Physical activity levels and osteoporotic fracture risk in 13,151 community-dwelling people aged 40–74 years

Toshi NISHIKURA, Kaori KITAMURA, Ryosaku KOBAYASHI, Rieko OSHIKI, Ribeka TAKACHI, Yumi WATANABE, Keiko KABASAWA, Akemi TAKAHASHI, Toshiko SAITO, Shoichiro TSUGANE, Osamu YAMAZAKI, Kei WATANABE, Kazutoshi NAKAMURA
Purpose:

The present study aimed to examine associations of total PA and PA subtypes with the risk of osteoporotic fracture in middle-aged and older Japanese people, using a flamework of longitudinal cohort study which is the Murakami cohort study.

Methods:

This was a 10-year cohort study. Participants were 13,151 people aged 40–74 years. Information on demographic characteristics, body size, lifestyle, and disease history was obtained by a self-administered questionnaire conducted in the 2011–2013 baseline survey. Levels of total PA and leisure-time PA (LTPA) were estimated by the metabolic equivalents (METs) score (MET-h/d). Incident cases of osteoporotic fractures of the distal radius, neck of the humerus, neck or trochanter of the femur, and vertebrae were identified in medical records during the follow-up period. A Cox proportional hazards model was used to calculate hazard ratios (HRs), and a simple regression or logistic regression model was used to calculate P for trend. P 0.05 was considered statistically significant.

Results:

Mean age of participants was 58.8 years, and the mean follow-up period was 9.6 (SD 1.8) years. In men, the lowest total PA quintile group had a higher HR for total fracture (HR=2.30, 95%CI:1.31–4.02) and vertebral fracture (HR=3.60, 95%CI:1.56–8.32), and the highest total PA quintile group had a significantly higher HR for vertebral fracture (HR=2.99, 95%CI:1.31–6.80), than the reference (middle quintile). LTPA levels in men were associated with lower limb fracture risk (P for trend=0.0304). These associations were not observed in women.

Conclusion(s):

The present 10-year cohort study showed that both low and high levels of PA are associated with a high risk of symptomatic vertebral fracture, suggesting a U-shaped association, in addition, higher levels of LTPA were associated with a lower risk of limb, especially distal radius, fractures in Japanese middle-aged and older men. However, these associations between PA, LTPA and osteoporotic fracture was not observed in women.

Implications:

Although high PA levels are believed to be favorable to bone health, the present study indicated that a high PA level may, in fact, increase the risk of vertebral fracture. This finding, which has implications in the primary prevention of osteoporotic fractures, suggests that a high PA level does not necessarily prevent vertebral fractures, especially in men.

Funding acknowledgements:
This work was supported by JSPS KAKENHI (JP23249035, JP15H04782) and the National Cancer Center Research and Development Fund [23-A31(toku)].
Keywords:
cohort study
vertebral fracture
physical activity
Primary topic:
Health promotion and wellbeing/healthy ageing/physical activity
Second topic:
Musculoskeletal: spine
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
The Ethics Committee of Niigata University
Provide the ethics approval number:
Nos. 1324 and 2018–0417
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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