Moderate Physical Activity Could Lower Fracture Risk in Middle-Aged Adults

An analysis of more than 30k middle-aged adults from a prospective cohort study in Sweden is providing insight into the effects of exercise and other variables on fracture risk in these patients.

While studies have exhaustively examined links between physical activity levels and risk of death or cardiovascular disease, a new study from Lund University in Sweden is providing insight into the beneficial effects of physical activity on fracture risk in aging adults.

The study, which examined the impact of multiple variables on fracture risk in more than 30,000 middle-aged patients, returned results suggesting even moderate levels of leisure-time physical activity reduced fracture risk compared to those with low levels of activity.

“Our results support the theory that even moderate physical activity in adulthood is beneficial for preventing future fractures. Furthermore, these results indicate the importance of social and psychological factors for the risk of future fractures, with subjects living alone having a 10% increased risk after adjustment for potential confounders,” wrote investigators.

As it stands, further clarification and identification of risk factors for conditions like osteoporosis could result in tangible benefits for patients in the way of reduced fracture risk. With this in mind, a trio of investigators sought to determine what aspects of physical activity and psychosocial situation were associated with incident fracture.

For the purpose of their analysis, investigators chose to pull patient data from the Malmö Diet and Cancer (MDC) study, which was a prospective population-based cohort study that enrolled 30,477 patients from 1991-1996 and followed them through 2016. Of these, 18,325 patients were female. The overall study cohort had a mean age of 58.0±7.6, the median follow-up time was 20.7 (IQR, 9.5) years, and an incident fracture occurred in 8240 (27%) of participants.

Investigators chose first incident fracture of the spine, thoracic cage, arms, shoulders, hands, pelvis, hips, or legs as the primary outcome of their study. These incident fracture events were identified through the National Patient Register. Associations between baseline variables and incident fracture were assessed in Cox regression models. Of note, baseline variables included in the investigators’ analysis included age, sex, BMI, systolic blood pressure, diastolic blood pressure, current smoking status, and daily alcohol intake.

In their analyses, results indicated age, female sex, body mass index, previous fracture, reported family history of fracture (P for all <.001), 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 factors independently associated with incident fracture. Additionally, results also indicated fracture risk score was strongly associated with incident fracture (P for trend <.001).

When assessing fracture risk in men, the incidence rate was 23.2 per 1000 person-years among men with 6 or more risk factors compared to 5.3 per 1000 person-years in those with no risk factors (HR, 5.5; 95% CI, 3.7-8.2). Among women, the incidence rate was 10.7 per 1000 person-years in those with no risk factors and 28.4 per 1000 person-years in women with 6 or more risk factors (HR, 3.1; 95% CI, 2.4-4.0).

For physical activity, results suggested even moderate levels of lesser-time physical activity were associated with a lower risk of incident fracture. Investigators pointed out results also suggested heavy work, living alone, smoking, and no or high alcohol consumption was associated with increased risk of incident fracture.

“In particular, a combination of several risk factors distinctly increases the fracture risk in later life. Our results emphasize the importance of these factors in public health initiatives for prevention of fractures,” wrote investigators.

This study, “Physical Activity and Psychosocial Factors Associated With Risk of Future Fractures in Middle-Aged Men and Women,” was published in the Journal of Bone and Mineral Research.