Medical Epidemiology

Medical epidemiology research aims at evaluating treatments of diseases and at investigating the importance of genes and lifestyle for development of diseases. Common to epidemiological research is that we observe and quantify associations, usually without performing interventions among the study participants.

An X-ray picture of a hip fracture.
Hip fracture. Photo: Karl Michaëlsson

The epidemiology research group of the section of orthopaedics is based at the Uppsala Clinical Research Center (UCR). This facilitates fruitful interaction with the biostatisticians, data managers and clinical researchers at UCR. We also collaborate with external epidemiological, nutritional, genetic, cardiovascular, injury, osteoporosis and bone density expertise. Our main research topics are fragility fractures but we are involved in other areas of epidemiological research as well.

Network

We administrate a multidisciplinary network of epidemiologists at Uppsala University and provide a discussion forum in the form of seminars for researchers and PhD students (www.ucr.uu.se/epinet). 

Fragility fractures among the elderly population

Fragility fractures are a major health care problem, by reason of its devastating consequences, in particular hip fractures. Such fractures not only entail high health care costs but are also frequently associated with loss of quality of life. Furthermore, osteoporotic fractures carry an increased risk of mortality. Half of all Swedish women and one fourth of all men will suffer a fragility fracture. The etiology of these fractures is complex in the sense that the fracture risk is influenced by both genetic and environmental factors, with lifestyle becoming more important with increasing age. Scandinavia has the highest incidence of fragility fractures in the world. Interestingly, a Swedish man has about twice the risk of having a hip fracture compared to a woman from England, Netherlands or Finland – an observation that cannot readily be explained by known lifestyle or genetic determinants, climate or longevity.

We use different internationally unique cohort designs with the main overall aim to study the etiology and prevention of fragility fractures: 

The Uppsala Longitudinal Study of Adult Men (ULSAM)

Most previous osteoporotic research has been accomplished in women. Prospective data identifying environmental and genetic risk factors for fracture in men are scarce.

All 2,841 men born in 1920-1924 and living in the municipality of Uppsala, Sweden, in 1970 were invited to participate in a health survey - the Uppsala Longitudinal Study of Adult Men (ULSAM; http://www.pubcare.uu.se/ULSAM/). A total of 2,322 men (82% of those invited), 50 years of age, participated in this first examination. Re-investigations have been performed at 60, 71, 77, 82, 88 and 93 years of age. Approximately 850 fractures after study entry (in 600 men) have been identified and scans with DXA (Lunar Prodigy providing measures of bone mineral density, fat and lean mass) have been performed at the last three investigations. 

ULSAM is a tremendous opportunity to prospectively explore environmental and genetic risk factors of osteoporosis and fracture in men. Based on data from the cohort we have published several manuscripts, all in rather high impact journals (N Engl J Med, J Bone Miner Res, PLoS Medicine, Am J Clin Nutr, J Clin Endocrinol Metab, BMJ), which emphasizes the potential of this longitudinal study. 

Screening Across the Lifespan Twin study (SALT)

By studying twins it is possible to estimate the overall relative importance of genetic and environmental influences. In the period 1998-2002, screening of twins born 1958 or before was performed within the Swedish twin registry. Data collection was carried out with a comprehensive computer assisted telephone interview. In total, 52,080 twins born 1958 or earlier have participated. In total, approximately 10,000 fracture cases have been identified.

We have, using the Swedish twin cohort, found that the genetic contribution to fracture risk is strongly and inversely associated with age (Arch of Intern Med 2007). The co-twin control method is applied in situations where one wants to investigate the importance of a putative risk factor such as impaired balance for fracture risk after controlling for genetic and shared environmental effects (Am J Epidemiol 2009). We have discovered the influence of cardio-vascular diseases on fracture risk including the genetic component for the associations (JAMA 2009). Moreover, we have discovered that the higher mortality following a hip fracture in women is to a large extent explained by genetic constitution whereas the substantial higher mortality risk in men is independent of genes. Whole-genome analysis has been performed in about 10,000 twins of the SALT study twins and Karl Michaëlsson, together with Peter Nordström, Umeå, is responsible for musculoskeletal outcomes.

Furthermore, twins born before 1958 and residents to the county of Uppsala have been invited for DXA measurement and blood collection. We have measured 204 sex-like twins. The heritability of bone density and bone size, bone turnover markers, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D has been determined. 

The Swedish Mammography Cohort (SMC) and SMC Clinical (SMCC)

The Swedish Mammography Cohort is a population-based prospective cohort study based on information given by 65,000 women from Västmanland and Uppsala counties born 1914-1948 (74% of all eligible women). Validated food frequency questionnaires (FFQs) have been used: the first answered at entry to the cohort, 1987-90, the second was sent out in 1997 and the third in 2009. We therefore have access to prospective and longitudinal information of nutrient intake yielding more precise nutrient estimates and other risk factors for fragility fractures in a large number of women. By register identification, we have found more than 25 000 fractures after study entry – this cohort is therefore unique in its size.

Randomly selected from the SMC, 5022 women have during the period 2003-2009 been invited to an additional dietary survey. These women have also examined by DXA-scans (bone, fat and lean mass measured by Lunar Prodigy). Blood, urine and fat biopsies have been collected and are stored in a biobank. A new sub-cohort of the SMC, SMC Clinical (SMCC) has therefore been built and finalized. PIs for SMCC are Karl Michaëlsson and Alicja Wolk. A second clinical examination of the SMCC was initiated in 2015. Our scientific papers based on longitudinal dietary data with fractures in SMC and bone mineral density in SMCC as outcomes have been published in journals such as BMJ, Am J Epidemiol, Am J Clin Nutr, JCEM, JBMR. 

The Cohort of Swedish Men (COSM)

Including about 50,000 men, born 1918-52 and living in Västmanland and Örebro Counties was established in 1997. The questionnaire investigation included information on diet, and other life-style habits, and will enable us to investigate dietary influences on fracture risk in men. A second questionnaire survey was done in 2009. Fracture data have been compiled from registry information. The study is performed in cooperation with Alicja Wolk, PI, Unit of Nutritional Epidemiology, IMM, KI. 

Randomly selected from the COSM, 3500 men and 1500 women (the man's wife or cohabitee) have during 2010-2016 participated in an additional dietary survey. The study is ongoing and we aim to include 5000 men and 3000 women. Blood, urine and fat biopsies as well as faecal samples have been collected and are stored in a biobank. A new sub-cohort of the COSM, COSM Clinical (COSM-C) is therefore under development, in parallel to the SMCC.

Other long-lasting projects with our involvement are:

EpiHealth and PIVUS, bisphosphonates and atypical femoral fractures (done in cooperation with Linköping University), the cohort from the ski race Vasaloppet, and the Uppsala Family Study.

Funding

The Swedish Research Council (VR), the Swedish Research Council for Health, Working Life and Welfare (FAS/FORTE) and ALF.

Members of the group

Headed by Karl Michaëlsson, Professor in Medical Epidemiology and Senior Consultant in Orthopaedic Surgery

Employees

Liisa Byberg, Associate Professor in Medical Epidemiology, Researcher
Carina Fredriksson, Research Nurse
Jonas Höijer, Statistician
Anna-Karin Kolseth, Project coordinator
Eva Warensjö Lemming, PhD, Researcher
Eva Strandberg, Research Nurse
Siv Tengblad, Medical laboratory scientist

PhD students (main supervision by Liisa Byberg or Karl Michaëlsson)

Mohammad Kharazmi: Bisphosphonate associated atypical fractures of the human skeleton
Adam Mitchell: The role of diabetes and glycemic traits in diabetic bone disease
Anna Sprinchorn: Peroneus brevis and longus tendon tears – anatomy, injuries and treatment
Karl Stattin: Physical activity and risk of fragility fractures
Rui Zheng: Large scale metabolomic profiling for precision medicine and nutrition

Theses

Björn Knutsson (2015): Body mass index and lumbar spinal stenosis 
Breiffni Leavy (2015): Fall-Related Hip Fracture: Predisposing and Precipitating Factors
Helena Hallström (2013): Coffee Consumption in Relation to Osteoporosis and Fractures: Observational Studies in Men and Women 
Helene Wagner (2012): Genetic and environmental influences on osteoporosis and fractures
Greta Snellman (2011): Boning up on vitamin D: Observational studies on bone and health 
Bengt Östman (2009): Influence of oxidative stress on muscle and bone 
Hans-Olov Hellström (2007): Bone and aluminium 

Course

We are giving an annual research training course in medical epidemiology at an intermediate and advanced level. Information about the course can be found at http://www2.medfarm.uu.se/utbildning/forskarniva/for_doktorander/kurser.html


Our publications (2012 - 2017, most recent first)

2017

Leavy B, Michaëlsson K, Åberg AC, Melhus H, Byberg L. The Impact of Disease and Drugs on Hip Fracture Risk. Calcif Tissue Int. 2017;100(1):1-12. doi:10.1007/s00223-016-0194-7.

2016

Byberg L, Bellavia A, Larsson SC, Orsini N, Wolk A, Michaëlsson K. Mediterranean Diet and Hip Fracture in Swedish Men and Women. J Bone Miner Res. 2016;31(12):2098-2105. doi:10.1002/jbmr.2896.

Försth P, Michaëlsson K, Sandén B. More on Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med. 2016;375(18):1806-1807. doi:10.1056/NEJMc1610998.

Öhrvik V, Lemming EW, Nälsén C, Becker W, Ridefelt P, Lindroos AK. Dietary intake and biomarker status of folate in Swedish adults. Eur J Nutr. 2016. doi:10.1007/s00394-016-1328-4.

Nybacka S, Bertéus Forslund H, Wirfält E, Larsson I, Ericson U, Warensjö Lemming E, Bergström G, Hedblad B, Winkvist A, Lindroos AK. Comparison of a web-based food record tool and a food-frequency questionnaire and objective validation using the doubly labelled water technique in a Swedish middle-aged population. J Nutr Sci. 2016;5:e39. doi:10.1017/jns.2016.29.

Nordström P, Pedersen NL, Gustafson Y, Michaëlsson K, Nordström A. Risks of Myocardial Infarction, Death, and Diabetes in Identical Twin Pairs With Different Body Mass Indexes. JAMA Intern Med. 2016;176(10):1522-1529. doi:10.1001/jamainternmed.2016.4104.

Michaëlsson K, Wolk A, Byberg L, Mitchell A, Mallmin H, Melhus H. The seasonal importance of serum 25-hydroxyvitamin D for bone mineral density in older women. J Intern Med. 2016. doi:10.1111/joim.12563.

Hantikainen E, Grotta A, Ye W, Adami HO, Surkan PJ, Serafini M, Michaëlsson K, Bellocco R, Trolle Lagerros Y. Prospective study of dietary Non Enzymatic Antioxidant Capacity on the risk of hip fracture in the elderly. Bone. 2016;90:31-6. doi:10.1016/j.bone.2016.05.006.

Benetou V, Orfanos P, Feskanich D, Michaëlsson K, Pettersson-Kymmer U, Eriksson S, Grodstein F, Wolk A, Bellavia A, Ahmed LA, Boffeta P, Trichopoulou A. Fruit and Vegetable Intake and Hip Fracture Incidence in Older Men and Women: The CHANCES Project. J Bone Miner Res. 2016;31(9):1743-52. doi:10.1002/jbmr.2850.

Becker W, Lindroos AK, Nälsén C, Warensjö Lemming E, Öhrvik V. Dietary habits, nutrient intake and biomarkers for folate, vitamin D, iodine and iron status among women of childbearing age in Sweden. Ups J Med Sci. 2016;25:1-5. doi:10.1080/03009734.2016.1201176.

Försth P, Michaëlsson K, Sandén B. Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med. 2016;375(6):599-600. doi:10.1056/NEJMc1606502.

Qundos U, Drobin K, Mattsson C, Hong MG, Sjöberg R, Forsström B, Solomon D, Uhlén M, Nilsson P, Michaëlsson K, Schwenk JM. Affinity proteomics discovers decreased levels of AMFR in plasma from Osteoporosis patients. Proteomics Clin Appl. 2016;10(6):681-90. doi:10.1002/prca.201400167.

Michaëlsson K, Aspenberg P. Postmenopausal Osteoporosis. N Engl J Med. 2016;374(21):2095. doi:10.1056/NEJMc1602599#SA1.

Försth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, Öhagen P, Michaëlsson K, Sandén B. A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med. 2016;374(15):1413-23. doi:10.1056/NEJMoa1513721.

Fang F, Hållmarker U, James S, Ingre C, Michaëlsson K, Ahlbom A, Feychting M. Amyotrophic lateral sclerosis among cross-country skiers in Sweden. Eur J Epidemiol. 2016;31(3):247-53. doi:10.1007/s10654-015-0077-7.

Carlsson AC, Ärnlöv J, Sundström J, Michaëlsson K, Byberg L, Lind L. Physical activity, obesity and risk of cardiovascular disease in middle-aged men during a median of 30 years of follow-up. Eur J Prev Cardiol. 2016;23(4):359-65. doi:10.1177/2047487314568034.

Kharazmi M, Hallberg P, Schilcher J, Aspenberg P, Michaëlsson K. Mortality After Atypical Femoral Fractures: A Cohort Study. J Bone Miner Res. 2016;31(3):491-7. doi:10.1002/jbmr.2767.

Ludvigsson JF, Almqvist C, Bonamy AK, Ljung R, Michaëlsson K, Neovius M, Stephansson O, Ye W. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol. 2016;31(2):125-36. doi:10.1007/s10654-016-0117-y.

Hållmarker U, Michaëlsson K, Ärnlöv J, Hellberg D, Lagerqvist B, Lindbäck J, James S. Risk of recurrent ischaemic events after myocardial infarction in long-distance ski race participants. Eur J Prev Cardiol. 2016;23(3):282-90. doi:10.1177/2047487315578664.

Reilly NR, Lebwohl B, Mollazadegan K, Michaëlsson K, Green PH, Ludvigsson JF. Celiac Disease Does Not Influence Fracture Risk in Young Patients with Type 1 Diabetes. J Pediatr. 2016;169:49-54. doi:10.1016/j.jpeds.2015.10.032.

Lu Y, Day FR, Gustafsson S, , ... , Michaëlsson K, ..., Lindgren C, Kilpeläinen TO, Loos RJ. New loci for body fat percentage reveal link between adiposity and cardiometabolic disease risk. Nat Commun. 2016;7:10495. doi:10.1038/ncomms10495.

Ax E, Warensjö Lemming E, Becker W, Andersson A, Lindroos AK, Cederholm T, Sjögren P, Fung TT. Dietary patterns in Swedish adults; results from a national dietary survey. Br J Nutr. 2016;115(1):95-104. doi:10.1017/S0007114515004110.

2015

Nordström P, Michaëlsson K, Hommel A, Norrman PO, Thorngren KG, Nordström A. Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission. J Am Med Dir Assoc. 2016;17(1):91.e1-7. doi:10.1016/j.jamda.2015.07.004.

Ljunggren M, Byberg L, Theorell-Haglöw J, Lindahl B, Michaëlsson K, Lindberg E. Increased risk of heart failure in women with symptoms of sleep-disordered breathing. Sleep Med. 2016;17:32-7. doi:10.1016/j.sleep.2015.09.018.

Robinson D, Garmo H, Stattin P, Michaëlsson K. Risk of Fractures and Falls during and after 5-α Reductase Inhibitor Use: A Nationwide Cohort Study. PLoS One. 2015;10(10):e0140598. doi:10.1371/journal.pone.0140598.

Michaëlsson K. Calcium supplements do not prevent fractures. BMJ. 2015;351:h4825. doi:10.1136/bmj.h4825.

Hållmarker U, Åsberg S, Michaëlsson K, Ärnlöv J, Hellberg D, Lindbäck J, Wester P, James S. Risk of Recurrent Stroke and Death After First Stroke in Long-Distance Ski Race Participants. J Am Heart Assoc. 2015;4(10):e002469. doi:10.1161/JAHA.115.002469.

Knutsson B, Sandén B, Sjödén G, Järvholm B, Michaëlsson K. Body Mass Index and Risk for Clinical Lumbar Spinal Stenosis: A Cohort Study. Spine. 2015;40(18):1451-6. doi:10.1097/BRS.0000000000001038.

Larsson SC, Crippa A, Orsini N, Wolk A, Michaëlsson K. Milk Consumption and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis. Nutrients. 2015;7(9):7749-63. doi:10.3390/nu7095363.

Benedict C, Byberg L, Cedernaes J, Hogenkamp PS, Giedratis V, Kilander L, Lind L, Lannfelt L, Schiöth HB. Self-reported sleep disturbance is associated with Alzheimer's disease risk in men. Alzheimers Dement. 2015;11(9):1090-7. doi:10.1016/j.jalz.2014.08.104.

Karampampa K, Ahlbom A, Michaëlsson K, Andersson T, Drefahl S, Modig K. Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival--A nationwide study of the Swedish population 60 years and older. Bone. 2015;78:55-61. doi:10.1016/j.bone.2015.04.032.

Wallin S, Gambacorta L, Kotova N, Lemming EW, Nälsén C, Solfrizzo M, Olsen M. Biomonitoring of concurrent mycotoxin exposure among adults in Sweden through urinary multi-biomarker analysis. Food Chem Toxicol. 2015;83:133-9. doi:10.1016/j.fct.2015.05.023.

Kharazmi M, Michaëlsson K, Hallberg P. Prodromal Symptoms in Patients with Bisphosphonate-Associated Atypical Fractures of the Femur. J Bone Miner Metab. 2015;33(5):516-22. doi:10.1007/s00774-014-0611-9.

Järvinen T, Michaëlsson K, Jokihaara J, Collins GS, Perry TL, Mintzes B, Musini V, Erviti J, Gorricho J, Wright JM, Sievänen H. Authors' reply to Lee and colleagues. BMJ. 2015;351:h3737. doi:10.1136/bmj.h3737.

Thiblin I, Garmo H, Garle M, Holmberg L, Byberg L, Michaëlsson K, Gedeborg R. Anabolic steroids and cardiovascular risk: A national population-based cohort study. Drug Alcohol Depend. 2015;152:87-92. doi:10.1016/j.drugalcdep.2015.04.013.

Warensjö Lemming E, Nälsén C, Becker W, Ridefelt P, Mattisson I, Lindroos AK. Relative validation of the dietary intake of fatty acids among adults in the Swedish National Dietary Survey using plasma phospholipid fatty acid composition. J Nutr Sci. 2015;4:e25. doi:10.1017/jns.2015.1.

Melhus H, Michaëlsson K. [Vitamin D supplementation may do more harm than good. Evidence-based threshold values for vitamin D status are still lacking] (Swedish). Läkartidningen. 2015;112:DHFF. link to article

Byberg L, Bellavia A, Orsini N, Wolk A, Michaëlsson K. Fruit and vegetable intake and risk of hip fracture: a cohort study of Swedish men and women. J Bone Miner Res. 2015;30(6):976-84. doi:10.1002/jbmr.2384.

Järvinen TL, Michaëlsson K, Aspenberg P, Sievänen H. Osteoporosis: the emperor has no clothes. J Intern Med. 2015;277(6):662-73. doi:10.1111/joim.12366.

Benetou V, Orfanos P, Feskanich D, Michaëlsson K, Pettersson-Kymmer U, Ahmed LA, Peasey A, Wolk A, Brenner H, Bobak M, Wilsgaard T, Schöttker B, Saum KU, Bellavia A, Grodstein F, Klinaki E, Valanou E, Papatesta EM, Boffetta P, Trichopoulou A. Education, marital status, and risk of hip fractures in older men and women: the CHANCES project. Osteoporos Int. 2015;26(6):1733-46. doi:10.1007/s00198-015-3054-9.

Järvinen TL, Michaëlsson K, Jokihaara J, Collins GS, Perry TL, Mintzes B, Musini V, Erviti J, Gorricho J, Wright JM, Sievänen H. Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ. 2015;350:h2088. doi:10.1136/bmj.h2088.

Cornelis MC, Byrne EM, Esko T, ... , Michaëlsson K, ..., Chasman DI. Genome-wide meta-analysis identifies six novel loci associated with habitual coffee consumption. Mol Psychiatry. 2015;20(5):647-56. doi:10.1038/mp.2014.107.

Arefalk G, Hambraeus K, Lind L, Michaëlsson K, Lindahl B, Sundström J. Response to letter regarding article, "Discontinuation of smokeless tobacco and mortality risk after myocardial infarction". Circulation. 2015;131(17):e423. doi:10.1161/CIRCULATIONAHA.114.014029.

Leavy B, Byberg L, Michaëlsson K, Melhus H, Åberg AC. The fall descriptions and health characteristics of older adults with hip fracture: a mixed methods study. BMC Geriatr. 2015;15:40. doi:10.1186/s12877-015-0036-x.

Hållmarker U, James S, Michaëlsson K, Ärnlöv J, Sandin F, Holmberg L. Cancer incidence in participants in a long-distance ski race (Vasaloppet, Sweden) compared to the background population. Eur J Cancer. 2015;51(4):558-68. doi:10.1016/j.ejca.2014.12.009.

Nordström P, Gustafson Y, Michaëlsson K, Nordström A. Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ. 2015;350:h696. doi:10.1136/bmj.h696.

Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use. Acta Orthop. 2015;86(1):100-7. doi:10.3109/17453674.2015.1004149.

Andersen K, Lind L, Ingelsson E, Ärnlöv J, Byberg L, Michaëlsson K, Sundström J. Skeletal muscle morphology and risk of cardiovascular disease in elderly men. Eur J Prev Cardiol. 2015;22(2):231-9. doi:10.1177/2047487313506828.

Jia T, Byberg L, Lindholm B, Larsson TE, Lind L, Michaëlsson K, Carrero JJ. Dietary acid load, kidney function, osteoporosis, and risk of fractures in elderly men and women. Osteoporos Int. 2015;26(2):563-70. doi:10.1007/s00198-014-2888-x.

Olsson E, Karlström B, Kilander L, Byberg L, Cederholm T, Sjögren P. Dietary patterns and cognitive dysfunction in a 12-year follow-up study of 70 year old men. J Alzheimers Dis. 2015;43(1):109-19. doi:10.3233/JAD-140867.

2014

Michaëlsson K, Byberg L. Authors' reply to Labos and Brophy, Kerr, Hill, Hettinga, Sundar, and Bonneux. BMJ. 2014;349:g7023. doi:10.1136/bmj.g7023.

Wulaningsih W, Van Hemelrijck M, Michaelsson K, Kanarek N, Nelson WG, Ix JH, Platz EA, Rohrmann S. Association of serum inorganic phosphate with sex steroid hormones and vitamin D in a nationally representative sample of men. Andrology. 2014;2(6):967-76. doi:10.1111/andr.285.

Hagström E, Kilander L, Nylander R, Larsson EM, Michaëlsson K, Melhus H, Ahlström H, Johansson L, Lind L, Arnlöv J. Plasma parathyroid hormone is associated with vascular dementia and cerebral hyperintensities in two community-based cohorts. J Clin Endocrinol Metab. 2014;99(11):4181-9. doi:10.1210/jc.2014-1736.

Holvik K, Gjesdal CG, Tell GS, Grimnes G, Schei B, Apalset EM, Samuelsen SO, Blomhoff R, Michaëlsson K, Meyer HE. Low serum concentrations of alpha-tocopherol are associated with increased risk of hip fracture. A NOREPOS study. Osteoporos Int. 2014;25(11):2545-54. doi:10.1007/s00198-014-2802-6.

Michaëlsson K, Wolk A, Langenskiöld S, Basu S, Warensjö Lemming E, Melhus H, Byberg L. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ. 2014;349:g6015. doi:10.1136/bmj.g6015.

Byberg L, Michaëlsson K, Goodman A, Zethelius B, Koupil I. Birth weight is not associated with risk of fracture: results from two Swedish cohort studies. J Bone Miner Res. 2014;29(10):2152-60. doi:10.1002/jbmr.2246.

Kharazmi M, Hallberg P, Warfvinge G, Michaëlsson K. Risk of atypical femoral fractures and osteonecrosis of the jaw associated with alendronate use compared with other oral bisphosphonates. Rheumatology. 2014 Oct;53(10):1911-3. doi:10.1093/rheumatology/keu286.

Knutsson B, Michaëlsson K, Sandén B. Obese patients report modest weight loss after surgery for lumbar spinal stenosis: a study from the Swedish spine register. Spine. 2014;39(20):1725-30. doi:10.1097/BRS.0000000000000464.

Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use. N Engl J Med. 2014;371(10):974-6. doi:10.1056/NEJMc1403799.

Maggio M, De Vita F, Lauretani F, Ceda GP, Volpi E, Giallauria F, De Cicco G,Cattabiani C, Melhus H, Michaëlsson K, Cederholm T, Lind L. Vitamin D and endothelial vasodilation in older individuals: data from the PIVUS study. J Clin Endocrinol Metab. 2014;99(9):3382-9. doi:10.1210/jc.2014-1536.

Vimaleswaran KS, Cavadino A, Berry DJ, ..., Michaëlsson K, ..., Whittaker JC, Järvelin MR, Hyppönen E. Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study. Lancet Diabetes Endocrinol. 2014;2(9):719-29. doi:10.1016/S2213-8587(14)70113-5.

Selin JZ, Lindblad BE, Rautiainen S, Michaëlsson K, Morgenstern R, Bottai M, Basu S, Wolk A. Are increased levels of systemic oxidative stress and inflammation associated with age-related cataract? Antioxid Redox Signal. 2014;21(5):700-4. doi:10.1089/ars.2014.5853.

Kharazmi M, Hallberg P, Michaëlsson K. Gender related difference in the risk of bisphosphonate associated atypical femoral fracture and osteonecrosis of the jaw. Ann Rheum Dis. 2014;73(8):1594. doi:10.1136/annrheumdis-2013-205080.

Arefalk G, Hambraeus K, Lind L, Michaëlsson K, Lindahl B, Sundström J. Discontinuation of smokeless tobacco and mortality risk after myocardial infarction. Circulation. 2014;130(4):325-32. doi:10.1161/CIRCULATIONAHA.113.007252.

Hagström E, Michaëlsson K, Melhus H, Hansen T, Ahlström H, Johansson L, Ingelsson E, Sundström J, Lind L, Arnlöv J. Plasma-parathyroid hormone is associated with subclinical and clinical atherosclerotic disease in 2 community-based cohorts. Arterioscler Thromb Vasc Biol. 2014;34(7):1567-73. doi:10.1161/ATVBAHA.113.303062.

Michaëlsson K. Surgeon volume and early complications after primary total hip arthroplasty. BMJ. 2014;348:g3433. doi:10.1136/bmj.g3433.

Hallström H, Wolk A, Glynn A, Michaëlsson K, Byberg L. Coffee consumption and risk of fracture in the Cohort of Swedish Men (COSM). PLoS One. 2014;9(5):e97770. doi:10.1371/journal.pone.0097770.

Witasp A, Carrero JJ, Michaëlsson K, Ahlström H, Kullberg J, Adamsson V, Risérus U, Larsson A, Helmersson-Karlqvist J, Lind L, Stenvinkel P, Arnlöv J. Inflammatory biomarker pentraxin 3 (PTX3) in relation to obesity, body fat depots and weight loss. Obesity. 2014;22(5):1373-9. doi:10.1002/oby.20695.

Michaëlsson K. The puzzling world of vitamin D insufficiency. Lancet Diabetes Endocrinol. 2014;2(4):269-70. doi:10.1016/S2213-8587(14)70008-7.

Byberg L, Kilander L, Warensjö Lemming E, Michaëlsson K, Vessby B. Cancer death is related to high palmitoleic acid in serum and to polymorphisms in the SCD-1 gene in healthy Swedish men. Am J Clin Nutr. 2014;99(3):551-8. doi:10.3945/ajcn.113.065714.

Nordström P, Michaëlsson K, Gustafson Y, Nordström A. Traumatic brain injury and young onset dementia: a nationwide cohort study. Ann Neurol. 2014;75(3):374-81. doi:10.1002/ana.24101.

Snellman G, Byberg L, Lemming EW, Melhus H, Gedeborg R, Mallmin H, Wolk A, Michaëlsson K. Long-term dietary vitamin D intake and risk of fracture and osteoporosis: a longitudinal cohort study of Swedish middle-aged and elderly women. J Clin Endocrinol Metab. 2014;99(3):781-90. doi:10.1210/jc.2013-1738.

Järvinen TL, Jokihaara J, Guy P, Alonso-Coello P, Collins GS, Michaëlsson K, Sievänen H. Conflicts at the heart of the FRAX tool. CMAJ. 2014;186(3):165-7. doi:10.1503/cmaj.121874.

Michaëlsson K, Nordström P, Nordström A, Garmo H, Byberg L, Pedersen NL, Melhus H. Impact of hip fracture on mortality: a cohort study in hip fracture discordant identical twins. J Bone Miner Res. 2014;29(2):424-31. doi:10.1002/jbmr.2029.

Lebwohl B, Michaëlsson K, Green PH, Ludvigsson JF. Persistent mucosal damage and risk of fracture in celiac disease. J Clin Endocrinol Metab. 2014;99(2):609-16. doi:10.1210/jc.2013-3164.

Michaëlsson K, Wolk A, Byberg L, Ärnlöv J, Melhus H. Intake and serum concentrations of α-tocopherol in relation to fractures in elderly women and men: 2 cohort studies. Am J Clin Nutr. 2014;99(1):107-14. doi:10.3945/ajcn.113.064691.

Tapsell LC, Dunning A, Warensjo E, Lyons-Wall P, Dehlsen K. Effects of vegetable consumption on weight loss: a review of the evidence with implications for design of randomized controlled trials. Crit Rev Food Sci Nutr. 2014;54(12):1529-38. doi:10.1080/10408398.2011.642029.

Wallin A, Di Giuseppe D, Burgaz A, Håkansson N, Cederholm T, Michaëlsson K, Wolk A. Validity of food frequency questionnaire-based estimates of long-term long-chain n-3 polyunsaturated fatty acid intake. Eur J Nutr. 2014;53(2):549-55. doi:10.1007/s00394-013-0563-1.

2013

Van Hemelrijck M, Michaelsson K, Nelson WG, Kanarek N, Dobs A, Platz EA, Rohrmann S. Association of serum calcium with serum sex steroid hormones in men in NHANES III. Aging Male. 2013;16(4):151-8. doi:10.3109/13685538.2013.772133.

Andersen K, Farahmand B, Ahlbom A, Held C, Ljunghall S, Michaëlsson K, Sundström J. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur Heart J. 2013;34(47):3624-31. doi:10.1093/eurheartj/eht188.

Blomberg H, Svennblad B, Michaelsson K, Byberg L, Johansson J, Gedeborg R. Prehospital trauma life support training of ambulance caregivers and the outcomes of traffic-injury victims in Sweden. J Am Coll Surg. 2013;217(6):1010-9.e1-2. doi:10.1016/j.jamcollsurg.2013.08.002.

Wagner H, Melhus H, Pedersen NL, Michaëlsson K. Genetic influence on bone phenotypes and body composition: a Swedish twin study. J Bone Miner Metab. 2013;31(6):681-9. doi:10.1007/s00774-013-0455-8.

Van Hemelrijck M, Garmo H, Michaëlsson K, Thorstenson A, Akre O, Stattin P, Holmberg L, Adolfsson J. Mortality following hip fracture in men with prostate cancer. PLoS One. 2013;8(9):e74492. doi:10.1371/journal.pone.0074492.

Hallström H, Byberg L, Glynn A, Lemming EW, Wolk A, Michaëlsson K. Long-term coffee consumption in relation to fracture risk and bone mineral density in women. Am J Epidemiol. 2013;178(6):898-909. doi:10.1093/aje/kwt062.

Leavy B, Åberg AC, Melhus H, Mallmin H, Michaëlsson K, Byberg L. When and where do hip fractures occur? A population-based study. Osteoporos Int. 2013;24(9):2387-96. doi:10.1007/s00198-013-2333-6.

Wulaningsih W, Michaelsson K, Garmo H, Hammar N, Jungner I, Walldius G, Lambe M, Holmberg L, Van Hemelrijck M. Serum calcium and risk of gastrointestinal cancer in the Swedish AMORIS study. BMC Public Health. 2013 Jul 17;13:663. doi:10.1186/1471-2458-13-663.

Försth P, Michaëlsson K, Sandén B. Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis?: A two-year follow-up study involving 5390 patients. Bone Joint J. 2013;95-B(7):960-5. doi:10.1302/0301-620X.95B7.30776.

Wulaningsih W, Michaelsson K, Garmo H, Hammar N, Jungner I, Walldius G, Holmberg L, Van Hemelrijck M. Inorganic phosphate and the risk of cancer in the Swedish AMORIS study. BMC Cancer. 2013;13:257. doi:10.1186/1471-2407-13-257.

Van Hemelrijck M, Michaelsson K, Linseisen J, Rohrmann S. Calcium intake and serum concentration in relation to risk of cardiovascular death in NHANES III. PLoS One. 2013;8(4):e61037. doi:10.1371/journal.pone.0061037.

Knutsson B, Michaëlsson K, Sandén B. Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish spine register. Spine. 2013;38(5):435-41. doi:10.1097/BRS.0b013e318270b243.

Michaëlsson K, Melhus H, Warensjö Lemming E, Wolk A, Byberg L. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ. 2013;346:f228. doi:10.1136/bmj.f228.

Robinson Y, Michaëlsson K, Sandén B. Instrumentation in lumbar fusion improves back pain but not quality of life 2 years after surgery. A study of 1,310 patients with degenerative disc disease from the Swedish Spine Register SWESPINE. Acta Orthop. 2013;84(1):7-11. doi:10.3109/17453674.2013.771300.

Lind L, Elmståhl S, Bergman E, Englund M, Lindberg E, Michaelsson K, Nilsson PM, Sundström J. EpiHealth: a large population-based cohort study for investigation of gene-lifestyle interactions in the pathogenesis of common diseases. Eur J Epidemiol. 2013;28(2):189-97. doi:10.1007/s10654-013-9787-x.

Hållmarker U, Michaëlsson K, Arnlöv J, James S. Reply: To PMID 22981556. J Am Coll Cardiol. 2013;61(3):389. doi:10.1016/j.jacc.2012.10.022.

Schilcher J, Koeppen V, Ranstam J, Skripitz R, Michaëlsson K, Aspenberg P. Atypical femoral fractures are a separate entity, characterized by highly specific radiographic features. A comparison of 59 cases and 218 controls. Bone. 2013;52(1):389-92. doi:10.1016/j.bone.2012.10.016.

Vimaleswaran KS, Berry DJ, Lu C, ..., Michaëlsson K, ..., Byberg L, ..., Whittaker JC, Hingorani AD, Hyppönen E. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013;10(2):e1001383. doi:10.1371/journal.pmed.1001383.

2012

Michaëlsson K, Schilcher J, Aspenberg P. Comment on Compston: pathophysiology of atypical femoral fractures and osteonecrosis of the jaw. Osteoporos Int. 2012;23(12):2901-2. doi:10.1007/s00198-012-1905-1.

Levin GP, Robinson-Cohen C, de Boer IH, Houston DK, Lohman K, Liu Y, Kritchevsky SB, Cauley JA, Tanaka T, Ferrucci L, Bandinelli S, Patel KV, Hagström E, Michaëlsson K, Melhus H, Wang T, Wolf M, Psaty BM, Siscovick D, Kestenbaum B. Genetic variants and associations of 25-hydroxyvitamin D concentrations with major clinical outcomes. JAMA. 2012;308(18):1898-905. doi:10.1001/jama.2012.17304.

Wang L, Song Y, Manson JE, Pilz S, März W, Michaëlsson K, Lundqvist A, Jassal SK, Barrett-Connor E, Zhang C, Eaton CB, May HT, Anderson JL, Sesso HD. Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes. 2012;5(6):819-29. doi:10.1161/CIRCOUTCOMES.112.967604.

Bergkvist C, Akesson A, Glynn A, Michaëlsson K, Rantakokko P, Kiviranta H, Wolk A, Berglund M. Validation of questionnaire-based long-term dietary exposure to polychlorinated biphenyls using biomarkers. Mol Nutr Food Res. 2012;56(11):1748-54. doi:10.1002/mnfr.201200196.

Hållmarker U, Michaëlsson K, Arnlöv J, James S. Cardiac arrest in a long-distance ski race (Vasaloppet) in Sweden. J Am Coll Cardiol. 2012;60(15):1431-2. doi:10.1016/j.jacc.2012.05.046.

Johansson J, Blomberg H, Svennblad B, Wernroth L, Melhus H, Byberg L, Michaëlsson K, Karlsten R, Gedeborg R. Prehospital Trauma Life Support (PHTLS) training of ambulance caregivers and impact on survival of trauma victims. Resuscitation. 2012;83(10):1259-64. doi:10.1016/j.resuscitation.2012.02.018.

Collins GS, Michaëlsson K. Fracture risk assessment: state of the art, methodologically unsound, or poorly reported? Curr Osteoporos Rep. 2012;10(3):199-207. doi:10.1007/s11914-012-0108-1.

Van Hemelrijck M, Hermans R, Michaelsson K, Melvin J, Garmo H, Hammar N, Jungner I, Walldius G, Holmberg L. Serum calcium and incident and fatal prostate cancer in the Swedish AMORIS study. Cancer Causes Control. 2012;23(8):1349-58. doi:10.1007/s10552-012-0015-x.

Rönnemaa E, Zethelius B, Vessby B, Lannfelt L, Byberg L, Kilander L. Serum fatty-acid composition and the risk of Alzheimer's disease: a longitudinal population-based study. Eur J Clin Nutr. 2012;66(8):885-90. doi:10.1038/ejcn.2012.63.

Engström A, Michaëlsson K, Vahter M, Julin B, Wolk A, Åkesson A. Associations between dietary cadmium exposure and bone mineral density and risk of osteoporosis and fractures among women. Bone. 2012 Jun;50(6):1372-8. doi:10.1016/j.bone.2012.03.018.

Wagner H, Melhus H, Pedersen NL, Michaëlsson K. Heritable and environmental factors in the causation of clinical vertebral fractures. Calcif Tissue Int. 2012;90(6):458-64. doi:10.1007/s00223-012-9592-7.

Carlsson S, Andersson T, Michaëlsson K, Vågerö D, Ahlbom A. Late retirement is not associated with increased mortality, results based on all Swedish retirements 1991-2007. Eur J Epidemiol. 2012;27(6):483-6. doi:10.1007/s10654-012-9696-4.

Wiberg B, Kilander L, Sundström J, Byberg L, Lind L. The relationship between executive dysfunction and post-stroke mortality: a population-based cohort study. BMJ Open. 2012;2(3):e000458. doi:10.1136/bmjopen-2011-000458.

Melhus H, Michaëlsson K. [Vitamin D and health: Lack of evidence is the biggest problem] (Swedish). Läkartidningen. 2012;109(12):604-5. link to article

Gedeborg R, Chen LH, Thiblin I, Byberg L, Melhus H, Michaelsson K, Warner M. Prehospital injury deaths--strengthening the case for prevention: nationwide cohort study. J Trauma Acute Care Surg. 2012;72(3):765-72. doi:10.1097/TA.0b013e3182288272