International Journal of Epidemiology 2000;29:308-314
© International Epidemiological Association 2000
Physical activity and hip fracture: a population-based case-control study
a Division of Epidemiology, Karolinska Hospital, Stockholm County Council and Institute of Environmental Medicine, Karolinska Institutet, Sweden.
b Department of Orthopaedics, University Hospital, Uppsala, Sweden.
c Department of Community and Family Medicine, Dartmouth Medical School, New Hampshire, USA.
d Department of Orthopaedics, Karolinska Hospital, Sweden.
e Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
f Department of Medicine, University Hospital, Uppsala, Sweden.
g The Swedish Hip Fracture Study Group comprised Akke Alberts, John A Baron, Thomas Dolk, Bahman Y. Farahmand, Olof Johnell, Lena Lindén, Sverker Ljunghall, Karl Michaëlsson, Per-Gunnar Persson, K-G Thorngren, Mats Thorslund, Carl Zetterberg and Lena Zidén.
Reprint requests to: Bahman Y Farahmand, Division of Epidemiology/Norrbacka, S-171 76 Stockholm, Sweden. E-mail: Bahman.Y.Farahmand{at}imm.ki.se
Background A growing body of literature suggests that physical activity may be a protective factor against hip fracture.
Methods To study the association between hip fracture risk and recreational physical activity at various ages, changes in activity during adult life, occupational physical activity and how risks vary by adult weight change, we performed a population-based case-control study among postmenopausal women aged 50–81 years residing in six counties in Sweden in 1993–1995. The analysis consisted of 1327 women with hip fracture and 3262 randomly selected controls. Information on leisure physical activity before age 18, at 18–30 years and during recent years was based on a questionnaire. Data on occupational physical activity were collected through an independent classification of job titles obtained from record linkage with census data from 1960, 1970 and 1980.
Results There was a protective effect of recent leisure physical activity. Compared to women who reported no leisure activity, the odds ratios (OR) were 0.79 (95% CI : 0.62–1.00), 0.67 (95% CI : 0.54–0.84) and 0.48 (95% CI : 0.39–0.60) for women who exercised <1 h per week, 1–2 h per week, and 3+ h per week, respectively. These decreased OR were more pronounced in women who had lost weight after 18 years of age than in those who had gained weight. Women with high physical activity at both 18–30 years and during recent years did not have a stronger protection than those with isolated high activity late in life, after accounting for recent activity. Occupational physical activity was not associated with hip fracture risk in this study.
Conclusions Recent physical activity is protective against hip fracture. The protective effect is most pronounced in women who had lost weight after age 18.
Keywords Case-control study, epidemiology, exercise, hip fracture, physical activity
Accepted 20 October 1999
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