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Biomedical subjects

R Honkanen

Publications and source records attributed to R Honkanen.

At least 55 records · Page 3Linked to original sources
PubMed1996

Does lactose intolerance predispose to low bone density? A population-based study of perimenopausal Finnish women.

The relationship of lactase malabsorption to osteoporosis is unclear. We examined the relationship of self-reported lactose intolerance (LI) to bone mineral density (BMD) in perimenopausal Finnish women. A random population sample of 2025 women aged 48-59, who underwent spinal and femoral BMD measurement with dual X-ray absorptiometry in Kuopio, Finland during 1989-1991 formed the study population. Out of these women, 162 women reported LI. The mean dairy calcium intake was 558 mg/day in women with LI and 828 mg/day in other women (p < 0.0001). The mean spinal BMDs were 1.097 and 1.129 g/cm2 (-2.8%) (p = 0.016) and the mean femoral BMDs were 0.906 and 0.932 g/cm2 (-2.8%) (p = 0.012) for the LI and other women, respectively. After adjusting for weight, age, years since menopause, and the history of hormone replacement therapy, these differences changed to -2.7% (p = 0.016) for the spinal and -2.4% (p = 0.012) for the femoral BMD, respectively. Dairy calcium intake was an independent determinant of femoral BMD. The addition of calcium intake variables into the multivariate model did not affect the spinal BMD difference, but weakened the femoral BMD difference to -1.9% (p = 0.075). Our results suggest that LI slightly reduces perimenopausal BMD, possibly through reduced calcium intake.

Bone Density↗
PubMed1996

Correlates of life satisfaction among psychiatric patients.

The aim of this study was to examine the sociodemographic and clinical variables associated with life satisfaction in psychiatric patients. The study population consisted of out-patients and in-patients (n = 1204) treated at the Department of Psychiatry of Kuopio University Hospital in North Savo, Finland, during May 1993. Sociodemographic, psychosocial and clinical correlates of life satisfaction were examined by means of two different questionnaires, one directed at patients and the other directed at the staff. Life satisfaction was assessed by means of a separate scale based on four questions. Patients with schizophrenia were less dissatisfied than patients with other disorders. The strongest correlates of dissatisfaction were depression and poor social support. Other factors relating to dissatisfaction in multiple regression analysis were self-rated health and poor financial circumstances. A psychosomatic reaction tendency or degree of psychosocial functioning at the time of the study was not independently related to life satisfaction. Psychiatric patients who are dissatisfied should be evaluated both for depression and for effectiveness of their social network.

Adult↗
PubMed1995

Prediction of fracture risk using axial bone mineral density in a perimenopausal population: a prospective study.

Several prospective studies have shown that the bone mineral density (BMD) measured in the appendicular or axial skeleton has an inverse relationship with the risk of subsequent fractures. However, most of these studies have concentrated on relatively old age groups, and the usefulness of measuring BMD at the time of menopause has not been established. In the present study, BMD was measured at the lumbar spine and femoral neck by dual X-ray absorptiometry (DXA) in a random stratified population sample of 3222 perimenopausal women (mean age 53.4 years, range 47-59 years). These women were followed for fractures over a period of 2 years. The fractures reported by a postal inquiry were verified from medical records. Fractures sustained in motor vehicle accidents were excluded from the analyses. During a mean follow-up of 2.4 years, 183 fractures occurred in 168 women. Wrist (n = 47), ankle (n = 31), and rib (n = 28) were the most common sites of a fracture. Women in the lowest quartile of spinal BMD had a 2.9 times greater risk of fracture than those in the highest quartile. The respective risk increased 2.2 times from the lowest to the highest quartile of femoral BMD, respectively. The relative risk for suffering from any fracture per one SD decrease in BMD was 1.50 (95% CI; 1.27-1.76) for the spine and 1.41 (1.21-1.64) for the femoral neck. The present study demonstrates that bone mass is important in the pathogenesis of fractures even in perimenopausal women. We conclude that the axial BMD measurement at the time of menopause can be of use in predicting subsequent fracture risk.

Absorptiometry, Photon↗
PubMed1995

The effect of gynecological risk factors on lumbar and femoral bone mineral density in peri- and postmenopausal women.

The relationship between gynecological history and bone mineral density (BMD) of the lumbar spine and femoral neck was studied in 3126 perimenopausal women. The study population was a random, stratified sample of participants, selected from the Kuopio Osteoporosis Study, which consisted primarily of all 14,220 women aged 47-56 years in Kuopio Province in 1989. After exclusion of 1521 women reporting past or present hormonal replacement therapy (HRT), 1605 women formed the final study population. Present HRT users had significantly higher lumbar BMD but not femoral BMD, than non-hormone users. Postmenopausal status, late menarche, and bilateral oophorectomy were risk factors for low BMD. Protective factors against low BMD were increased body weight, increased number of pregnancies, as well as hysterectomy without bilateral oophorectomy. The majority (43.8%) of these operations had been performed due to the presence of leiomyomas. No significant correlation was found between nulliparity, breast-feeding or amenorrhea before the age of 30 and BMD. In the multiple regression analysis, gynecological variables could account for only 18.4-26.8% of the variance in BMD, while time since last periods, age, age at menarche, weight and hysterectomy were the most significant variables. We conclude that reproductive history gives rise to some special risk groups, to whom BMD measurements and osteoporosis prevention efforts should be directed. However, it is impossible to predict BMD by gynecological characteristics.

Bone Density↗
PubMed1995

Fractures and low axial bone density in perimenopausal women.

The relationship between past fractures and current bone density (BMD) was analyzed in a population sample of 3222 women aged 48-58. BMD was determined with dual X-ray absorptiometry (DXA) at the spine and femoral neck. 702 women reported fractures. Wrist and ankle were the most common fracture sites. Fracture history increased the risk [OR (95% CI)] of low spinal BMD (of more than 1 SD below the study population mean) by 1.75 (1.41; 2.18). The sensitivity and specificity of fracture history to detect a low spinal BMD were 31 and 80%, respectively. One SD decreases of spinal and femoral BMD equalled to respective overall fracture risks (adjusted ORs) of 1.36 (1.24; 1.50) and 1.38 (1.25; 1.51). Both BMDs related more strongly to wrist fracture [1.73 (1.47; 2.05)/1.69 (1.43; 1.99)] than to all nonwrist fractures combined [1.24 (1.11; 1.37)/1.27 (1.14; 1.42)]. Ankle and rib fractures related only to spinal [1.21 (1.00; 1.46)/1.45 (1.12; 1.87)] but tibia and foot bone fractures only to femoral [2.04 (1.37; 3.04)/2.20 (1.42; 3.41)] BMD. Spinal BMD related more strongly to fractures due to falls on same level than to fractures due to all other trauma combined. Fracture history poorly screens out low perimenopausal BMD. The results suggest that pre- and perimenopausal fractures relate to low axial bone density and that the magnitude of this relation depends on the sites of fracture and densitometry as well as on the type of trauma.

Absorptiometry, Photon↗
PubMed1995

Incidence of injury-causing falls among older adults by place of residence: a population-based study.

OBJECTIVE: To describe the incidence and associated factors of injury-causing falls by place of residence. DESIGN: A prospective population-based study. SETTING: Five municipalities in northern Finland. PARTICIPANTS: All persons in the five communities aged 70 years or older living at home (n = 1016) and in long-term institutionalized care (n = 143). MEASUREMENTS: We recorded all fall incidents during a 2-year period by occurrence and severity of injury, using diary reporting and regular calls and by examining the medical and nursing records of all participants. The times, places, circumstances, and medical treatment needed were recorded as well. RESULTS: Men living at home experienced 71 minor injuries/1000 person years (PY), 42 major soft tissue injuries/1000PY, and 12 fractures/1000PY; women at home experienced 175 minor injuries/1000PY, 65 major soft tissue injuries/1000PY, and 33 fractures/1000PY. Institutionalized older men had 272 minor injuries/1000PY, 122 major soft tissue injuries/1000PY, and 41 fractures/1000PY; institutionalized women had 292 minor injuries/1000PY, 131 major soft tissue injuries/1000PY, and 58 fractures/1000PY. Falls causing injury to older adults in long-term institutionalized care were more evenly distributed by time of day than those that occurred at home. The majority of the injuries sustained in long-term institutionalized care were injuries to the head. The incidence rate of fall injuries requiring medical attention in women, 113/1000PY, was twice that in men, 57/1000PY. CONCLUSIONS: Injury-causing falls are more frequent in older people living in long-term institutionalized care, and the time-distribution and some circumstances differ from those of injury-causing falls in home-dwelling older people.

Accidental Falls↗
PubMed1995

Risks of perimenopausal fractures--a prospective population-based study.

OBJECTIVE: To examine the associations between potential risk factors and fractures in perimenopausal women. SUBJECTS: A total of 3,140 women (mean age 53.4 +/- 2.8 (s.d.) years) were followed-up for 2.4 years after axial bone densitometry (lumbar spine and femoral neck) with regard to the occurrence of fractures. RESULTS: In all, 5.6% of the women sustained a fracture. There were 169 low energy fractures (falling on a level surface) in 157 women after the exclusion of 18 fractures caused by a high energy trauma. The wrist was the most frequent site of fracture (n = 46). Lumbar bone mineral density was 5.8% lower and femoral bone mineral density 4.6% lower among fracture cases compared with non-fracture cases (p < 0.0001). History of a fracture during 1980-1989 elevated the risk of all fractures 2.83-fold (95% confidence interval (CI) 1.95-4.10) and the risk of a first wrist fracture 2.25-fold (95% CI 1.10-4.62). The amount of weekly alcohol intake was higher among fracture cases than among non-fracture cases yielding an age-adjusted odds ratio (OR) of 1.45 (95% CI 1.05-2.02). Past or present use of hormone replacement therapy was protective against fractures (age-adjusted OR 0.70, 95% CI 0.50-0.96). If bilateral oophorectomy had been carried out under the age of 45 years, the risk of fracture was 3.64-fold (95% CI 1.01-13.04) compared with women operated upon after the age of 45 years. Age at menarche, parity, lactation and smoking history did not differ between the fracture and non-fracture groups. CONCLUSIONS: A former history of fractures, low baseline bone mineral density (BMD) and use of alcohol are predisposing factors associated with perimenopausal fractures, while hormone replacement therapy is protective in this respect.

Alcohol Drinking↗
PubMed1994

Bone mineral density and risk factors for osteoporosis--a population-based study of 1600 perimenopausal women.

Population-based epidemiological studies on osteoporosis are few. Our study evaluated the effects of menopause and certain putative behavioural risk factors on bone mineral density (BMD). Spinal and femoral neck BMD were measured with dual X-ray absorptiometry (DXA) from 1600 perimenopausal women aged 48-59 years (mean 53.2 years) with no diseases or medications known to affect bone metabolism. These women were a selected sample of the Kuopio Osteoporosis Risk Factor and Prevention Study population (n = 14,220). There was a wide variation of BMD among perimenopausal women. Menopause had a major effect on BMD. Postmenopausal women had significantly lower BMD in both spine (-6.2%) and femoral neck (-3.9%) as compared with premenopausal women. Multiple regression analysis showed that weight, menopausal status, age, and grip strength were significant independent predictors of both spinal and femoral BMD. Additionally, physical activity was found to be a significant predictor of femoral BMD, and alcohol consumption was a significant predictor of spinal BMD. However, current anthropometric and lifestyle factors explained only 18.7-25.4% of the variability of BMD. Therefore, the estimation of the risk factor status at menopause is not an adequate substitute for bone densitometry. However, our results may in part help clinicians to identify the risk groups at which to direct bone density measurements.

Absorptiometry, Photon↗
PubMed1994

The effect of previous oral contraceptive use on bone mineral density in perimenopausal women.

The bone mineral density (BMD) of the lumbar vertebrae L2-4 and femoral neck was determined by dual-energy X-ray absorptiometry (DXA) in 3222 perimenopausal women-a random stratified sample of the population-based Kuopio Osteoporosis Study (OSTPRE). The mean age of the women was 53.4 years (range 47.9-59.6 years). Twenty-nine percent of the women were past users of oral contraceptives (OC) containing 50 micrograms or less of ethinyl estradiol and 7.4% (n = 250) of the women reported OC use for more than 6 years. There was a slight but statistically significant difference between OC users (n = 939) and non-users (n = 2283) in lumbar BMD (1.134 +/- 0.155 g/cm2 v 1.123 +/- 0.161 g/cm2, p = 0.014). A statistically significant difference was recorded also after adjustment for years since menopause, duration of hormonal replacement therapy (HRT) and present weight (p = 0.044). When the analysis was performed among women who had never used oestrogen replacement therapy (n = 1427) and among premenopausal women (n = 387), no differences in BMD were found between OC users and non-users. Similarly, femoral neck BMD did not differ between the groups. This population-based study demonstrated a slightly higher lumbar BMD among past OC users. However, OC users and non-users differed from each other in many behavioral characteristics. Thus, the differences in BMD may be accounted for more by other factors than by past OC use itself. The low-dosage estrogen OCs used today would not be expected to have any positive bone effects among future perimenopausal women.

Bone Density↗
PubMed1994

The effect of fluoridated drinking water on axial bone mineral density--a population-based study.

Bone mineral density (BMD) of the spine and femoral neck was measured in a random stratified sample of 3222 perimenopausal women aged 47-59 years. A total of 969 women had used fluoridated drinking water (1.0-1.2 mg/l) for over 10 years. These women were compared with 2253 women with low levels of fluoride in drinking water (< 0.3 mg/l). BMD of the spine was significantly higher in the fluoride group than in the non-fluoride group (1.138 +/- 0.165 vs. 1.123 +/- 0.156 g/cm2, P = 0.026). Femoral neck BMDs did not differ between the groups. When the BMD values were adjusted for confounding factors (age, weight, menopausal status, calcium intake, physical activity level, deliveries, alcohol consumption and estrogen use), the differences between the groups increased (P < 0.001 for the spine and P = 0.004 for the femoral neck, respectively). There was no significant difference between the groups in the prevalence of self-reported fractures sustained during 1980-1989. We propose that the fluoridation of drinking water has a slight increasing effect on axial BMD in women in low fluoride areas.

Absorptiometry, Photon↗
PubMed1994

Decreased axial bone mineral density in perimenopausal women with rheumatoid arthritis--a population based study.

OBJECTIVES: Although periarticular osteoporosis is a well-recognised phenomenon in rheumatoid arthritis (RA), there is considerable controversy over whether RA is associated with more generalised osteoporosis. The aetiology of this bone loss is probably multifactorial, including both life-style risk factors and disease-related determinants. Population-based studies on bone mineral density (BMD) in RA have not previously been conducted, and the purpose of the present cross-sectional population-based study was to determine whether patients with RA are at an increased risk of having osteoporosis. Furthermore, the determinants of BMD in RA patients were investigated. METHODS: BMD at the spine and femoral neck was measured in 143 women with RA. The control group consisted of 1611 women with no disease or taking any drugs known to affect bone metabolism. The study population was a random stratified sample from the Kuopio Osteoporosis Study, which included all perimenopausal women aged 47-56 years residing in Kuopio Province, Eastern Finland in 1989 (n = 14,220). The mean age of the patients at the time of densitometry was 53.7 years. RESULTS: The mean (SD) spinal and femoral neck BMD was significantly lower in patients with RA compared with controls [spine: 1.067 (0.161) v 1.129 (0.157) g/cm2, p < 0.001; femoral neck: 0.851 (0.136) v 0.932 (0.123) g/cm2, p < 0.001]. Analysis of variance showed that at the spine the difference was significant only in patients having corticosteroid treatment, whereas at the femoral neck patients with non-steroid treatment also had significantly lower BMD. When confounding factors were corrected, no significant difference could be found between non-steroid and corticosteroid treated patients with RA, suggesting that the independent effect of corticosteroids on BMD is only minimal. Multiple regression analysis found age, weight and functional grade to be significant predictors of spinal BMD (R2 = 0.403, p < 0.001). In the femoral neck weight, cumulative corticosteroid dose and functional grade were significant predictors of BMD (R2 = 0.410, p < 0.001). CONCLUSIONS: RA is associated with generalised osteoporosis. The physical impairment and body weight are the major determinants of both spinal and femoral bone mass in RA patients. The cumulative corticosteroid dose was also a significant determinant of femoral neck BMD. However, the independent effect of corticosteroids is questionable because the use of corticosteroids may be an indicator of more severe disease.

Absorptiometry, Photon↗
PubMed1993

Increasing incidence of hip fractures in Finland.

The incidence of hip fracture in Finland was studied for the year 1988. During 1988, 6139 patients were treated for a fresh hip fracture. Three out of four hip fracture patients were women, and the occurrence of cervical fractures was 2.8 times and that of trochanteric fractures 2.5 times more common in women than in men. The incidence rates of hip fractures per 100,000 were 174 in women, 70 in men and 123 in the whole population. The mean hospitalization time for fresh hip fractures was 33 days for cervical fractures and 38 days for trochanteric fractures. The costs of primary hospitalizations due to fresh hip fractures in 1988 were estimated at US $66 million.

Adolescent↗
PubMed1993

Osteoporosis risk factors, gynaecological history and fractures in perimenopausal women--the results of the baseline postal enquiry of the Kuopio Osteoporosis Risk Factor and Prevention Study.

The Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) Study examines the risk factors of osteoporosis, the relationship of risk factors to bone density and fractures, as well as the possibility to prevent bone loss by administering certain hormones. The baseline postal enquiry in 1989 was sent to all the 14,220 women aged 47-56 years residing in the Kuopio Province, Finland. The questionnaire included questions about their gynaecological history, physical exercise and smoking habits, calcium intake, body weight and height, history of bone fractures, health disorders, their current and previous use of drugs, as well as their willingness to participate in bone densitometry and in a clinical hormone trial. The response rate was 92.8%. In all, 56% reported some previous use of female hormones. Strong contraindications for oestrogen replacement therapy were found in 9.3% of the women. Almost half of the respondents reported lack of regular physical exercise, 11.9% were smokers, and 17.0% reported a calcium intake from milk products of less than 500 mg daily. The incidence of fractures increased steadily with age. The incidence of premenopausal fractures within the last 10 years was 7.65 per 1000 person/years and that of postmenopausal fractures was 17.40 per 1000 person/years (P = 0.000). The effect of menopause on fracture incidence was stronger than the effect of a 5-year age increase. Of the respondents, 84.4% were willing to participate in bone densitometry and 68.3% for long-term prevention of osteoporosis with oestrogen.

Bone Density↗
PubMed1993

Alcohol in home and leisure injuries.

The part that alcohol plays in non-motor vehicle unintentional injuries is not well known. Injuries at home and during leisure form a very heterogeneous group. Alcohol involvement varies considerably from one subgroup to another: for example, all cases of alcohol poisoning involve alcohol by definition, whereas alcohol involvement is very infrequent in sports injuries. One-third of falls, half of drownings and fire deaths and two-thirds of hypothermia deaths involve alcohol. Young and middle-aged males form a risk group of alcohol-related trauma. Alcohol involvement varies also from country to country: deaths from alcohol poisoning are several times as common in Finland as in other Western countries. In contrast to experience in Western countries, in Dar es Salaam, Tanzania, wealthier injured Africans were found to have alcohol involvement more often than poor Africans. Alcohols seems to increase the risk of falling, bicycle and motor vehicle injuries largely to the same extent. The relative importance of the two main components of alcohol-related risk--risk-taking and impaired psychomotor functions--requires further exploration in each main external cause category of home and leisure injuries.

Accidents, Home↗
PubMed1993

Bicycle accidents often cause disability--an analysis of medical and social consequences of nonfatal bicycle accidents.

Social and medical consequences of 278 children and 264 adults injured in bicycle accidents and seen in two hospitals in Helsinki in 1985-86 were analyzed. Information was collected from patient records, by means of a special questionnaire and by telephone interview. A child outpatient required 1.7 and a child inpatient 3.0 physician visits on an average, while adults required 2.2 and 4.9 visits, respectively. The average duration of hospital stay was 8 days for hospitalized adults and 6 days for children. Rehabilitative care outside the hospital was received by 6% of the adult outpatients and 25% of the inpatients, but none of the injured children. The mean duration of work disability was 82 days among inpatients, 11 days among outpatients, 127 days among the inpatients injured in motor vehicle collisions and 65 days among inpatients injured in other bicycle accidents. Of inpatients 32% and of outpatients 5% reported persistent (> 6 months) disability. Persistent disability was recorded in 11% of children, in 47% of adults and in 67% of elderly inpatients. Most serious consequences were due to intracranial injuries in motor vehicle-bicycle collisions. Of the hospitalized bicyclists 4% suffered from severe cognitive and behavioural changes or sense impairment and of adult inpatients 3% suffered from permanent work disability. The average costs of health and social services were about FIM 1000 per adult outpatient and FIM 13000 per adult inpatient. In prevention high priority should be given to motor vehicle collisions, head injuries and injuries among the elderly bicyclists.

Accidents, Traffic↗
PubMed1993

Medications and chronic diseases as risk factors for falling injuries in the elderly.

Diseases and medications associated with the occurrence of falls leading to medical treatment in elderly Finns (65 yrs or older) during a one-year period are presented. The design was that of a case-control study involving 380 fallers seeking medical treatment and 342 unmatched controls selected randomly from the population register. The occurrence of a fall was shown by logistic regression analysis to be related to advanced age, presence of benzodiazepine in the serum, hypertrophy of the prostate, poor mental capacity, presence of chronic lung disease and asthma, use of analgesics and use of digitalis in the men, and to advanced age, poor mental capacity, presence of benzodiazepine in the serum, use of analgesics and non-occurrence of lower limb arthrosis in the women. The corresponding log-linear models showed advanced age and the presence of benzodiazepine in the serum to be independent risk factors for falling both in the men and women. Furthermore, the use of analgesics was related to falling in the women with normal mental capacities. No disease was independently associated with falls. The results suggest caution in the use of benzodiazepines among the elderly.

Accidental Falls↗
PubMed1992

Recurrent elderly fallers.

Factors associated with recurrent falling during a one-year period were analysed among elderly Finns (65 yrs and more) seeking medical treatment due to a fall. Recurrent falling in men was independently related to a lesser amount of depressive symptoms and to less severe injury due to the first fall. In women, recurrent falling was independently related to the non-occurrence of a fear of falling. Furthermore, recurrent falling, amount of daily movement, mental capacity, and falling during the previous year were related variables. Here the risk of recurrent falling was high among persons with poor mental capacity, who moved about a large amount daily, and who had had at least one accident during the previous year. In addition, there was an association between poor health and recurrent falling women. Demented women moving about daily, frail women, and incautious men and women seemed to be the main risk groups for repeated falling. What could general practitioners do to prevent repeated falls in the elderly? First, the overall health status and functional capacities of frail elderly women should be improved. Second, all elderly persons, especially those who have fallen, should be informed about how to minimize the risks of falls. Prevention is not easy among the demented population, however.

Accidental Falls↗