Issue: May 2021
Disclosures: The authors report no relevant financial disclosures.
February 22, 2021
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Moderate physical activity may prevent fractures for middle-aged adults

Issue: May 2021
Disclosures: The authors report no relevant financial disclosures.
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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.

Any level of physical activity was associated with a lower risk for bone fractures in middle-aged adults, while heavy work was associated with an increased fracture risk.

“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.”

Cecilia Rogmark

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.