Physical Activity and Psychosocial Factors Associated With Risk of Future Fractures in Middle-Aged Men and Women

Abstract

Identification of risk factors for fractures is important for improving public health. We aimed to identify which factors related to physical activity and psychosocial situation were associated with incident fractures among 30,446 middle-aged women and men, followed from 1991-1996 to 2016, in a prospective population-based cohort study. The association between the baseline variables and first incident fracture was assessed by Cox regression models, and significant risk factors were summed into fracture risk scores. Any first incident fracture affecting spine, thoracic cage, arms, shoulders, hands, pelvis, hips, or legs was obtained from the National Patient Register, using the unique personal identity number of each citizen. A total of 8240 subjects (27%) had at least one fracture during the follow-up of median 20.7 years. Age, female sex, body mass index, previous fracture, reported family history of fracture >50 years (all p < .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. The fracture risk score (0-9 points) was strongly associated with incident fracture (p for trend <.001). Among men without risk factors, the incidence rate was 5.3/1000 person-years compared with 23.2 in men with six or more risk factors (hazard ratio [HR] = 5.5; 95% confidence interval [CI] 3.7-8.2). Among women with no risk factors, the incidence rate was 10.7 compared with 28.4 in women with six or more risk factors (HR = 3.1; 95% CI 2.4-4.0). Even moderate levels of leisure-time physical activity in middle age are associated with lower risk of future fractures. In contrast, heavy work, living alone, smoking, and no or high alcohol consumption increase the risk of fracture. Our results emphasize the importance of these factors in public health initiatives for fracture prevention.

Living alone and health-related quality of life among adults with obstructive sleep apnea in a single-center cohort study

“…Among people 45 years of age or older with atherosclerotic thrombosis, living alone was independently associated with an increased risk of mortality and cardiovascular death [ 9 ]. In a prospective cohort study of more than 30,000 people, living alone was found to increase the risk of fractures [ 28 ]. In the English longitudinal study, which included 4,478 older adults, living alone and social disengagement were associated with an increased risk of hospitalization for respiratory disease, independent of sociodemographic, health, and behavioral factors [ 29 ].…”

Living alone decreased calcaneus ultrasound T-score in a large Taiwanese population follow-up study

“…In addition, several studies have investigated the relationship between fractures and living status ( 28 – 30 ). A prospective population-based cohort study in Sweden identified that living alone was an independent risk factor related to incident fractures among 30,446 middle-aged persons during a median follow-up period of 20.7 years ( 29 ). However, there is little information on the relationship between osteoporosis and living status.…”

“…In addition to age, genetic factors and nutrition, lifestyle factors such as smoking, drinking alcohol, chewing betel nut and physical activity also influence bone mass ( 7 ). Numerous studies have suggested that unhealthy lifestyle habits including smoking and low leisure-time physical activity can increase the risk of fractures ( 28 , 29 ). We also found that smoking and a lack of exercise were related to low baseline T -score.…”

Deciphering Fracture Risk: A Comprehensive Analysis of Blood Metabolites via Mendelian Randomization.

“…Given the high incidence of fractures and their profound impact on individuals and society, it is particularly important to explore the various factors in uencing fracture risk. Numerous factors affect the risk of fractures, including age, gender, body mass index, previous fracture history, family history of fractures, lifestyle factors such as the frequency of leisure activities, work intensity, and social living conditions (e.g., living alone), as well as smoking and alcohol consumption habits [10] . Additionally, speci c populations, such as those undergoing military training, may face unique risk factors, such as previous stress fractures and menstrual dysfunctions [11] .…”