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. 2024 Dec 31;40(1):27-37.
doi: 10.1093/jbmr/zjae160.

24-hour activity composition is associated with lower fall and fracture risk in older men

Lauren S Roe  1 , Elsa S Strotmeyer  1 , Peggy M Cawthon  2   3 , Nancy W Glynn  1 , Yan Ma  4 , Sonia Ancoli-Israel  5 , Kristine Ensrud  6   7 , Susan Redline  8 , Katie L Stone  2   3 , Kelley Pettee Gabriel  9 , Jane A Cauley  1
Affiliations

24-hour activity composition is associated with lower fall and fracture risk in older men

Lauren S Roe et al. J Bone Miner Res. .

Abstract

Physical activity (PA), sedentary behavior (SB), and sleep are each individually associated with falls and fractures, but often are not examined simultaneously. Compositional data analysis examined the combined prospective associations between the proportion of time in PA, SB, and sleep relative to the remaining behaviors with recurrent falls (2+ falls in any yr), any fractures, and major osteoporotic fracture (MOF) from tri-annual questionnaires, with adjudication for fractures, in 2918 older men aged 78.9 ± 5.1 yr in the Osteoporotic Fractures in Men (MrOS) Study. Accelerometers were worn on the right tricep for seven consecutive 24-h periods and measured PA (>1.5 METs), SB (≤1.5 METs), and sleep. Generalized estimating equations evaluated associations with recurrent falls. Cox proportional hazards regression estimated any incident fracture and MOF risk separately. Over 4 yr of follow-up, 1025 (35.2%) experienced recurrent falls; over 10 ± 4 yr of follow-up, 669 (22.9%) experienced incident fractures, and 370 (12.7%) experienced a MOF. Higher proportions of PA relative to SB and sleep were associated with lower odds of recurrent falls [odds ratio (OR): 0.87, 95% CI: 0.76-0.99]. Higher proportions of SB relative to PA and sleep were associated with a higher odds of recurrent falls (OR: 1.38, 95% CI: 1.06-1.81) and a higher risk of any fracture [hazard ratio (HR): 1.42, 95% CI: 1.05-1.92]. Higher proportions of sleep relative to PA and SB were associated with a lower risk of fracture (HR: 0.74, 95% CI: 0.54-0.99). No associations of activity composition with MOF were observed. When accounting for the co-dependence of daily activities, higher proportions of SB relative to the proportion of PA and sleep were associated with higher odds of recurrent falls and fracture risk. Results suggest reducing SB (and increasing PA) may lower fall and fracture risk in older men, which could inform future interventions.

Keywords: aging; epidemiology; exercise; fracture prevention; statistical methods.

Plain language summary

Physical activity (PA), sedentary behavior (SB), and sleep are each individually associated with falls and fractures. However, there is only a finite amount of time for each activity in a 24-h day, and the ideal structure of the day for these activities is unknown. We evaluated the association between the combination of PA, SB, and sleep together with recurrent falls and fractures in older men. Spending a higher proportion of the day in PA was associated with a lower risk of falls, while a higher proportion of SB was associated with a higher risk of falls and fractures. For sleep, higher proportions of the day spent sleeping were associated with a lower risk of fractures. These results can inform future PA interventions aimed at lowering falls and fracture risk in older men by focusing on increasing the amount of time in PA by specifically lowering the amount of time in SB.

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Conflict of interest statement

S.R. reports consulting fees from Eli Lilly, Apnimed Inc., and Jazz Pharma, unrelated to this study. S.A.I. is a consultant for Eisai, Merck, and Idorsia. E.S.S. reports a grant funded by Agmen, Inc.

Figures

Figure 1
Figure 1
Difference in compositional mean of physical activity (PA), sedentary behavior (SB), and sleep between the overall sample and (A) non-recurrent faller vs recurrent faller, (B) no clinical fracture vs any clinical fracture, and (C) no major osteoporotic fracture vs major osteoporotic fracture. ap < .05. Abbreviations: PA, physical activity; SB; sedentary behavior; MOF, major osteoporotic fracture.
Figure 2
Figure 2
Simplex representing the distribution of time spent in physical activity (PA), sedentary behavior (SB), and sleep for (A) non-recurrent fallers vs recurrent fallers, (B) no clinical fracture vs clinical fracture, and (C) no major osteoporotic fracture vs major osteoporotic fracture. Abbreviations: PA, physical activity; SB, sedentary behavior; MOF, major osteoporotic fracture.
Figure 3
Figure 3
The odds of recurrent falls for physical activity (PA), sedentary behavior (SB), and sleep (SLP) relative to the remaining behaviors. Abbreviations OR, odds ratio; CI, confidence interval. Model 1: age, race, site, season, marital status, education; Model 2: Model 1 + body mass index, number of physician-diagnosed conditions, health status, current smoking status.
Figure 4
Figure 4
The risk of (A) any clinical fracture and (B) major osteoporotic fracture (MOF) [hazard ratio (HR) and 95% confidence interval (CI)] for physical activity (PA), sedentary behaviors (SB), and sleep (SLP) relative to the remaining behaviors in the osteoporotic fractures in men (MrOS) study. Abbreviations: HR, hazard ratio; CI, confidence interval; ilr1, first isometric logratio; ilr2, second isometric logratio. Model 1: age, race, site, season, marital status, education; Model 2: Model 1 + body mass index, number of physician-diagnosed conditions, health status, current smoking status; Model 3: Model 2 + total hip bone mineral density.
See this image and copyright information in PMC

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