Measures of physical performance as a predictor of fracture risk independent of BMD: The Chungju metabolic disease cohort study

Effects of walking and sun exposure on bone density and balance in elderly with osteopenia

INTRODUCTION

Bone mineral density (BMD) decreases with age, leading to fractures, decreased mobility, and impaired quality of life. We aimed to determine the effects of brisk walking and exposure to sunlight on BMD and balance in the elderly with osteopenia.

MATERIALS AND METHODS

We recruited 81 elderly subjects with osteopenia from January 2019 to March 2019. They were divided into four groups: a daytime-walking group (n = 20), a night-time-walking group (n = 20), a sun-exposure-only group (n = 20), and a control group (n = 21). The subjects walked briskly for 30-60 min three times a week for 24 weeks. The sun-exposure-only group received sunlight for 20-30 min three times a week. All four groups received supplemental calcium. Lumbar L1-L4 BMD, serum 25-hydroxyvitamin D3, timed-up-go-test (TUGT), five-times-sit-stand-test (FTSST), open-eye and closed-eye one-leg-stance-test (OLST) were measured at baseline and 1 day after program completion.

RESULTS

The lumbar L1-L4 BMD was higher in all intervention groups (P < 0.05), with the daytime-walking group outperforming the others. There was no significant difference between the night-time-walking and sun-exposure-only groups (P > 0.05). The levels of serum 25-hydroxyvitamin D3 in the daytime-walking and sun-exposure-only groups were higher than those in the night-time-walking and control groups (P < 0.05). The TUGT and FTSST times decreased in all three intervention groups and predominantly so in the daytime-walking group, whereas the open-eye and closed-eye OLST times increased (P < 0.05).

CONCLUSION

Brisk walking and sun exposure increase BMD and improve dynamic and static balance in the elderly with osteopenia.

Combined results of three physical performance tests predict incident fracture independently of aBMD in community-dwelling elderly Japanese men: Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study

BACKGROUND

Several studies have examined the association between physical performance and fracture in women, but few such studies have targeted elderly men. This study aimed to determine whether the combined results of several physical performance tests can predict the subsequent incidence of fractures in elderly men after adjusting for confounding factors.

METHODS

Of the 2174 elderly men who participated in this study, 2012 completed the baseline study visit, including physical performance tests (walking speed, hand grip strength, and one-leg standing) and measurement of bone mineral density by dual-energy X-ray absorptiometry. Follow-up study visits were conducted five and ten years later, during which incident fractures were identified by detailed interviews. We excluded 140 men with diseases or who took medications known to affect bone metabolism at baseline, 185 with missing values for predictors and potential confounding factors, and one who did not participate in any of the follow-up study visits. The remaining 1686 men were analyzed. Each physical performance test was analyzed by quartiles. Poor performance was defined as belonging to the worst quartile of performance. The association between physical performance and fracture was assessed using Cox proportional hazards models.

RESULTS

We identified 175 clinical fractures (osteoporotic fracture: 77, major osteoporotic fracture: 48) in 1686 men during a mean follow-up period of 8.4 years. After adjusting for potential confounding factors including bone mineral density, men who performed poorly on all three physical performance tests had a 3.7-fold higher risk of osteoporotic fracture and a 6.6-fold higher risk of major osteoporotic fracture than men who did not perform poorly on any of the tests.

CONCLUSIONS

Japanese elderly men who performed poorly on all three physical performance tests had a significantly higher risk of incident osteoporotic fracture independently of bone mineral density. The combined results of several physical performance tests may be useful for predicting incident fractures in elderly men.