Abstract
BackgroundDetection of high-risk individuals for fractures are needed. This study assessed whether level of physical activity (PA) and a musculoskeletal composite score could be used as fracture predictive tools, and if the score could predict fractures better than areal bone mineral density (aBMD).MethodsMrOs Sweden is a prospective population-based observational study that at baseline included 3014 men aged 69–81 years. We assessed femoral neck bone mineral content (BMC), bone area, aBMD and total body lean mass by dual energy X-ray absorptiometry, calcaneal speed of sound by quantitative ultrasound and hand grip strength by a handheld dynamometer. PA was assessed by the Physical Activity Scale for the Elderly (PASE) questionnaire. We followed the participants until the date of first fracture, death or relocation (median 9.6 years). A musculoskeletal composite score was calculated as mean Z-score of the five measured traits. A Cox proportional hazards model was used to analyze the association between the musculoskeletal traits, the composite score and incident fractures (yes/no) during the follow-up period. Data are presented as hazard ratios (HR) with 95% confidence intervals (95% CI) for fracture for a + 1 standard deviation (SD) change (+ 1 Z-score) in the various musculoskeletal traits as well as the composite score. We used a linear regression model to estimate the association between level of PA, measured as PASE-score and the different musculoskeletal traits as well as the composite score.ResultsA + 1 SD higher composite score was associated with an incident fracture HR of 0.61 (0.54, 0.69), however not being superior to aBMD in fracture prediction. A + 1 SD higher PASE-score was associated with both a higher composite score and lower fracture incidence (HR 0.83 (0.76, 0.90)).ConclusionsThe composite score was similar to femoral neck aBMD in predicting fractures, and also low PA predicted fractures. This highlights the need of randomized controlled trials to evaluate if PA could be used as a fracture preventive strategy.
Highlights
Detection of high-risk individuals for fractures are needed
A favorable composite score was associated with a lower fracture incidence (HR per + 1 standard deviations (SD) = 0.61), which was similar to the corresponding hazard ratios (HR) per + 1 SD change in femoral neck bone mineral content (BMC), areal bone mineral density (aBMD) and calcaneal speed of sound (SOS) (Table 3)
N Numbers, β Linear regression coefficient, S.E Standard error, 95% confidence intervals (95% CI) 95% confidence interval, BMC Bone mineral content, aBMD Areal bone mineral density, SOS Speed of sound, PASE Physical Activity Scale for the Elderly fracture incidence was attenuated, but to a lesser extent, by each + 1 SD change in hand grip strength (HR 0.80) and total body lean mass
Summary
Detection of high-risk individuals for fractures are needed. This study assessed whether level of physical activity (PA) and a musculoskeletal composite score could be used as fracture predictive tools, and if the score could predict fractures better than areal bone mineral density (aBMD). Recent studies have projected that hip fracture rates in Sweden and Denmark will increase substantially during the upcoming decades, causing pain, disability and death for individual patients, and a heavy burden on the health care systems [3] With this in mind, new preventive methods are necessary together with improved early identification of individuals at high risk for fractures. A current method of preference for identifying high risk individuals is a femoral neck areal bone mineral density (aBMD) measurement, where each standard deviation lower aBMD is associated with a two to three times higher fracture risk [4]. Another approach is to combine several risk factors, and based on these quantify the fracture risk. Several risk factors for fracture are not included in FRAX, such as neuromuscular function, bone quality, level of physical activity (PA) and fall risk [6,7,8,9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
