Leisure-time Physical Activity Levels and Changes in Relation to Risk of Hip Fracture in Men and Women

Abstract

The authors prospectively studied the effect of leisure-time physical activity level on hip fracture risk along with the influence of within-subject changes in activity levels, while taking possible confounding by other health behaviors and poor health into account. Analyses were based on pooled data from three population studies conducted in Copenhagen, Denmark. Among 13,183 women and 17,045 men, 1,121 first hip fractures were identified during follow-up. In comparison with being sedentary, the relative risk (RR) of hip fracture associated with being moderately physically active 2-4 hours per week was 0.72 (95% confidence interval (CI): 0.59, 0.89) in women and 0.75 (95% CI: 0.55, 1.03) in men after adjustment for confounders. Being in the most active leisure activity category did not decrease the risk of hip fracture further. Adjustment for poor health affected the risk estimates only modestly. Subjects who, during follow-up, reduced their physical activity level from the highest or the intermediate activity level to a sedentary level had a higher risk of hip fracture than did those who remained moderately physically active at the intermediate level (multivariate adjusted RR = 2.19, 95% CI: 1.00, 4.84 and RR = 1.89, 95% CI: 1.21, 2.95, for reduction from the highest and intermediate levels, respectively). There was no evidence of a fracture-protective effect from increasing physical activity. In conclusion, moderate levels of physical activity appear to provide protection against later hip fracture. Decline in the physical activity level over time is an important risk factor for hip fracture.

Male risk factors for hip fracture—a 30-year follow-up study in 7,495 men

“…Leisure-time physical activity remained a protective factor after adjustment for other factors. Earlier analyses have also found fracture protection from leisure-time physical activity [11,[20][21][22][23][24] and higher BMI [24,25]. To our knowledge, no other studies reported a difference between leisure-time and work activity with regard to the fracture risk.…”

Body mass index and physical activity in relation to the incidence of hip fracture in postmenopausal women

“…(19) A protective association of physical activity, often measured as leisure time activity in older studies, with hip fracture has been reported previously. (2)(3)(4)(5)(6)(7)(8)(9) One previous study has considered the potential competing effect of BMI with respect to the effects of walking and other leisure time activities on hip fracture risk. Total physical activity, made up of both leisure time and incidental physical activities, is increasingly recognized as a key determinant of disease risk.…”

“…(1) Previous studies have reported a decreased risk of hip fracture among physically active women. (2)(3)(4)(5)(6)(7)(8)(9) Regular physical activity also has been associated with a lower risk of osteoporosis, obesity, (10) and falls. (11,12) The protective effect of physical activity on hip fracture has been attributed to increased forces on the bones that may slow the rate of decline in bone mineral density (BMD) related to aging (13,14) and/or prevent falls by improving balance, coordination, and muscular strength.…”

Slowing of bone loss in patients with rheumatoid arthritis by long‐term high‐intensity exercise: Results of a randomized, controlled trial

“…Exercise is important in the prevention of osteoporosis and osteoporosis-related fractures, and hip fractures generate the most morbidity and mortality and the highest costs (10,29) in the general population. Exercise has also been found to be important in reducing the risk of falling by improving balance and coordination (30).…”