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Physical activity, bone density, and fragility fractures in women
Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Scandinavia has among the highest incidence of fragility fractures in the world. The reasons for this are unknown, but might involve differences in genetic and/or environmental factors, such as sunlight exposure and levels of physical activity. Weight-bearing exercise is thought to have a beneficial effect on bone health in the young, but few studies have evaluated whether exercise in older subjects affects bone density and protects against fragility fractures.

The initial objective of this thesis was to evaluate whether a combined weight-bearing training programme twice a week would be beneficial as regards bone mineral density (BMD) and neuromuscular function in older women. Forty-eight community living women with a mean age of 73 years were recruited for this 12-month prospective, randomised controlled trial, and were randomly assigned to an intervention group (n=24) or a control group (n=24). The intervention group displayed significant increments in BMD at the Ward’s triangle, maximum walking speed, and isometric grip strength compared to the control group. The second objective was to investigate if training effects were retained in older women five years after the cessation of training. The 40 women who completed the first study included in this thesis were invited to take part in a follow-up assessment five years later, and 34 women (~79 years) agreed to participate. During these five years both groups had sustained significant losses in hip BMD and in all neuromuscular function tests, and the previous exercise-induced intergroup differences were no longer seen.

The third and fourth objective of this thesis was to investigate whether exercise and weight-bearing leisure activities in middle-aged women are associated with a decreased risk of sustaining hip or wrist fractures at a later stage. A cohort of women participating in the Umeå Fracture and Osteoporosis (UFO) study, a longitudinal, nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures, was used for the purpose of this investigation. Eighty-one hip fracture cases and 376 wrist fracture cases, which had reported lifestyle data before they sustained their fracture, were identified. These cases were compared with age-matched controls identified from the same cohort. Using conditional logistic regression analysis with adjustments for height, BMI, smoking, and menopausal status, results showed that moderate frequency of leisure physical activities such as gardening and berry/mushroom picking, were associated with reduced hip fracture risk (OR 0.28; 95% CI 0.12 – 0.67), whereas active commuting (especially walking) along with dancing and snow shoveling in leisure time, reduced the wrist fracture risk (OR 0.48; 95% CI 0.27 – 0.88, OR 0.42; 95% CI 0.22 – 0.80 and OR 0.50; 95% CI 0.32 – 0.79 respectively).

In summary, this thesis suggests that weight-bearing physical activity is beneficial for BMD and neuromuscular functions such as muscle strength and gait in older women, and that a physically active lifestyle, with outdoor activities, in middle age is associated with reduced risk of both hip and wrist fractures. Possible mechanisms underlying this association include improved muscle strength, coordination, and balance, resulting in a decreased risk of falling and perhaps also direct skeletal benefits.

Place, publisher, year, edition, pages
2009. , 101 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1298
Keyword [en]
physical activity, bone density, neuromuscular function, fragility fractures, women
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-29883ISBN: 978-91-7264-867-8 (print)OAI: oai:DiVA.org:umu-29883DiVA: diva2:278423
Public defence
2009-12-18, Sal B, 9 tr, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-12-02 Created: 2009-11-26 Last updated: 2010-01-18Bibliographically approved
List of papers
1. A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women
Open this publication in new window or tab >>A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women
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2005 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 16, no 9, 1117-1123 p.Article in journal (Refereed) Published
Abstract [en]

Forty-eight community living women 66–87 years old volunteered to participate in a 12-month prospective, randomized, controlled, trial. The aim was to determine if a combined weight-bearing training program twice a week would be beneficial to bone mineral density and neuromuscular function. The participants were pairwise age-matched and randomly assigned to either an exercise group (n=24) or a control group (n=24). Twenty-one subjects in the intervention group and 19 in the control group completed the study. The exercise program lasted for 50 min and consisted of a combination of strengthening, aerobic, balance and coordination exercises. The mean percentage of scheduled sessions attended for the exercise group was 67%. At the completion of the study, the intervention group showed significant increments in bone mineral density of the Wards triangle (8.4%, P<0.01) as well as improvement in maximum walking speed (11.4%, P<0.001) and isometric grip strength (9.9%, P<0.05), as compared to the control group. The conclusion was that a combined weight-bearing training program might reduce fracture risk factors by improving bone density as well as muscle strength and walking ability. This program could be suitable for older community living women in general, and might, therefore, have important implications for fracture prevention.

Place, publisher, year, edition, pages
Springer, 2005
Keyword
Bone mass, Neuromuscular improvement, Training, Women
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-29821 (URN)10.1007/s00198-004-1821-0 (DOI)
Available from: 2009-11-24 Created: 2009-11-24 Last updated: 2017-12-12Bibliographically approved
2. The beneficial effects of exercise on BMC are lost after cessation: a 5-year follow-up in older post-menopausal women
Open this publication in new window or tab >>The beneficial effects of exercise on BMC are lost after cessation: a 5-year follow-up in older post-menopausal women
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2009 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 3, 381-388 p.Article in journal (Refereed) Published
Abstract [en]

This study investigates whether the positive effects on bone mineral density (BMD, g/cm2) and neuromuscular function following a combined weight-bearing program are sustained in older women, a longer period after cessation of training. Thirty-four women (18 exercisers and 16 controls) aged 73–88 years, who completed a 12-month randomized-controlled trial, were invited to a 5-year follow-up assessment of BMD and neuromuscular function. Both groups sustained significant losses in BMD of the femoral neck, trochanter, and Ward's triangle during the follow-up period. Significant losses were also seen in all neuromuscular function tests. The inter-group change was, however, significant only for maximal walking speed where the exercise group had a significantly greater loss. In conclusion, this study suggests that gains in bone density and neuromuscular functions achieved by training are lost after cessation of training. Continuous high-intensity weight-loading physical activity is probably necessary to preserve bone density and neuromuscular function in older women.

Place, publisher, year, edition, pages
Copenhagen: Munksgaard, 2009
Keyword
bone density, muscle strength, detraining, post-menopausal, women
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-29822 (URN)10.1111/j.1600-0838.2008.00802.x (DOI)
Available from: 2009-11-24 Created: 2009-11-24 Last updated: 2017-12-12Bibliographically approved
3. Physical activity in middle-aged women and hip fracture risk: the UFO study
Open this publication in new window or tab >>Physical activity in middle-aged women and hip fracture risk: the UFO study
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2011 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 22, no 2, 499-505 p.Article in journal (Refereed) Published
Abstract [en]

Summary: In a population-based case-control study, we demonstrate that middle-aged women who were active with walking or in different physical spare time activities were at lower risk of later sustaining a hip fracture compared to more sedentary women.

Introduction: In middle-aged women participating in the Umeå Fracture and Osteoporosis (UFO) study, we investigated whether physical activity is associated with a subsequent decreased risk of sustaining a hip fracture.

Methods: The UFO study is a nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures. We identified 81 female hip fracture cases that had reported lifestyle data before they sustained their fracture. Each case was compared with two female controls who were identified from the same cohort and matched for age and week of reporting data, yielding a total cohort of 237 subjects. Mean age at baseline was 57.2 ± 5.0 years, and mean age at fracture was 65.4 ± 6.4 years.

Results: Conditional logistic regression analysis with adjustments for height, weight, smoking, and menopausal status showed that subjects who were regularly active with walking or had a moderate or high frequency of physical spare time activities (i.e. berry/mushroom picking and snow shovelling) were at reduced risk of sustaining a hip fracture (OR 0.14; 95% CI; 0.05–0.53 for walking and OR 0.19; 95% CI; 0.08–0.46, OR 0.17, 95% CI; 0.05–0.64 for moderate and high frequency of spare time activities, respectively) compared to more sedentary women.

Conclusion: An active lifestyle in middle age seems to reduce the risk of future hip fracture. Possible mechanisms may include improved muscle strength, coordination, and balance resulting in a decreased risk of falling and perhaps also direct skeletal benefits.

Keyword
Epidemiology, Hip fracture, Physical activity, Risk factors, Women
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-29823 (URN)10.1007/s00198-010-1234-1 (DOI)
Available from: 2009-11-24 Created: 2009-11-24 Last updated: 2017-12-12Bibliographically approved
4. Active commuting reduces the risk of wrist fractures in middle-aged women: the UFO study
Open this publication in new window or tab >>Active commuting reduces the risk of wrist fractures in middle-aged women: the UFO study
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2013 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 24, no 2, 533-540 p.Article in journal (Refereed) Published
Abstract [en]

Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus.

INTRODUCTION: Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture.

METHODS: The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years.

RESULTS: Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk.

CONCLUSION: This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.

Place, publisher, year, edition, pages
Springer, 2013
National Category
Orthopedics
Identifiers
urn:nbn:se:umu:diva-29829 (URN)10.1007/s00198-012-1988-8 (DOI)
Available from: 2009-11-25 Created: 2009-11-24 Last updated: 2017-12-12Bibliographically approved

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