportion of all injured. Age and sex are associated with the risk for new injury. Injury types and severity, also have implications for future injury.

  • 14.
    Röding, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Bergström, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lysholm, Jack
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Epidemiologic patterns of injuries treated at the emergency department of a Swedish medical center2015Inngår i: Injury Epidemiology, ISSN 0176-3733, E-ISSN 2197-1714, Vol. 2, nr 3, s. ?-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The injury spectrum published in the literature has mainly been presented for a certain age group, as elderly or for a certain type of injury, as fracture and often restricted to in-hospital care cases. Our objective was to give an overview of the major types of injuries for all age groups and trends in the adult population.

    Methods: We analyzed 68,159 adult injury events, which occurred between 1999 and 2008  and was treated at the Emergency Department of Umea University Hospital. All these injuries are registered in a database. The injuries were analyzed depending on frequency, type of injury, and activity at the time of injury. Incidence rates were calculated using population data from Statistics Sweden.

    Results: Injury event incidence varied between 614 (2004) and 669 (2007) per 10,000 persons. The most common injury was a fracture, although contusions and wounds were also frequent. Fractures were responsible for almost three quarters of hospital days related to injury. The risk for fractures increased with age, as did contusions and concussions, whereas sprains decreased with age. Fracture incidence increased among the 50- to 59-year age group for both women and men. Fall-related injuries increased significantly for middle-aged adults. Sports-related and work injuries decreased, while injuries occurring during leisure time increased the most.

    Conclusion: A fracture is the most frequent type of injury for adults and accounts for the largest proportion of the trauma care burden. Contusions are also common and responsible for a significant proportion of the in-hospital days. Injuries caused by a fall increased among middle-age adults imply a need for an extension of fall prevention programs.

  • 15. Zheng, H. -F
    et al.
    Duncan, E.
    Eriksson, J.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Yerges-Armstrong, L.
    Leo, P.
    Vandenput, L.
    Nicholson, G.
    Ladouceur, M.
    Prince, R.
    Leslie, W.
    Eisman, J.
    Goltzman, D.
    Jones, G.
    Xiao, Y.
    Liu, J.
    Reid, I.
    Sambrook, P.
    Dennison, E.
    Danoy, P.
    Wilson, S.
    McCloskey, E.
    Eastell, R.
    Spector, T.
    Mitchell, B.
    Streeten, E.
    Brommage, R.
    Lorentzon, M.
    Pettersson, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Brown, M.
    Ohlsson, C.
    Richards, J. B.
    The 7Q31 locus, containing WNT16, is associated with bone mineral density, osteoporotic fracture and bone strength2012Inngår i: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 50, nr Supplement 1, s. S33-S34Artikkel i tidsskrift (Fagfellevurdert)
  • 16. Zheng, Hou-Feng
    et al.
    Duncan, Emma
    Eriksson, Joel
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Yerges-Armstrong, Laura M.
    Leo, Paul J.
    Vandenput, Liesbeth
    Nicholson, Geoffrey
    Ladouceur, Martin
    Prince, Richard L.
    Leslie, William D.
    Eisman, John A.
    Goltzman, David
    Jones, Graeme
    Xiao, Yongjun
    Liu, Jeff
    Reid, Lanr
    Sambrook, Philip N.
    Dennison, Elaine M.
    Danoy, Patrick
    Wilson, Scott G.
    McCloskey, Eugene
    Eastell, Richard
    Spector, Tim
    Mitchell, Braxton D.
    Streeten, Elizabeth A.
    Brommage, Robert
    Lorentzon, Mattias
    Pettersson, Ulrika
    Brown, Matthew A.
    Ohlsson, Claes
    Richards, J. Brent
    WNT16 is associated with bone mineral density, osteoporotic fracture and bone strength: a large-scale meta-analysis of genomewide association studies2012Inngår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 23, nr Suppl 2, s. S402-S403Artikkel i tidsskrift (Annet vitenskapelig)
  • 17. Zheng, Hou-Feng
    et al.
    Duncan, Emma L.
    Yerges-Armstrong, Laura M.
    Eriksson, Joel
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Leo, Paul J.
    Leslie, William D.
    Goltzman, David
    Blangero, John
    Hanley, David A.
    Carless, Melanie A.
    Streeten, Elizabeth A.
    Lorentzon, Mattias
    Brown, Matthew A.
    Spector, Tim D.
    Pettersson-Kymmer, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk farmakologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Ohlsson, Claes
    Mitchell, Braxton D.
    Richards, J. Brent
    Meta-analysis of genome-wide studies identifies MEF2C SNPs associated with bone mineral density at forearm2013Inngår i: Journal of Medical Genetics, ISSN 0022-2593, E-ISSN 1468-6244, Vol. 50, nr 7, s. 473-478Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Forearm fractures affect 1.7 million individuals worldwide each year and most occur earlier in life than hip fractures. While the heritability of forearm bone mineral density (BMD) and fracture is high, their genetic determinants are largely unknown. Aim To identify genetic variants associated with forearm BMD and forearm fractures. Methods BMD at distal radius, measured by dual-energy x-ray absorptiometry, was tested for association with common genetic variants. We conducted a meta-analysis of genome-wide association studies for BMD in 5866 subjects of European descent and then selected the variants for replication in 715 Mexican American samples. Gene-based association was carried out to supplement the single-nucleotide polymorphism (SNP) association test. We then tested the BMD-associated SNPs for association with forearm fracture in 2023 cases and 3740 controls. Results We found that five SNPs in the introns of MEF2C were associated with forearm BMD at a genome-wide significance level (p<5x10(-8)) in meta-analysis (lead SNP, rs11951031[T] -0.20 SDs per allele, p=9.01x10(-9)). The gene-based association test suggested an association between MEF2C and forearm BMD (p=0.003). The association between MEF2C variants and risk of fracture did not achieve statistical significance (SNP rs12521522[A]: OR=1.14 (95% CI 0.92 to 1.35), p=0.14). Meta-analysis also revealed two genome-wide suggestive loci at CTNNA2 and 6q23.2. Conclusions These findings demonstrate that variants at MEF2C were associated with forearm BMD, implicating this gene in the determination of BMD at forearm.

  • 18. Zheng, Hou-Feng
    et al.
    Tobias, Jon H
    Duncan, Emma
    Evans, David M
    Eriksson, Joel
    Paternoster, Lavinia
    Yerges-Armstrong, Laura M
    Lehtimäki, Terho
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Kähönen, Mika
    Leo, Paul J
    Raitakari, Olli
    Laaksonen, Marika
    Nicholson, Geoffrey C
    Viikari, Jorma
    Ladouceur, Martin
    Lyytikäinen, Leo-Pekka
    Medina-Gomez, Carolina
    Rivadeneira, Fernando
    Prince, Richard L
    Sievanen, Harri
    Leslie, William D
    Mellström, Dan
    Eisman, John A
    Movérare-Skrtic, Sofia
    Goltzman, David
    Hanley, David A
    Jones, Graeme
    St Pourcain, Beate
    Xiao, Yongjun
    Timpson, Nicholas J
    Smith, George Davey
    Reid, Ian R
    Ring, Susan M
    Sambrook, Philip N
    Karlsson, Magnus
    Dennison, Elaine M
    Kemp, John P
    Danoy, Patrick
    Sayers, Adrian
    Wilson, Scott G
    Nethander, Maria
    McCloskey, Eugene
    Vandenput, Liesbeth
    Eastell, Richard
    Liu, Jeff
    Spector, Tim
    Mitchell, Braxton D
    Streeten, Elizabeth A
    Brommage, Robert
    Pettersson-Kymmer, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Farmakologi.
    Brown, Matthew A
    Ohlsson, Claes
    Richards, J Brent
    Lorentzon, Mattias
    WNT16 influences bone mineral density, Cortical bone thickness, bone strength, and Osteoporotic fracture risk2012Inngår i: PLoS genetics, ISSN 1553-7404, Vol. 8, nr 7, s. e1002745-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We aimed to identify genetic variants associated with cortical bone thickness (CBT) and bone mineral density (BMD) by performing two separate genome-wide association study (GWAS) meta-analyses for CBT in 3 cohorts comprising 5,878 European subjects and for BMD in 5 cohorts comprising 5,672 individuals. We then assessed selected single-nucleotide polymorphisms (SNPs) for osteoporotic fracture in 2,023 cases and 3,740 controls. Association with CBT and forearm BMD was tested for ∼2.5 million SNPs in each cohort separately, and results were meta-analyzed using fixed effect meta-analysis. We identified a missense SNP (Thr>Ile; rs2707466) located in the WNT16 gene (7q31), associated with CBT (effect size of -0.11 standard deviations [SD] per C allele, P = 6.2×10(-9)). This SNP, as well as another nonsynonymous SNP rs2908004 (Gly>Arg), also had genome-wide significant association with forearm BMD (-0.14 SD per C allele, P = 2.3×10(-12), and -0.16 SD per G allele, P = 1.2×10(-15), respectively). Four genome-wide significant SNPs arising from BMD meta-analysis were tested for association with forearm fracture. SNP rs7776725 in FAM3C, a gene adjacent to WNT16, was associated with a genome-wide significant increased risk of forearm fracture (OR = 1.33, P = 7.3×10(-9)), with genome-wide suggestive signals from the two missense variants in WNT16 (rs2908004: OR = 1.22, P = 4.9×10(-6) and rs2707466: OR = 1.22, P = 7.2×10(-6)). We next generated a homozygous mouse with targeted disruption of Wnt16. Female Wnt16(-/-) mice had 27% (P<0.001) thinner cortical bones at the femur midshaft, and bone strength measures were reduced between 43%-61% (6.5×10(-13)<P<5.9×10(-4)) at both femur and tibia, compared with their wild-type littermates. Natural variation in humans and targeted disruption in mice demonstrate that WNT16 is an important determinant of CBT, BMD, bone strength, and risk of fracture.

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