Abstract
ABSTRACTThere is a paucity of information on associations between specific types of physical activity and fracture risk at different sites in otherwise healthy postmenopausal women. Therefore, we examined risk of fracture at seven different sites associated with seven different types of physical activity in the population‐based prospective UK Million Women Study. A total of 371,279 postmenopausal women (mean age 59.8 years), rating their health as good or excellent and reporting participation in walking, cycling, gardening, doing housework, yoga, dance, and sports club activities, were followed for site‐specific incident fracture through record linkage to national databases on day‐case and overnight hospital admissions. Cox regression yielded adjusted relative risks (RRs) and, because of the large number of statistical tests done, 99% confidence intervals (CIs) for fracture at seven different sites in relation to seven different physical activities. During an average follow‐up of 12 years, numbers with a first site‐specific fracture were as follows: humerus (2341), forearm (1238), wrist (7358), hip (4354), femur (not neck) (617), lower leg (1184), and ankle (3629). For upper limb fractures there was significant heterogeneity across the seven activity types (test for heterogeneity p = 0.004), with gardening more than 1 hour/week associated with a lower risk (RR = 0.91; 99% CI, 0.86 to 0.96; p < 0.0001), whereas cycling more than 1 hour/week was associated with an increased risk (RR = 1.11; 99% CI, 1.00 to 1.23; p = 0.008). For fractures of the lower limb (including hip) there was no significant heterogeneity by type of activity, with significant approximately 5% to 15% reductions in risk associated with most activities, except cycling. For hip fractures, there was no significant heterogeneity by type of activity, but with significant 15% to 20% reductions in risk associated with walking for 1 hour/day and participating in yoga and sporting activities. Physical activity is a modifiable risk factor for fracture, but the effects differ between different types of activities and different fracture sites. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
Highlights
IntroductionFractures are an important cause of morbidity and mortality among postmenopausal women.[1]
Fractures are an important cause of morbidity and mortality among postmenopausal women.[1]. Prior research has shown a reduction in the risk of hip fracture with increased physical activity,(2–6) and clinical trials show physical activity reduces fractures and falls through improvements in balance and muscular strength.[7,8,9,10] there is limited evidence on how physical activity is associated with fracture at sites other than the hip and there is a paucity of information on how a variety of specific physical activities are associated with risk of fracture.[11,12] Physical activities may improve balance[13] and muscle strength,(14)
Injury risk may be increased while engaging in physical activity.[17]. Increased automation has resulted in reduced activity requirements in daily life, with a higher proportion of the population spending more time sedentary.[18]. Further, increasing leisure time activity in older adults may be challenging with a lack of interest cited as an important deterrent.[19] determining whether there is an association between fracture and physical activities such as gardening and housework may be as important as assessing activities more commonly measured such as walking, cycling, and other leisure time activities
Summary
Fractures are an important cause of morbidity and mortality among postmenopausal women.[1]. Aid in the preservation of bone mineral density,(15,16) which could reduce the risk of fracture. Injury risk may be increased while engaging in physical activity.[17] Increased automation has resulted in reduced activity requirements in daily life, with a higher proportion of the population spending more time sedentary.[18] Further, increasing leisure time activity in older adults may be challenging with a lack of interest cited as an important deterrent.[19] determining whether there is an association between fracture and physical activities such as gardening and housework may be as important as assessing activities more commonly measured such as walking, cycling, and other leisure time activities In this large, prospective study of healthy postmenopausal UK women, we describe the independent relationships of seven specific physical activities: walking, gardening, housework, cycling, yoga, sports club participation, and dance participation, with the risk of fracture at seven sites: humerus, forearm, wrist, hip, femur (not neck), lower leg, and ankle
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