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Femoral and whole-body bone mineral density in middle-aged and older Norwegian men and women: suitability of the reference values

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Abstract

The aim of this study was to compare bone mineral density (BMD) in a population-based sample of middle-aged and older Norwegians, with reference values provided by the manufacturer of the densitometer (Lunar) in order to evaluate whether these reference values are suitable for Norwegians. Additional aims were to estimate the prevalence of osteoporosis. Bone mineral density of the hip and total body was measured by dual-energy X-ray absorptiometry in 2303 men and 3105 women 47–50 and 71–75 years old, respectively, in western Norway, as part of the Hordaland Health Study (HUSK). Of these, 3403 white individuals were free of medications or diseases known to influence bone metabolism (reference group). Compared with the Lunar reference population, men and older women had a slightly but significantly lower BMD of trochanter and total femur and middle aged women had significantly higher total body BMD. Except for the higher mean BMD of total body among middle-aged women and the uniformly lower BMD values of Ward’s triangle, the deviations from the reference values of the manufacturer were less than 4%. Approximately 2.6% of middle-aged men vs 0.9% of middle-aged women were classified as osteoporotic on the basis of BMD of femoral neck. While the BMD values for femoral neck in this healthy Norwegian population are similar to the reference population of Lunar, the values of trochanter and total femur are lower in all groups except middle-aged women; however, the discrepancies are not of sufficient magnitude to warrant rejection of this commonly used database among Norwegians. Use of the young adult means from the Lunar reference database classified a higher proportion of middle-aged men than women as osteoporotic and osteopenic.

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Acknowledgements

The data collection was conducted as part of HUSK (the Hordaland Health Study 1997–1999) in collaboration with the Norwegian National Health Screening Service. This project has been financed with support from the Norwegian Research Council, The Norwegian Osteoporosis Foundation, Norwegian Rheumatism Association, T. Gythfeldt and Wife’s Research Foundation, TINE BA (Norwegian Dairy Industry), and Merck, Sharpe and Dohme. We thank J. Falch for comments on a previous version of this manuscript.

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Authors and Affiliations

  1. Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway

    Clara Gram Gjesdal & Grethe S. Tell

  2. Institute of Medicine, University of Bergen, Bergen, Norway

    Sylvi J. Aanderud

  3. Department of Rheumatology, Rikshospitalet, Oslo, Norway

    Hans-Jacob Haga

  4. Department of Rheumatology, Haukeland University Hospital, Bergen, Norway

    Clara Gram Gjesdal & Johan G. Brun

Authors
  1. Clara Gram Gjesdal
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  2. Sylvi J. Aanderud
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  3. Hans-Jacob Haga
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  4. Johan G. Brun
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  5. Grethe S. Tell
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Corresponding author

Correspondence to Clara Gram Gjesdal.

Appendices

Appendices

Appendix 1: Exclusion criteria applied to create the HUSK reference group

Renal disease

Thyroid disease

Hospitalization for malignancy the last 6 years

Chronic gastrointestinal disease

Diabetes mellitus

Hypogonadism

Menopause <40 years of age

Inflammatory rheumatic diseases

Ever use of hormone replacement therapy

Thiazide diuretics

Glucocorticoids

Anticonvulsants

Sodium fluoride

Heparin

Thyroxine

Vitamin D metabolites

Bisphosphonates

Ever fracture of wrist or hip

  

Appendix 2a: For T-score estimations, the following mean BMD values (SD) for healthy young adults (ages 20–39 years) were used:

 

For men:

For women:

Femoral neck

1.07 (0.13)

0.98 (0.12)

Ward’s triangle

0.96 (0.13)

0.91 (0.13)

Trochanter

0.93 (0.11)

0.79 (0.11)

Total femur

1.09 (0.13)

1.00 (0.12)

Total body

1.22 (0.08)

1.125 (0.08)

Appendix 2b: The following equations were used to compute age- and weight-adjusted BMD (“expected BMD”) and to estimate Z score:

For men:

Femoral neck:

1.07−[0.004×(age−30 years)]+[0.003×(weight−78 kg)]

Ward’s triangle:

0.96−[0.006×(age−30 years)]+[0.003×(weight−78 kg)]

Trochanter:

0.93−[0.0015×(age−30 years)]+[0.003×(weight−78 kg)]

Total femur 47–49 years:

1.045−[0.0025×(age−45 years)]+[0.003×(weight−78 kg)]

Total femur 71–74 years:

0.995−[0.003×(age−65 years)]+[0.003×(weight−78 kg)]

Total body:

1.22−[0.0025×(age−55 years)]+[0.0035×(weight−78 kg)]

For 47− to 49-year-old women:

Femoral neck:

0.95−[0.007×(age−45 years)]+[0.003×(weight−65 kg)]

Ward’s triangle:

0.85−[0.010×(age−45 years)]+[0.003×(weight−65 kg)]

Trochanter:

0.79−[0.004×(age-45 years)+[0.003×(weight−65 kg)]

Total femur:

0.985−[0.006×(age−45 years)]+[0.003×(weight−65 kg)]

Total body:

1.125−[0.005×(age−45 years]+[0.0035×(weight−65 kg)]

For 71−74-year-old women:

Femoral neck:

0.81−[0.004×(age−65 years)]+[0.003×(weight−65 kg)]

Ward’s triangle:

0.65−[0.004×(age−65 years)]+[0.003×(weight−65 kg)]

Trochanter:

0.71−[0.004×(age−65 years)]+[0.003×(weight−65 kg)]

Total femur:

0.865−[0.0055×(age−45 years)]+[0.003×(weight−65 years)]

Total body:

1.025−[0.002×(age−65 years)]+[0.0035×(weight−65 kg)]

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Gjesdal, C.G., Aanderud, S.J., Haga, HJ. et al. Femoral and whole-body bone mineral density in middle-aged and older Norwegian men and women: suitability of the reference values. Osteoporos Int 15, 525–534 (2004). https://doi.org/10.1007/s00198-003-1573-2

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  • DOI: https://doi.org/10.1007/s00198-003-1573-2

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