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- Title
Association of Physical Activity and Fracture Risk Among Postmenopausal Women.
- Authors
LaMonte, Michael J.; Wactawski-Wende, Jean; Larson, Joseph C.; Mai, Xiaodan; Robbins, John A.; LeBoff, Meryl S.; Chen, Zhao; Jackson, Rebecca D.; LaCroix, Andrea Z.; Ockene, Judith K.; Hovey, Kathleen M.; Cauley, Jane A.
- Abstract
Key Points: Question: Is the amount and intensity of physical activity associated with total and site-specific fracture among postmenopausal women who participated in the Women's Health Initiative study? Findings: In this cohort study of 77 206 postmenopausal women with a mean follow-up of 14 years, higher amounts of total, mild, moderate to vigorous, and walking physical activity were significantly associated with lower risk of hip fracture. Positive associations existed for moderate to vigorous physical activity with wrist or forearm fractures and for sedentary behavior with total fractures. Meaning: Regular physical activity, including lighter-intensity activities, and less sedentary time is associated with reduced risk of fracture in older women. This cohort study of the Women's Health Initiative (WHI) assesses the associations of physical activity and sedentary behavior with fracture incidence among postmenopausal women. Importance: Physical activity is inversely associated with hip fracture risk in older women. However, the association of physical activity with fracture at other sites and the role of sedentary behavior remain unclear. Objective: To assess the associations of physical activity and sedentary behavior with fracture incidence among postmenopausal women. Design, Setting, and Participants: The Women's Health Initiative prospective cohort study enrolled 77 206 postmenopausal women aged 50 to 79 years between October 1993 and December 1998 at 40 US clinical centers. Participants were observed for outcomes through September 2015, with data analysis conducted from June 2017 to August 2019. Exposures: Self-reported physical activity and sedentary time. Main Outcomes and Measures: Hazard ratios (HRs) and 95% CIs for total and site-specific fracture incidence. Results: During a mean (SD) follow-up period of 14.0 (5.2) years among 77 206 women (mean [SD] age, 63.4 [7.3] years; 66 072 [85.6%] white), 25 516 (33.1%) reported a first incident fracture. Total physical activity was inversely associated with the multivariable-adjusted risk of hip fracture (>17.7 metabolic equivalent [MET] h/wk vs none: HR, 0.82; 95% CI, 0.72-0.95; P for trend <.001). Inverse associations with hip fracture were also observed for walking (>7.5 MET h/wk vs none: HR, 0.88; 95% CI, 0.78-0.98; P for trend =.01), mild activity (HR, 0.82; 95% CI, 0.73-0.93; P for trend =.003), moderate to vigorous activity (HR, 0.88; 95% CI, 0.81-0.96; P for trend =.002), and yard work (HR, 0.90; 95% CI, 0.82-0.99; P for trend =.04). Total activity was positively associated with knee fracture (>17.7 MET h/wk vs none: HR, 1.26; 95% CI, 1.05-1.50; P for trend =.08). Mild activity was associated with lower risks of clinical vertebral fracture (HR, 0.87; 95% CI, 0.78-0.96; P for trend =.006) and total fractures (HR, 0.91; 95% CI, 0.87-0.94; P for trend <.001). Moderate to vigorous activity was positively associated with wrist or forearm fracture (HR, 1.09; 95% CI, 1.03-1.15; P for trend =.004). After controlling for covariates and total physical activity, sedentary time was positively associated with total fracture risk (>9.5 h/d vs <6.5 h/d: HR, 1.04; 95% CI, 1.01-1.07; P for trend =.01). When analyzed jointly, higher total activity mitigated some of the total fracture risk associated with sedentary behavior. Analysis of time-varying exposures resulted in somewhat stronger associations for total physical activity, whereas those for sedentary time were materially unchanged. Conclusions and Relevance: In older ambulatory women, higher total physical activity was associated with lower total and hip fracture risk but higher knee fracture risk. Mild activity and walking were associated with lower hip fracture risk, a finding with important public health implications because these activities are common in older adults. The positive association between sedentary time and total fracture risk requires further investigation.
- Subjects
UNITED States; AGE distribution; ANALYSIS of variance; CHI-squared test; CONFIDENCE intervals; ELBOW fractures; BONE fractures; HIP joint injuries; HOSPITALS; KNEE fractures; LONGITUDINAL method; OSTEOPOROSIS; QUESTIONNAIRES; REGRESSION analysis; RESEARCH funding; RISK assessment; TIME; WALKING; WOMEN'S health; INDEPENDENT living; DISEASE incidence; OXYGEN consumption; PROPORTIONAL hazards models; POSTMENOPAUSE; EXERCISE intensity; SEDENTARY lifestyles; PHYSICAL activity; DATA analysis software; DESCRIPTIVE statistics; DISEASE risk factors
- Publication
JAMA Network Open, 2019, Vol 2, Issue 10, pe1914084
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.14084