High physical activity is associated with greater cortical bone size, better physical function, and with lower risk of incident fractures independently of clinical risk factors in older women from the SUPERB study.

The Physical Activity Scale for the Elderly (PASE) is a validated test to assess physical activity in older people. It has not been investigated if physical activity, according to PASE, is associated with fracture risk independently from the clinical risk factors (CRFs) in FRAX, bone mineral density (BMD), comorbidity, and if such an association is due to differences in physical performance or bone parameters. The purpose of this study was to evaluate if PASE score is associated with bone characteristics, physical function, and independently predicts incident fracture in 3014 75-80-year-old women from the population-based cross-sectional SUPERB study. At baseline participants answered questionnaires, and underwent physical function tests, detailed bone phenotyping with dual x-ray absorptiometry, and high-resolution peripheral quantitative computed tomography. Incident fractures were x-ray verified. Cox regression models were used to assess the association between PASE score and incident fractures, with adjustments for CRFs, FN BMD and Charlson comorbidity index. Women were divided into quartiles according to PASE score. Quartile differences in bone parameters (1.56% for cortical volumetric BMD and 4.08% for cortical area, Q4 vs. Q1, p = 0.007 and p = 0.022, respectively) were smaller than quartile differences in physical performance (27% shorter timed up and go test, 52% longer one leg standing time, Q4 vs. Q1). During 8 years (median, range 0.20-9.9) of follow-up, 1077 women had any fracture, 806 a major osteoporotic fracture (MOF; spine, hip, forearm, humerus), and 236 a hip fracture. Women in Q4 had 30% lower risk of any fracture, 32% lower risk of MOF, and 54% lower risk of hip fracture, compared to women in Q1. These associations remained in fully adjusted models. In conclusion, high physical activity was associated with substantially better physical function and a lower risk of any fracture, MOF and hip fracture, independently of risk factors used in FRAX, FN BMD and comorbidity. The Physical Activity Scale for the Elderly (PASE) is a test to assess physical activity in older people. The purpose of this study was to evaluate if physical activity, according to PASE, is associated with bone parameters, physical function, and independently predicts future fracture in 3014 75–80-year-old women from the population-based SUPERB study. At baseline participants answered questionnaires, underwent physical function tests and dual x-ray absorptiometry. Subsequent fractures were x-ray verified. Women were divided into quartiles according to PASE score (Q1 least and Q4 most physically active). Women in Q4 had 27% shorter timed up and go test and 52% longer one leg standing time compared with Q1. During 8 years of follow-up, 1077 women had any fracture, 806 a major osteoporotic fracture (MOF; spine, hip, forearm, humerus), and 236 a hip fracture. Women in Q4 had 30% lower risk of any fracture, 32% lower risk of MOF, and 54% lower risk of hip fracture, compared to women in Q1. These associations remained in models considering comorbidity, bone mineral density and clinical risk factors. In conclusion, high physical activity was independently associated with better physical function and a lower risk of any fracture.

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© The Author(s) [2024]. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.