Moderate physical activity may prevent fractures for middle-aged adults
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Even moderate levels of leisure-time physical activity in middle age are associated with lower risk for fractures, according to study data published in the Journal of Bone and Mineral Research.
In a prospective, population-based analysis, researchers also found that heavy work, living alone, smoking, and no or high alcohol consumption increase the risk for fracture among middle-aged men and women.
“Aside from the much-focused-on bone health, lifestyle choices and psychosocial factors play a role for the risk for sustaining a fracture,” Cecilia Rogmark, MD, PhD, associate professor in the department of orthopedics at Lund University and Skåne University Hospital in Malmö, Sweden, told Healio. “Any degree of physical activity is associated with a protective effect against fractures in middle age and 'young-old' age. Living alone, smoking and not drinking or high volumes of alcohol were risk factors as well.”
Rogmark and colleagues analyzed data from 30,446 adults followed from 1991-1996 to 2016 as part of the Malmö Diet and Cancer study (mean age, 58 years). Participants provided blood samples and completed self-administered questionnaires about health and lifestyle habits, including smoking, education and physical activity and leisure time, as well as recent mental stress. Researchers used Cox regression models to assess the association between baseline variables and first incident fracture (obtained via National Patient Register), with significant risk factors summed into fracture risk scores.
Within the cohort, 8,240 adults (27%; 73% women) experienced at least one fracture during a median follow-up of 20.7 years. The most common fractures were sustained at the lower arm and hand, followed by hip fractures and fractures of the lower limb and foot.
Researchers found that every increase in physical activity in middle age was associated with a reduction in fracture risk during follow-up. The quintile with the lowest physical activity had an 8% higher risk for fracture vs. those participants in all other quintiles.
Age, female sex, BMI, previous fracture, reported family history of fracture after age 50 years were each independently associated with incident fracture (P < .001 for all). Additionally, low leisure-time physical activity (P = .018), heavy work (P = .024), living alone (P = .002), smoking (P < .001), and no or high alcohol consumption (P = .005) were also independently associated with incident fracture. The fracture risk score (0-9 points) was strongly associated with incident fracture (P for trend < .001).
Among men without risk factors, the incidence rate was 5.3 per 1,000 person-years compared with 23.2 per 1,000 person-years among men with six or more risk factors (HR = 5.5; 95% CI, 3.7-8.2). Among women with no risk factors, the incidence rate was 10.7 per 1,000 person-years compared with 28.4 per 1,000 person-years among women with six or more risk factors (HR = 3.1; 95% CI, 2.4-4).
“In contrast to leisure-time physical activity, physical activity during working time in the form of heavy workload increased the risk of fractures,” the researchers wrote. “Other cohort studies have failed to demonstrate any difference associated with the workload level. The fact that our study participants were still of working age can possibly explain the higher risk of fracture in the heavy-work group, as they may have suffered occupational injuries.”
Rogmark said that understanding the complexity of concurrent factors that increase the risk for fracture can allow providers to address behavior changes and not rely on osteoporosis prevention alone.
For more information:
Cecilia Rogmark, MD, PhD, can be reached at cecilia.rogmark@skane.se.
Perspective
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E. Michael Lewiecki, MD, FACE, FACP
Exercise has many benefits, including cardiovascular fitness, weight control, enhanced sense of well-being and improvement of many metabolic factors. Regular weight-bearing and muscle-strengthening physical activity and balance training to reduce fall risk are standard recommendations for patients with osteoporosis. However, the effects of physical activity on bone density, fall risk and fractures have been difficult to ascertain due to variability of study designs, study populations and the type and intensity of exercise interventions.
This large prospective study from Sweden provides solid evidence for the benefits of leisure-time physical activities of moderate intensity in reducing the risk for clinical fractures in middle-aged men and women. This is good news for those of us who are now physically active, even at a modest level, and should provide motivation for those who are sedentary to become more active. The study also supports public health policies that encourage physical activity.
Keeping active is good for bones, and almost any kind of activity is probably better than none.
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