31.12.2007

Cameron, A. J., Zimmet, P. Z., Soderberg, S., Alberti, K., Sicree, R., Tuomilehto, J., Chitson, P. and Shaw, J. E.

Diabetic Medicine. 2007; 24(12): 1460-1469. Article. IF 2.484

Aims To assess the utility of the metabolic syndrome (MetS) and a Diabetes Predicting Model as predictors of incident diabetes.

Methods A longitudinal survey was conducted in Mauritius in 1987 (n = 4972; response 80%) and 1992 (n = 3685; follow-up 74.2%). Diabetes status was retrospectively determined using 1999 World Health Organization (WHO) criteria. MetS was determined according to four definitions and sensitivity, positive predictive value (PPV), specificity and the association with incident diabetes before and after adjustment for MetS components calculated.

Results Of the 3198 at risk, 297 (9.2%) developed diabetes between 1987 and 1992. The WHO MetS definition had the highest prevalence (20.3%), sensitivity (42.1%) and PPV (26.8%) for prediction of incident diabetes, the strongest association with incident diabetes after adjustment for age and sex [odds ratio 4.6 (3.5-6.0)] and was the only definition to show a significant association after adjustment for its component parts (in men only). The low prevalence and sensitivity of the International Diabetes Federation (IDF) and ATPIII MetS definitions resulted from waist circumference cut-points that were high for this population, particularly in men, and both were not superior to a diabetes predicting model on receiver operating characteristic analysis.

Conclusions Of the MetS definitions tested, the WHO definition best identifies those who go on to develop diabetes, but is not often used in clinical practice. If cut-points or measures of obesity appropriate for this population were used, the IDF and ATPIII MetS definitions could be recommended as useful tools for prediction of diabetes, given their relative simplicity.

Impact of the 1976 Tobacco Control Act in Finland on the proportion of ever daily smokers by socioeconomic status

Helakorpi, S., Martelin, T., Torppa, J., Vartiainen, E., Uutela, A. and Patja, K.

Prev Med. 2007. IF 2.390

OBJECTIVE.: To assess the impact of the 1976 Tobacco Control Act (TCA) on smoking initiation across socioeconomic groups.

METHODS.: Nationwide data from independent annual cross-sectional postal surveys in 1978-2002 in Finland. Subjects were 25-64-year-old men and women born 1926-1975 (n=68 071). Socioeconomic status was derived individually from population census data. Logistic regression was applied to assess the impact of the 1976 TCA on the prevalence of ever daily smoking in birth cohorts and socioeconomic groups.

RESULTS.: Clear socioeconomic differences in ever daily smoking among men and women were found. In all socioeconomic groups a declining cohort trend was observed among men whereas women showed an increasing trend in early cohorts and a declining one thereafter. A statistically significant decline in the proportion of ever daily smokers compatible with the impact of the TCA was found in all socioeconomic groups except farmers. Among women the decline was roughly similar in each socioeconomic group, while among men it varied and was most pronounced among white collar employees.

CONCLUSIONS.: The impact of the 1976 TCA was less pronounced among male lower socioeconomic groups. In spite of the even impact of the TCA on female smoking across socioeconomic groups, large socioeconomic disparities remain. Tobacco control policy measures specifically directed at lower socioeconomic groups are needed.

The sociodemographic patterning of drinking and binge drinking in Estonia, Latvia, Lithuania and Finland, 1994-2002

Helasoja, V., Lahelma, E., Prattala, R., Petkeviciene, J., Pudule, I. and Tekkel, M.

BMC Public Health. 2007; 7: 241. IF 1.603

BACKGROUND: Despite the relatively low recorded alcohol consumption level, the Baltic countries (Estonia, Latvia and Lithuania) and neighbouring Finland suffer from similar harmful consequences related to the use of alcoholic beverages, including socio-economic inequalities in alcohol related mortality. Comparative evidence is needed to understand harmful drinking patterns and to implement preventive alcohol policies also in the Baltic countries.

This study compared heavy and binge drinking by sex, age, education, urbanisation and marital status in the Baltic countries and Finland. The data were nationally representative postal surveys conducted in Estonia (n = 6271), Latvia (n = 6106), Lithuania (n = 7966) and Finland (n = 15764) during 1994-2002. The criterion for heavy drinking was at least 15 portions weekly among men, and at least five among women, and for binge drinking at least six portions per one occasion.

Heavy drinking was more common among younger participants in all countries, and in Latvia among the less-educated. Among Finnish men, and among women from all countries except Latvia, the better-educated were more often heavy drinkers. In Latvia and Finland, urban men, and in all countries, urban women, were more often heavy drinkers. Heavy drinking was more common among non-married Lithuanian and Finnish men, and Finnish women. Binge drinking was more common among less-educated Estonian and Latvian men, and among younger and less-educated women in all countries.

Our results support the continued power of traditional drinking habits in the North Eastern part of Europe. In the future the target groups for prevention of excessive drinking should also include young and less-educated women in all four countries studied.

Quality of Treatment and Disability Compensation in Depression: Comparison of 2 Nationally Representative Samples With a 10-Year Interval in Finland

Honkonen, T. I., Aro, T. A., Isometsa, E. T., Virtanen, E. M. and Katila, H. O.

J Clin Psychiatry. 2007; 68(12): 1886-1893. IF 5.533

OBJECTIVE: Depressive disorders cause substantial work impairment that can lead to disability compensation. The authors compared treatment received for depression preceding disability pension between 2 nationally representative samples with a 10-year interval.

METHOD: The medical statements for 2 random samples drawn from the Finnish national disability pension registers, representing populations granted a disability pension for DSM-III-R major depression during a 12-month period from October 1993 through September 1994 (N = 277) and for ICD-10 depressive disorders (F32-F33) from October 2003 through September 2004 (N = 265) were examined. The proportions of persons receiving weekly psychotherapy, antidepressants, adequate antidepressant dosage, sequential antidepressant trials, lithium augmentation, and electroconvulsive therapy (ECT) were compared.

RESULTS: No significant differences emerged between the 2 samples, except for the adequacy of antidepressant dosage. Few subjects in either of the samples (8.7% for 1993-1994 vs. 10.6% for 2003-2004, p = .45) had received weekly psychotherapy. Most had received antidepressants (87.4% vs. 85.6%, p = .55) with increasingly adequate dosage (75.6% vs. 85.0%, p = .02), but only a minority had received sequential antidepressant trials (39.5% vs. 44.5%, p = .24). Lithium augmentation and ECT were rare (1.1% vs. 1.5%, p = .66 and 4.0% vs. 1.5%, p = .08, respectively). Even in 2003-2004, over half of the subjects were granted a disability pension without sequential antidepressant trials.

CONCLUSION: This nationally representative study indicates that, despite an increased antidepressant use and improved practice guidelines for depression, a considerable proportion of the people granted long-term compensation for depression seem to be suboptimally treated. Given the enormous costs of the disability, attention to the quality of treatment provided for depression is warranted before long-term disability compensations are granted.

Occupational, commuting and leisure-time physical activity in relation to coronary heart disease among middle-aged Finnish men and women

Hu, G., Jousilahti, P., Borodulin, K., Barengo, N. C., Lakka, T. A., Nissinen, A. and Tuomilehto, J.

Atherosclerosis. 2007; 194(2): 490-7. IF 3.811

OBJECTIVE: To examine the association of different levels of occupational, commuting, and leisure-time physical activity with the risk of coronary heart disease (CHD) events.

METHODS AND RESULTS: The study comprised 47,840 Finnish participants aged 25-64 years without history of CHD and stroke at baseline. During a mean follow-up of 18.9 years, 4660 new CHD events were documented. The multivariable-adjusted (age, body mass index, systolic blood pressure, total cholesterol, education, alcohol consumption, smoking, history of diabetes, and other two types of physical activity) hazard ratios (HRs) of CHD events associated with low, moderate, and high occupational activity were 1.00, 0.87, and 0.90 (P(trend)=0.019) for men, and 1.00, 0.75, and 0.80 (P(trend)<0.001) for women, respectively. The multivariable-adjusted HRs of CHD events associated with low, moderate, and high leisure-time physical activity were 1.00, 0.95, and 0.84 (P(trend)=0.026) for men, and 1.00, 0.85, and 0.77 (P(trend)=0.003) for women, respectively. Active commuting had a significant inverse association with the risk of CHD events in women but not in men.

CONCLUSION: Moderate or high levels of occupational or leisure-time physical activity are associated with a reduced risk of CHD. Daily walking or cycling to and from work is associated with a decreased risk of CHD among women.

Body size at birth predicts hypothalamic-pituitary-adrenal axis response to psychosocial stress at age 60 to 70 years

Kajantie, E., Feldt, K., Raikkonen, K., Phillips, D. I. W., Osmond, C., Heinonen, K., Pesonen, A. K., Andersson, S., Barker, D. J. P. and Eriksson, J. G.

Journal of Clinical Endocrinology and Metabolism. 2007; 92(11): 4094-4100. Article. IF 5.799

Background: Studies in humans and animals have suggested intrauterine programming of hypothalamic-pituitary-adrenal axis ( HPAA) function as an important mechanism in linking fetal life conditions with adult disease.

Objective: Our aim was to assess how body size at birth, a marker of intrauterine conditions, is associated with hypothalamic-pituitary-adrenal axis response to psychosocial stress in late adulthood.

Design and Setting: We conducted a clinical study in the Helsinki Birth Cohort.

Participants: Two hundred eighty-seven men and women born between 1934 and 1944 whose birth measurements and gestational age came from hospital records participated in the study.

Measurements: We measured salivary cortisol and, for 215 individuals, plasma cortisol and ACTH concentrations in conjunction with a standardized psychosocial stressor ( Trier Social Stress Test).

Results: There was a linear relationship between low birth weight and low plasma ACTH but no linear relationship with cortisol. There were, however, quadratic relationships between birth weight and salivary ( mixed model P = 0.001) and plasma cortisol ( P = 0.005) but not with plasma ACTH ( P = 0.1). The lowest peak salivary cortisol concentrations were seen in the lowest third of birth weights ( adjusted for gestational age and sex): 12.9 nmol/liter (95% confidence interval of mean 11.2-15.0), compared with 17.1 nmol/liter (14.8-19.8) in the middle and 14.1 nmol/liter ( 12.6-15.7) in the highest third of birth weights. Corresponding figures for plasma cortisol were 418 nmol/ liter ( 380-459), 498 nmol/ liter (455-545), and 454 nmol/ liter (428-482), and for plasma ACTH 8.17 pmol/ liter (6.98-9.57), 12.42 pmol/ liter (10.64-14.51), and 11.50 (10.06-13.14), respectively. Results for areas under the curve were similar.

Conclusions: We found an inverse U-shaped relationship between birth weight and cortisol concentrations during psychosocial stress. The lowest cortisol and ACTH concentrations were seen in subjects with the lowest birth weights. These results support the hypothesis that both hyper- and hypocortisolism may be programmed during the fetal period.

Common DNA sequence variants at six new loci with varied effects on blood lipids in humans

Kathiresan, S., Melander, O., Guiducci, C., Surti, A., Burtt, N. P., Rieder, M. J., Cooper, G. M., Roos, C., Voight, B. F., Havulinna, A. S., Hedner, T., Berglund, G., Vartiainen, E., Jousilahti, P., Hedblad, B., Newton-Cheh, C., Salomaa, V., Peltonen, L., Groop, L., Altshuler, D. M. and Orho-Melander, M.

Circulation Research. 2007; 101(11): 1207-1207. Meeting Abstract. IF 9.854

The association between visual acuity and functional limitations: findings from a nationally representative population survey

Laitinen, A., Sainio, P., Koskinen, S., Rudanko, S. L., Laatikainen, L. and Aromaa, A.

Ophthalmic Epidemiol. 2007; 14(6): 333-42. IF 1.640

Purpose: To determine the independent effect of visual acuity on individual activities of daily living (ADL), instrumental activities of daily living (IADL) and mobility.

Methods: Cross-sectional survey on a sample representing the Finnish population aged 55 years and above. Of the 3392 eligible people, 3185 (93.9%) were interviewed, 2870 (84.6%) attended a comprehensive health examination, and 2781 (82.0%) had distance visual acuity (VA) assessed. A home interview included assessment of ADL, IADL and mobility, demographic variables and chronic conditions. Mobility measurements and binocular VA were assessed during the examination.

Results: Prevalence of ADL, IADL, and mobility limitations increased with decreasing VA (p < 0.001). Visually impaired persons (VA /= 0.8) after adjustment for socio-demographic and behavioral factors, and chronic conditions (OR 4.36, 95%CI 2.44-7.78). Limitations in IADL and measured mobility were five times as likely (OR 4.82, 95%CI 2.38-9.76 and OR 5.37, 95%CI 2.44-7.78, respectively), and self-reported mobility limitations were three times as likely (OR 3.07, 95%CI 1.67-9.63) as in persons with good VA.

Conclusions: Decreased VA is strongly associated with functional limitations, and even a slight decrease in VA was found to be associated with limitations in functioning.

Specific developmental disruption of disrupted-in-schizophrenia-1 function results in schizophrenia-related phenotypes in mice

Li, W., Zhou, Y., Jentsch, J. D., Brown, R. A. M., Tian, X., Ehninger, D., Hennah, W., Peltonen, L., Lonnqvist, J., Huttunen, M. O., Kaprio, J., Trachtenberg, J. T., Silva, A. J. and Cannon, T. D.

Proceedings of the National Academy of Sciences of the United States of America. 2007; 104(46): 18280-18285. Article. IF 9.643

Disrupted-in-schizophrenia 1 (DISC1) was initially discovered through a balanced translocation (1;11)(q42.1;q14.3) that results in loss of the C terminus of the DISC1 protein, a region that is thought to play an important role in brain development.

Here, we use an inducible and reversible transgenic system to demonstrate that early postnatal, but not adult induction, of a C-terminal portion of DISC1 in mice results in a cluster of schizophrenia-related phenotypes, including reduced hippocampal dendritic complexity, depressive-like traits, abnormal spatial working memory, and reduced sociability. Accordingly, we report that individuals in a discordant twin sample with a DISC1 haplotype, associating with schizophrenia as well as working memory impairments and reduced gray matter density, were more likely to show deficits in sociability than those without the haplotype.

Our findings demonstrate that alterations in DISC1 function during brain development contribute to schizophrenia pathogenesis.

Genome-wide association scans identify novel loci that influence lipid levels and risk of coronary artery disease

Najjar, S. S., Willer, C. J., Sanna, S., Jackson, A. U., Arbor, A., Scuteri, A., Clarke, R., Galan, P., Meneton, P., Zelenika, D., Sundvall, J., Watanabe, R. M., Shuldiner, A. R., Collins, R., Bergman, R. N., Uda, M., Tuomilehto, J., Collins, F. S., Lathrop, G. M., Boehnke, M., Schlessinger, D., Abecasis, G. R., Cao, A., Mohlke, K. L. and Lakatta, E. G.

Circulation Research. 2007; 101(11): 1207-1207. Meeting Abstract. IF 9.854

The comparative sero-epidemiology of varicella zoster virus in 11 countries in the European region

Nardone, A., de Ory, F., Carton, M., Cohen, D., van Damme, P., Davidkin, I., Rota, M. C., de Melker, H., Mossong, J., Slacikova, M., Tischer, A., Andrews, N., Berbers, G., Gabutti, G., Gay, N., Jones, L., Jokinen, S., Kafatos, G., de Aragon, M. V. M., Schneider, F., Smetana, Z., Vargova, B., Vranckx, R. and Miller, E.

Vaccine. 2007; 25(45): 7866-7872. Article. IF 3.159

The European sero-epidemiology network (ESEN2) aims to standardise serological surveillance of varicella zoster virus (VZV) in I I participant countries. In each country, serum banks were collected between 1996 and 2003 and tested for VZV antibodies. Assay results were standardised so that international comparisons could be made. Age-specific forces of infection were calculated for three age groups (<5, 5-9 and >= 10 years of age) and used to estimate the base reproduction number (R-0) and the herd immunity threshold (H). Most VZV infection occurred in childhood, but there was a wide variation in transmissibility, with R-0 ranging from 16.9 in the Netherlands to 3.3 in Italy. Herd immunity thresholds varied from 70% in Italy to 94% in the Netherlands. There are substantial differences in VZV sero-epidemiology within the European region, which will need to be taken into account in designing national policies regarding VZV vaccination. (c) 2007 Elsevier Ltd. All rights reserved.

Retinoic acid inhibits the infectivity and growth of Chlamydia pneumoniae in epithelial and endothelial cells through different receptors

Puolakkainen, M., Lee, A., Nosaka, T., Fukushi, H., Kuo, C. C. and Campbell, L. A.

Microb Pathog. 2007. IF 2.258

Chlamydia pneumoniae is a human respiratory pathogen that has also been associated with cardiovascular disease. C. pneumoniae infection accelerates atherosclerotic plaque development in hyperlipidemic animals and promotes oxidation of low density lipoprotein in vitro. All-trans-retinoic acid (ATRA), an antioxidant, has been shown to inhibit C. pneumoniae infectivity for endothelial cells by preventing binding of the organism to the M6P/IGF2 receptor on the cell surface.

This current study investigates whether ATRA similarly affects C. pneumoniae infectivity of epithelial cells, which are the primary site of infection in the respiratory tract, and the effects on intracellular growth in both endothelial and epithelial cells. Because ATRA binds to both the nuclear retinoid acid receptor (RAR) and the M6P/IGF2 receptor, 4-[(E)-2-(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-naphthalenyl)-1-propenyl]benzo ic acid (TTNPB), an ATRA analog, which binds to the RAR but not the M6P/IGF2 receptor was used to differentiate the receptor mediating the effects of ATRA.

The results of this study showed two separate effects of ATRA. The first effect is through interaction with the M6P/IGF2 receptor on the cell surface preventing attachment of the organism (inhibition by ATRA but not TTNPB) in endothelial cells and the second is through the nuclear receptor (inhibition by both ATRA and TTNPB) which inhibits growth in both epithelial and endothelial cells.

Age and gender differences in social anxiety symptoms during adolescence: The Social Phobia Inventory (SPIN) as a measure

Ranta, K., Kaltiala-Heino, R., Koivisto, A. M., Tuomisto, M. T., Pelkonen, M. and Marttunen, M.

Psychiatry Research. 2007; 153(3): 261-270. Article. IF 2.310

The aim of the present study was to examine age and gender differences in social anxiety symptoms during adolescence, and to investigate the psychometrics of the Social Phobia Inventory (SPIN) among adolescents.

The SPIN was administered to a large general population sample (n=5252) of Finnish adolescents aged 12-16 years. Age and gender trends in scores and internal consistency and factorial composition of the SPIN were examined in this sample. The test-retest reliability of the SPIN was examined in a smaller sample of adolescents (n=802).

Results showed that girls scored higher than boys on the SPIN full scale and three subscales across the whole age range. Eighth graders (14- to 15-year-olds) scored higher than seventh and ninth graders on the full scale, for boys the differences were significant. Good test-retest reliability (r=0.81), and internal consistency (alpha=0.89) were found for the SPIN. An exploratory factor analysis (EFA) performed on a random half (n = 2625) of the population sample yielded a one-factor model accounting for 38% of the variance between items. This one-factor model, plus an alternative three-factor model, were examined in the holdout half of the population sample (n=2627) by means of a confirmatory factor analysis (CFA). Some support was gained for both factor structures.

Our results indicate that symptoms of social phobia may increase in mid-adolescence. The SPIN appears to be a reliable self-report instrument among adolescents. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

Human papilloma virus immunization in adolescent and young adults - A cohort study to illustrate what events might be mistaken for adverse reactions

Siegrist, C. A., Lewis, E. M., Eskola, J., Evans, S. J. W. and Black, S. B.

Pediatric Infectious Disease Journal. 2007; 26(11): 979-984. Article. IF 3.215

Background: The large-scale implementation of human papilloma virus (HPV) immunization will be followed by cases of autoimmune diseases occurring in temporal association with immunizations. To anticipate events that might be mistakenly assumed to be caused by immunization, their prevalence was monitored before vaccine introduction.

Method: Cohort study carried out within a database of female adolescents (n = 214,896) and young adults (n = 221,472) followed in the pre-HPV vaccine era (2005), computing rates of emergency consultations, hospitalizations and outpatient consultations, and estimation of risks of coincident associations.

Results: Immune-mediated conditions were a frequent cause (10.3%) of emergency room consultation by adolescent girls. Non-allergic immune-mediated conditions affected 86 per 100,000, diabetes ranking first. In 2005, 53 per 100,000 adolescents and 389 per 100,000 women were hospitalized for diseases of presumed autoimmune origin, thyroiditis being the most frequent diagnosis. If HPV immunization had been used with 80% coverage, 3 per 100,000 adolescents would have required emergency care for asthma/allergy within 24 hours and 2 per 100,000 for diabetes within 1 week of an injection. The risks of hospitalization in temporal association with immunization are 4 times higher for thyroiditis than for multiple sclerosis or Guillain-Barre's syndrome, and more than 20 times higher in young women than in adolescents.

Conclusion: The distinction between HPV vaccine-caused adverse reactions and events only observed by chance in temporal association is difficult. The prior use of population-based data allows for identification of issues of potential concern, for monitoring the impact of large-scale interventions and for addressing rapidly vaccine-safety issues that may compromise vaccine programs.

Prevalence and psychiatric comorbidity of attention-deficit/hyperactivity disorder in an adolescent Finnish population

Smalley, S. L., McGough, J. J., Moilanen, I. K., Loo, S. K., Taanila, A., Ebeling, H., Hurtig, T., Kaakinen, M., Humphrey, L. A., McCracken, J. T., Varilo, T., Yang, M. H., Nelson, S. F., Peltonen, L. and Jarvelin, M. R.

Journal of the American Academy of Child and Adolescent Psychiatry. 2007; 46(12): 1575-1583. Article. IF 4.767

Objective: The purpose of the study was to estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD) and its clinical characteristics in the Northern Finland Birth Cohort 1986.

Method: A general population Northern Finland Birth Cohort 1986 of 9,432 children followed prospectively from the early fetal period was surveyed at adolescence (ages 16-18) for ADHD behaviors. Among 6,622 respondents to the survey, a subset of 457 likely cases and controls were evaluated for ADHD and other psychiatric disorders. Chi-square and descriptive statistics were used to examine clinical characteristics of ADHD in the subset, and logistic regression was used to estimate prevalence by weighted extrapolation in the larger cohort.

Results: The estimated prevalence of ADHD among adolescents in the Northern Finland Birth Cohort 1986 is 8.5% with a male/female ratio of 5.7:1. The distribution of ADHD subtypes among the ADHD adolescents is 28% Combined, 64% Inattentive, and 8% Hyperactive-Impulsive. A lifetime diagnosis of a broadly defined ADHD (probable or definite) had a prevalence of 18.2% with a male/female odds ratio (OR) of 3.2. This lifetime diagnosis of ADHD is significantly associated with anxiety (OR 2.4), mood (OR 2.9), and disruptive behavioral disorders (OR 17.3) in the cohort.

Conclusions: ADHD is a common neurobehavioral disorder among Northern Finnish adolescents and significantly associated with psychiatric comorbidity in adolescence.

Chlamydial lipopolysaccharide is present in serum during acute coronary syndrome and correlates with CRP levels

Tiirola, T., Sinisalo, J., Nieminen, M. S., Silvennoinen-Kassinen, S., Paldanius, M., Saikku, P., Jauhiainen, M. and Leinonen, M.

Atherosclerosis. 2007; 194(2): 403-7. IF 3.811

Infections, Chlamydia pneumoniae as a major candidate, have been suggested to participate in inflammatory processes ultimately leading to atherosclerosis.

In the present study we measured serum levels of chlamydial lipopolysaccharide (cLPS) and highly sensitive C-reactive protein (hsCRP) in the acute coronary syndrome (ACS) patients (n=145). During ACS, both cLPS and hsCRP were elevated and significant correlation (P=0.003, r=0.25) between them was observed. Both cLPS and hsCRP levels decreased after the event and correlation remained significant during the follow-up period.

Our results suggest that cLPS is liberated from the damaged tissue persistently infected with C. pneumoniae during the ACS event. The significant correlation between cLPS and hsCRP levels further point to the possibility that both levels reflect the magnitude of tissue damage.

Determinants of changes in bone density: A 5-year follow-up study of adult male monozygotic twins

Videman, T., Battie, M. C., Ripatti, S., Jurvelin, J., Vanninen, E. and Kaprio, J.

Journal of Clinical Densitometry. 2007; 10(4): 408-414. Article. IF 2.277

The relative importance of determinants in bone mineral density (BMD) in adult men is partly unclear.

Our goals were to investigate the effects of familial aggregation and behavioral factors on the change in BMD during a 5-yr follow-up. Subjects (n = 140) were 70 exposure-discordant monozygotic twin pairs (age 35-69 yr). BMD was measured with the same dual-energy X-ray absorptiometry scanner at baseline and at the 5-yr follow-up. A variety of covariates were used including physical examination and interview data. Multivariate linear regression was used.

The mean annual decrease in femoral BMD was 0.2%. The mean lumbar BMD was unchanged, although 8-17% of subjects had a decrease of more than 5%. Familial aggregation explained 14% of the changes in femoral BMD and 19% in lumbar BNID. The stability of BMD in the follow-up was high, both for individuals (intraclass correlation coefficient [ICC] = 0.90-0.94) and for co-twins in a pair (ICC = 0.77-0.84). In femoral BMD, use of alcohol (p = 0.006), coffee (p = 0.046), and beta-blockers (p = 0.043) led to increases, whereas smoking led to a decrease (p < 0.01).

We concluded that frequent increases in BMD, influenced by beta-blockers, partly explain the minor mean changes during follow-up; however, about every 10th subject had a significant decrease. Overall, familial effects played a dominant role in BMD changes in adult men.