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Decreased Hip, Lower Leg, and Humeral Fractures but Increased Forearm Fractures in Highly Active Individuals
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Mora Lasarett, Dept Internal Med, Mora, Sweden.ORCID iD: 0000-0003-2146-7382
Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden;Dalarna Univ, Sch Hlth & Social Studies, Falun, Dalarna, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.ORCID iD: 0000-0003-4413-9736
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2018 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, no 10, p. 1842-1850Article in journal (Refereed) Published
Abstract [en]

It is not known how physical exercise affects the risk of different types of fractures, especially in highly active individuals. To investigate this association, we studied a cohort of 118,204 men and 71,757 women who from 1991 to 2009 participated in Vasaloppet, a long-distance cross-country skiing race in Sweden, and 505,194 nonparticipants frequency-matched on sex, age, and county of residence from the Swedish population. Participants ranged from recreational exercisers to world-class skiers. Race participation, distance of race run, number of races participated in, and finishing time were used as proxies for physical exercise. Incident fractures from 1991 to 2010 were obtained from national Swedish registers. Over a median follow-up of 8.9 years, 53,175 fractures of any type, 2929 hip, 3107 proximal humerus, 11,875 lower leg, 11,733 forearm, and 2391 vertebral fractures occurred. In a Cox proportional hazard regression analysis using time-updated exposure and covariate information, participation in the race was associated with an increased risk of any type of fracture (hazard ratio [HR], 1.02; 95% CI, 1.00 to 1.05); forearm fractures had an HR, 1.11 with a 95% CI, 1.06 to 1.15. There was a lower risk of hip (HR, 0.75; 95% CI, 0.67 to 0.83), proximal humerus (HR, 0.90; 95% CI, 0.82 to 0.98), and lower leg fractures (HR, 0.93; 95% CI, 0.89 to 0.97), whereas the HR of vertebral fracture was 0.97 with a 95% CI, 0.88 to 1.07. Among participants, the risk of fracture was similar irrespective of race distance and number of races run. Participants close to the median finishing time had a lower risk of fracture compared with faster and slower participants. In summary, high levels of physical exercise were associated with a slightly higher risk of fractures of any type, including forearm fractures, but a lower risk of hip, proximal humerus, and lower leg fractures. © 2018 American Society for Bone and Mineral Research.

Place, publisher, year, edition, pages
2018. Vol. 33, no 10, p. 1842-1850
Keywords [en]
EPIDEMIOLOGY, EXERCISE, FRACTURE PREVENTION, ORTHOPEDICS, OSTEOPOROSIS
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-367531DOI: 10.1002/jbmr.3476ISI: 000448078300011PubMedID: 29933501OAI: oai:DiVA.org:uu-367531DiVA, id: diva2:1267247
Available from: 2018-11-30 Created: 2018-11-30 Last updated: 2020-01-19Bibliographically approved
In thesis
1. Epidemiology of Physical Activity and Fragility Fractures
Open this publication in new window or tab >>Epidemiology of Physical Activity and Fragility Fractures
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Fragility fractures mainly affect elderly individuals and often cause long term pain, loss of function and higher mortality rates. Physical activity improves balance, increases muscle strength and bone mineral density, and may reduce the risk of fragility fractures. The aim of this thesis is to investigate the association between physical activity and fragility fractures.

In Paper I the risk of hip and any fracture was investigated across levels of habitual walking/bicycling and exercise in participants from the population-based Cohort of Swedish Men (COSM) and Swedish Mammography Cohort (SMC). Individuals walking/bicycling a maximum of 20 minutes per day had a lower risk of hip and any fracture than individuals who did not walk or bicycle. The risk of hip and any fracture was gradually lower with increasing levels of exercise. In Paper II participants in the cross-country skiing race Vasaloppet were compared to non-participants from the general population, and were found to have a higher risk of any and forearm fracture but a lower risk of hip, proximal humerus and lower leg fracture. There was no difference in the risk of vertebral fracture. In Paper III, the association between physical activity and cardiovascular candidate plasma protein concentrations were analyzed in participants from the EpiHealth cohort and the Swedish Mammography Cohort Clinical. Of 184 assayed proteins, 75 associations with physical activity were discovered and 28 subsequently replicated in multivariable adjusted models. In Paper IV the COSM, SMC and the Vasaloppet cohort were combined to achieve as wide a range of physical activity as possible and a common measure of physical activity was created using generalized structural equation modeling (GSEM). Low levels of physical activity were associated with higher risk of any and hip fracture but lower risk of wrist fracture. Individuals with physical activity close to the median of the combined cohort had the lowest risk of fracture, and higher levels of physical activity was associated with a higher risk of any fracture.

In conclusion, physical activity is associated with a lower risk of major fractures such as hip fractures, but may in large quantities increase the risk of wrist and any fracture. Physical activity is associated with more beneficial concentrations of 28 cardiovascular plasma proteins.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 64
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1635
Keywords
physical activity, fracture, fragility fracture, epidemiology, cohort study, proteomic, walking, exercise, cross-country skiing, skiing, Vasaloppet.
National Category
Clinical Medicine
Research subject
Epidemiology
Identifiers
urn:nbn:se:uu:diva-402747 (URN)978-91-513-0862-3 (ISBN)
Public defence
2020-03-13, H:son Holmdahl-salen, Akademiska sjukhuset, ingång 100, bv, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-02-19 Created: 2020-01-19 Last updated: 2020-02-19

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Stattin, KarlHållmarker, UlfJames, StefanMichaëlsson, KarlByberg, Liisa

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