绝经后女性的步行及休闲活动与髋部骨折风险

Walking and leisure-time activity and risk of hip fracture in postmenopausal women.

作者信息

Feskanich Diane, Willett Walter, Colditz Graham

机构信息

Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA 02115, USA.

出版信息

JAMA. 2002 Nov 13;288(18):2300-6. doi: 10.1001/jama.288.18.2300.

DOI:10.1001/jama.288.18.2300

PMID:12425707

Abstract

CONTEXT

Physical activity can reduce the risk of hip fractures in older women, although the required type and duration of activity have not been determined. Walking is the most common activity among older adults, and evidence suggests that it can increase femoral bone density and reduce fracture risk.

OBJECTIVE

To assess the relationship of walking, leisure-time activity, and risk of hip fracture among postmenopausal women.

DESIGN, SETTING, AND PARTICIPANTS: Prospective analysis begun in 1986 with 12 years of follow-up in the Nurses' Health Study cohort of registered nurses within 11 US states. A total of 61,200 postmenopausal women (aged 40-77 years and 98% white) without diagnosis of cancer, heart disease, stroke, or osteoporosis at baseline.

MAIN OUTCOME MEASURES

Incident hip fracture resulting from low or moderate trauma, analyzed by intensity and duration of leisure-time activity and by time spent walking, sitting, and standing, measured at baseline and updated throughout follow-up.

RESULTS

From 1986 to 1998, 415 incident hip fracture cases were identified. After controlling for age, body mass index, use of postmenopausal hormones, smoking, and dietary intakes in proportional hazards models, risk of hip fracture was lowered by 6% (95% confidence interval [CI], 4%-9%; P<.001) for each increase of 3 metabolic equivalent (MET)-hours per week of activity (equivalent to 1 h/wk of walking at an average pace). Active women with at least 24 MET-h/wk had a 55% lower risk of hip fracture (relative risk [RR], 0.45; 95% CI, 0.32-0.63) compared with sedentary women with less than 3 MET-h/wk. Even women with a lower risk of hip fracture due to higher body weight experienced a further reduction in risk with higher levels of activity. Risk of hip fracture decreased linearly with increasing level of activity among women not taking postmenopausal hormones (P<.001), but not among women taking hormones (P =.24). Among women who did no other exercise, walking for at least 4 h/wk was associated with a 41% lower risk of hip fracture (RR, 0.59; 95% CI, 0.37-0.94) compared with less than 1 h/wk. More time spent standing was also independently associated with lower risks.

CONCLUSION

Moderate levels of activity, including walking, are associated with substantially lower risk of hip fracture in postmenopausal women.

摘要

背景

体育活动可以降低老年女性髋部骨折的风险，尽管所需的活动类型和持续时间尚未确定。步行是老年人中最常见的活动，有证据表明步行可以增加股骨骨密度并降低骨折风险。

目的

评估绝经后女性步行、休闲活动与髋部骨折风险之间的关系。

设计、地点和参与者：1986年开始进行前瞻性分析，对美国11个州注册护士的护士健康研究队列进行了12年的随访。共有61200名绝经后女性（年龄40 - 77岁，98%为白人），基线时未诊断出癌症、心脏病、中风或骨质疏松症。

主要观察指标

由低或中度创伤导致的髋部骨折事件，通过休闲活动的强度和持续时间以及步行、坐着和站立所花费的时间进行分析，在基线时测量并在整个随访过程中更新。

结果

1986年至1998年，共确定了415例髋部骨折事件。在比例风险模型中控制年龄、体重指数、绝经后激素使用、吸烟和饮食摄入量后，每周活动量每增加3代谢当量（MET）-小时（相当于以平均速度步行1小时/周），髋部骨折风险降低6%（95%置信区间[CI]，4% - 9%；P <.001）。与每周活动量少于3 MET -小时的久坐女性相比，每周至少有24 MET -小时的活跃女性髋部骨折风险降低55%（相对风险[RR]，0.45；95% CI，0.32 - 0.63）。即使是由于体重较高而髋部骨折风险较低的女性，随着活动水平的提高，风险也会进一步降低。在未服用绝经后激素的女性中，髋部骨折风险随活动水平的增加呈线性下降（P <.001），但在服用激素的女性中并非如此（P = 0.24）。在没有进行其他锻炼活动的女性中，每周步行至少4小时与每周步行少于1小时相比，髋部骨折风险降低41%（RR，0.59；95% CI，0.37 - 0.94）。站立时间越长也与较低的风险独立相关。