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Article ; Online: Declining hip fracture burden in Sweden 1998-2019 and consequences for projections through 2050.

Michaëlsson, Karl / Baron, John A / Byberg, Liisa / Larsson, Susanna C / Melhus, Håkan / Gedeborg, Rolf

2024 Volume 14, Issue 1, Page(s) 706

Abstract: We aimed to estimate the absolute and age-standardized number of hip fractures in Sweden during the past two decades to produce time trends and future projections. We used nationwide register data from 1998 to 2019 and a validated algorithm to calculate ... ...

Abstract	We aimed to estimate the absolute and age-standardized number of hip fractures in Sweden during the past two decades to produce time trends and future projections. We used nationwide register data from 1998 to 2019 and a validated algorithm to calculate the annual absolute and age-standardized number of incident hip fractures over time. The total hip fracture burden was 335,399 incident events over the 22 years, with a change from 16,180 in 1998 to 13,929 in 2019, a 14% decrease. One decade after the index hip fracture event, 80% of the patients had died, and 11% had a new hip fracture. After considering the steady growth of the older population, the decline in the age-standardized number of hip fractures from 1998 through 2019 was 29.2% (95% CI 28.1-30.2%) in women and 29.3% (95% CI 27.5-30.7%) in men. With a continued similar reduction in hip fracture incidence, we can predict that 14,800 hip fractures will occur in 2034 and 12,000 in 2050 despite doubling the oldest old (≥ 80 years). Without an algorithm, a naïve estimate of the total number of hip fractures over the study period was 539,947, with a second 10-year hip fracture risk of 35%. We note an ongoing decline in the absolute and age-standardized actual number of hip fractures in Sweden, with consequences for future projections.
MeSH term(s)	Male ; Aged, 80 and over ; Humans ; Female ; Sweden/epidemiology ; Hip Fractures/epidemiology ; Algorithms ; Death
Language	English
Publishing date	2024-01-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-51363-6
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Book ; Thesis: Studies of the vitamin A transporting protein complex retinol binding protein - transthyretin

Melhus, Håkan

(Comprehensive summaries of Uppsala dissertations from the Faculty of Medicine ; 271 ; Acta Universitatis Upsaliensis)

1990

Author's details	by Håkan Melhus
Series title	Comprehensive summaries of Uppsala dissertations from the Faculty of Medicine ; 271 Acta Universitatis Upsaliensis
Collection
Language	English
Size	31 S. : graph. Darst.
Publishing country	Sweden
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Uppsala, Univ., Diss., 1990
HBZ-ID	HT007580068
ISBN	91-554-2618-2 ; 978-91-554-2618-7
Database	Catalogue ZB MED Medicine, Health

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Article: Svenska rekommendationer om D-vitamin ger stöd vid behandling. Ovre gränsen för insufficiens är sänkt--fler frågetecken återstår att räta ut.

Melhus, Håkan

Lakartidningen

2014 Volume 111, Issue 37, Page(s) 1502–1503

Title translation	Swedish recommendations on vitamin D provides support in treatment. The upper limit for insufficiency is lowered--more questions remain to straighten out.
MeSH term(s)	Humans ; Practice Guidelines as Topic ; Reference Values ; Sweden ; Vitamin D/analogs & derivatives ; Vitamin D/blood ; Vitamin D Deficiency/blood ; Vitamin D Deficiency/diagnosis ; Vitamin D Deficiency/ethnology
Chemical Substances	Vitamin D (1406-16-2) ; 25-hydroxyvitamin D (A288AR3C9H)
Language	Swedish
Publishing date	2014
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	391010-6
ISSN	1652-7518 ; 0023-7205
ISSN (online)	1652-7518
ISSN	0023-7205
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Article ; Online: A Trial of Blood-Pressure Reduction in Black Barbershops.

Kempen, Thomas / Melhus, Håkan

The New England journal of medicine

2018 Volume 379, Issue 2, Page(s) 199

MeSH term(s)	Barbering ; Health Promotion ; Humans ; Hypertension/therapy
Language	English
Publishing date	2018-07-12
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc1806026
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Article ; Online: Serum Parathyroid Hormone and Risk of Coronary Artery Disease: Exploring Causality Using Mendelian Randomization.

Melhus, Håkan / Michaëlsson, Karl / Larsson, Susanna C

The Journal of clinical endocrinology and metabolism

2020 Volume 104, Issue 11, Page(s) 5595–5600

Abstract: Context: Elevated circulating parathyroid hormone concentrations have been associated with increased risk of cardiovascular disease in observational studies, but whether the association is causal is unknown.: Objective: We used the Mendelian ... ...

Abstract	Context: Elevated circulating parathyroid hormone concentrations have been associated with increased risk of cardiovascular disease in observational studies, but whether the association is causal is unknown. Objective: We used the Mendelian randomization design to test whether genetically increased serum parathyroid hormone (S-PTH) concentrations are associated with coronary artery disease (CAD). Design, setting, and participants: Five single-nucleotide polymorphisms robustly associated with S-PTH concentrations were used as instrumental variables to estimate the association of genetically higher S-PTH concentrations with CAD. Summary statistics data for CAD were obtained from a genetic consortium with data from 184,305 individuals (60,801 CAD cases and 123,504 noncases). Main outcome measure: OR of CAD per genetically predicted one SD increase of S-PTH concentrations. Results: Genetically higher S-PTH concentration was not associated with CAD as a whole or myocardial infarction specifically (∼70% of total cases). The ORs per genetically predicted one SD increase in S-PTH concentration were 1.01 (95% CI: 0.93 to 1.09; P = 0.88) for CAD and 1.02 (95% CI: 0.94 to 1.10; P = 0.64) for myocardial infarction. The lack of association remained in various sensitivity analyses. Conclusion: Genetic predisposition to higher S-PTH concentrations does not appear to be an independent risk factor for CAD.
MeSH term(s)	Case-Control Studies ; Coronary Artery Disease/blood ; Coronary Artery Disease/genetics ; Databases, Genetic ; Genetic Predisposition to Disease ; Humans ; Mendelian Randomization Analysis ; Parathyroid Hormone/blood ; Phenotype ; Polymorphism, Single Nucleotide ; Risk Assessment ; Risk Factors
Chemical Substances	Parathyroid Hormone
Language	English
Publishing date	2020-02-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/jc.2019-01063
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Article ; Online: Elevated low-density lipoprotein cholesterol: An inverse marker of morbidity and mortality in patients with myocardial infarction.

Schubert, Jessica / Lindahl, Bertil / Melhus, Håkan / Renlund, Henrik / Leosdottir, Margrét / Yari, Ali / Ueda, Peter / Jernberg, Tomas / Hagström, Emil

Journal of internal medicine

2023 Volume 294, Issue 5, Page(s) 616–627

Abstract: Background: The incidence of atherosclerotic cardiovascular disease increases with levels of low-density lipoprotein cholesterol (LDL-C). Yet, a paradox may exist where lower LDL-C levels at myocardial infarction (MI) are associated with poorer ... ...

Abstract	Background: The incidence of atherosclerotic cardiovascular disease increases with levels of low-density lipoprotein cholesterol (LDL-C). Yet, a paradox may exist where lower LDL-C levels at myocardial infarction (MI) are associated with poorer prognoses. Objective: To assess the association between LDL-C levels at MI with risk factor burden and cause-specific outcomes. Methods: Statin-naive patients hospitalized for a first MI and registered in SWEDEHEART were included. Data were linked to Swedish registers. Primary outcomes were all-cause mortality and nonfatal MI. Associations between LDL-C and outcomes were assessed using adjusted proportional hazards models. Results: Among 63,168 patients (median age, 66 years), the median LDL-C level was 3.0 mmol/L (interquartile range 2.4-3.6). Patient age and comorbidities increased as LDL-C decreased. During a median follow-up of 4.5 years, 10,236 patients died, and 4973 had nonfatal MI. Patients with the highest LDL-C had a lower risk of mortality (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.71-0.80). The risk of hospitalization for pneumonia, hip fracture, chronic obstructive pulmonary disease, and new cancer diagnosis was lower with higher LDL-C (HR range, 0.40-0.81). Patients with the highest LDL-C had a greater risk of recurrent MI (HR 1.16; 95% CI 1.07-1.26). Conclusions: Patients with the highest LDL-C levels at MI had the lowest incidence of mortality and morbidity. This seems to reflect lower age at MI, less underlying morbidities, paired with the modifiability of LDL-C. However, supporting the causal association between LDL-C and ischemic heart disease, elevated LDL-C was simultaneously associated with an increased risk of nonfatal MI.
MeSH term(s)	Humans ; Aged ; Cholesterol, LDL ; Myocardial Infarction ; Cholesterol ; Risk Factors ; Morbidity
Chemical Substances	Cholesterol, LDL ; Cholesterol (97C5T2UQ7J)
Language	English
Publishing date	2023-05-31
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	96274-0
ISSN	1365-2796 ; 0954-6820
ISSN (online)	1365-2796
ISSN	0954-6820
DOI	10.1111/joim.13656
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Article ; Online: Type 2 Diabetes and Change in Total Hip Bone Area and Bone Mineral Density in Swedish Men and Women Older Than 55 Years.

Mitchell, Adam / Fall, Tove / Melhus, Håkan / Lind, Lars / Michaëlsson, Karl / Byberg, Liisa

The Journal of clinical endocrinology and metabolism

2021 Volume 106, Issue 10, Page(s) 2840–2854

Abstract: Context: In a cross-sectional study, we found an association between type 2 diabetes mellitus (T2DM) and smaller bone area together with greater bone mineral density (BMD) at the total hip.: Objective: This work aims to investigate these associations ...

Abstract	Context: In a cross-sectional study, we found an association between type 2 diabetes mellitus (T2DM) and smaller bone area together with greater bone mineral density (BMD) at the total hip. Objective: This work aims to investigate these associations longitudinally, by studying T2DM status (no T2DM n = 1521, incident T2DM n = 119, or prevalent T2DM n = 106) in relation to changes in total hip bone area and BMD. Methods: In 3 cohorts, the Swedish Mammography Cohort Clinical (SMCC; n = 1060), Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; n = 483), and Uppsala Longitudinal Study of Adult Men (ULSAM; n = 203), with repeat assessment of T2DM status and dual energy x-ray absorptiometry (DXA) measurements of total hip bone area and BMD on average 8 years apart, a linear regression model was used to assess the effect of T2DM status on change in bone area and BMD at the total hip. Results: After meta-analysis, the change in bone area at the total hip was 0.5% lower among those with incident T2DM compared to those without T2DM (-0.18 cm2; 95% CI, -0.30 to -0.06). The change in bone area was similar among those with prevalent T2DM compared to those without (0.00 cm2; 95% CI, -0.13 to 0.13). For BMD, the combined estimate was 0.004 g/cm2 (95% CI, -0.006 to 0.014) among those with incident T2DM and 0.010 g/cm2 (95% CI, -0.000 to 0.020) among those with prevalent T2DM, compared to those without T2DM. Conclusion: Those with incident T2DM have a lower expansion in bone area at the total hip compared to those without T2DM.
MeSH term(s)	Absorptiometry, Photon ; Bone Density ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/diagnostic imaging ; Diabetes Mellitus, Type 2/physiopathology ; Female ; Humans ; Incidence ; Longitudinal Studies ; Male ; Middle Aged ; Pelvic Bones/diagnostic imaging ; Pelvic Bones/physiopathology ; Prevalence ; Prospective Studies ; Sweden
Language	English
Publishing date	2021-07-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/clinem/dgab490
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Article ; Online: Fasting glucose, bone area and bone mineral density: a Mendelian randomisation study.

Mitchell, Adam / Larsson, Susanna C / Fall, Tove / Melhus, Håkan / Michaëlsson, Karl / Byberg, Liisa

Diabetologia

2021 Volume 64, Issue 6, Page(s) 1348–1357

Abstract: Aims/hypothesis: Observational studies indicate that type 2 diabetes mellitus and fasting glucose levels are associated with a greater risk for hip fracture, smaller bone area and higher bone mineral density (BMD). However, these findings may be biased ... ...

Abstract	Aims/hypothesis: Observational studies indicate that type 2 diabetes mellitus and fasting glucose levels are associated with a greater risk for hip fracture, smaller bone area and higher bone mineral density (BMD). However, these findings may be biased by residual confounding and reverse causation. Mendelian randomisation (MR) utilises genetic variants as instruments for exposures in an attempt to address these biases. Thus, we implemented MR to determine whether fasting glucose levels in individuals without diabetes are causally associated with bone area and BMD at the total hip. Methods: We selected 35 SNPs strongly associated with fasting glucose (p < 5 × 10 Results: In a meta-analysis of the three cohorts, a genetically predicted 1 mmol/l increment of fasting glucose was associated with a 2% smaller total hip bone area (-0.67 cm Conclusions/interpretation: Fasting glucose may be a causal risk factor for smaller bone area at the hip, yet possibly for greater BMD. Further MR studies with larger sample sizes are required to corroborate these findings.
MeSH term(s)	Aged ; Blood Glucose ; Bone Density/physiology ; Fasting/blood ; Female ; Femur/diagnostic imaging ; Hip Joint/diagnostic imaging ; Humans ; Male ; Mendelian Randomization Analysis ; Middle Aged ; Polymorphism, Single Nucleotide ; Risk Factors
Chemical Substances	Blood Glucose
Language	English
Publishing date	2021-03-02
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1694-9
ISSN	1432-0428 ; 0012-186X
ISSN (online)	1432-0428
ISSN	0012-186X
DOI	10.1007/s00125-021-05410-w
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Article ; Online: Serum 25-hydroxyvitamin D is associated with fracture risk only during periods of seasonally high levels in women with a high body mass index.

Michaëlsson, Karl / Byberg, Liisa / Svennblad, Bodil / Larsson, Susanna C / Baron, John A / Melhus, Håkan

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research

2021 Volume 36, Issue 10, Page(s) 1957–1966

Abstract: Serum 25-hydroxyvitamin D (S-25OHD) is used to assess vitamin D status and is known to be affected by season and fat mass. Because these factors are often ignored when interpreting S-25OHD, assessment of vitamin D associations with disease outcomes may ... ...

Abstract	Serum 25-hydroxyvitamin D (S-25OHD) is used to assess vitamin D status and is known to be affected by season and fat mass. Because these factors are often ignored when interpreting S-25OHD, assessment of vitamin D associations with disease outcomes may be distorted. We aimed to investigate the impact of season of blood draw and fat mass on the association of S25OHD with fracture risk. We enrolled 5000 women, mean ± SD age 68 ± 7 years, with dual-energy x-ray absorptiometry (DXA) scans and blood collection in a population-based cohort. Proportional hazards regression, stratified by season and fat mass, was used to determine hazard ratios (HRs) of fracture according to categories of S-25OHD. Our secondary exposures were serum 1,25-dihydroxycholecalciferol (1,25-(OH)
MeSH term(s)	Aged ; Body Mass Index ; Bone Density ; Calcifediol ; Female ; Humans ; Middle Aged ; Parathyroid Hormone ; Vitamin D/analogs & derivatives ; Vitamin D Deficiency
Chemical Substances	Parathyroid Hormone ; Vitamin D (1406-16-2) ; 25-hydroxyvitamin D (A288AR3C9H) ; Calcifediol (P6YZ13C99Q)
Language	English
Publishing date	2021-07-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632783-7
ISSN	1523-4681 ; 0884-0431
ISSN (online)	1523-4681
ISSN	0884-0431
DOI	10.1002/jbmr.4400
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Article: Serum 25-Hydroxyvitamin D Concentrations and Major Depression: A Mendelian Randomization Study

Michaëlsson, Karl / Melhus, Håkan / Larsson, Susanna C

Nutrients. 2018 Dec. 15, v. 10, no. 12

2018

Abstract: Whether vitamin D insufficiency is a contributing cause of depression remains unclear. We assessed whether serum 25-hydroxyvitamin D (S-25OHD) concentrations, the clinical marker of vitamin D status, were associated with major depression using Mendelian ... ...

Abstract	Whether vitamin D insufficiency is a contributing cause of depression remains unclear. We assessed whether serum 25-hydroxyvitamin D (S-25OHD) concentrations, the clinical marker of vitamin D status, were associated with major depression using Mendelian randomization. We used summary statistics data for six single-nucleotide polymorphisms significantly associated with S-25OHD concentrations in the Study of Underlying Genetic Determinants of Vitamin D and Highly Related Traits (SUNLIGHT) consortium and the corresponding data for major depression (n = 59,851 cases and 113,154 controls) from the Psychiatric Genomics Consortium. Genetically predicted S-25OHD concentrations were not associated with major depression. The odds ratio per genetically predicted one standard deviation decrease in S-25OHD concentrations was 1.02 (95% confidence interval 0.97–1.08; p = 0.44). The results of this study indicate that genetically lowered S-25OHD concentrations are not associated with increased risk of developing major depression.
Keywords	blood serum ; confidence interval ; genomics ; odds ratio ; single nucleotide polymorphism ; solar radiation ; standard deviation ; vitamin D ; vitamin D deficiency ; vitamin status
Language	English
Dates of publication	2018-1215
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
ZDB-ID	2518386-2
ISSN	2072-6643
ISSN	2072-6643
DOI	10.3390/nu10121987
Database	NAL-Catalogue (AGRICOLA)

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